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Study on Compensation Equity of Chengdu-Chongqing Model of Integrated Medical Insurance

Author: JiangTao
Tutor: XiangLi；YaoZuo
School: Huazhong University of Science and Technology
Course: Social Medicine and Health Management
Keywords: Medical Insurance Coordinative Development of Urban and Rural Area Benefit Equity Net Profit Per Capita Chengdu-Chongqing Model
CLC: R197.1
Type: Master's thesis
Year: 2011
Downloads: 35
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Abstract

Objective: This thesis, began with the definition of integrated urban and rural medical insurances, analyzed practically the compensation equity and tried to find out its main factors leading the results of 2008 and 2009 of a typical integrated medical insurance experimented in Jiangbei District of Chongqing Municipality; proposed some suggestions that will make the compensation results more equitable; summarized some useful practical experience from Jiangbei, as references to some other areas that has many similarities with Jiangbei in socioeconomic situation.Methods: This thesis collected documents about integrating urban and rural medical insurance in recent years through literature study and made some references from them after analysis and reorganization; analyzed compensation equity of the fund of Jiangbei’s integrated medical insurance with such indexes as medical fund utilization, net profit per capita, actual compensation rate and so on, using data of 2008 and 2009 from the computer information system of the Integrated Medical Insurance Management Center of Jiangbei; used descriptive methods, centralization index and equity theories to judge if the result of compensation was equity.Results: (1) The meaning of integrated medical insurance is as follows. At present, urban and rural medical insurances are dualistic, which not only decreases medical insurances’efficiency, but also widens disparity of medical benefit between the urban and the rural; at the same time, it that the gap of economic incomes of the urban and the rural becoming wide, health resources distribution in urban and rural areas not equitable, and the great differences of the distribution of the urban and the rural gonging to medical institutions and of their medical expenses deepens health disparities between urban residents and rural residents. Therefore, to integrating urban and rural medical insurances is necessary. But because the urban and rural medical financial assistance system refers to a relatively very small number of people and the gap between urban workers and urban residents or rural residents cannot be crossed at the present stage, as a result, many pilot areas integrate medical insurances for urban residents and rural residents only, which is called“integrated medical insurance for the urban and the rural”in this thesis.(2) Situation of the insured residents’participation: nearly 90% of the rural residents insured have chosen the lower financing level, which was dramatically higher than that of the urban insured.(3) Compensation results of the medical insurance fund:①Fund of the higher financing level had been overspend;②As a whole the urban insured benefited more;③The utilization rate of the lower financing level was too low.(4) Net profit per capita in the field of medical insurance equals to the value left by gross benefit per capita from medical insurance fund subtracting the average insurance premium per capita. This thesis divided all the beneficiaries into 4 groups based on their household registration and financing level, then computed out CI (Concentration Index) of 2008 and of 2009, respectively 0.56 and 0.30, implying great inequitable of compensation.①The urban residents insured benefited more;②Those who participated in the higher financing level benefited more;③Equity was improved greatly as the policy had been adjusted. (5) Medical service benefit of the urban and the rural:①In 2008 and in 2009, outpatient benefit rate and hospitalization benefit rate of those who chosen the higher financing level were respectively higher greatly than that of those who selected the lower financing level;②In the same financing level, outpatient benefit rate and hospitalization benefit rate of the rural were respectively observably higher than that of the urban in 2009;③In 2009, all of the 4 beneficiary groups’ outpatient benefit rate and hospitalization benefit rate increased dramatically, of which those who chosen the higher financing level had increased more benefit rate than those chosen the lower financing level. (6) The actual compensation rate in 2009:①The disparities of actual compensation of outpatient between the urban and the rural were very small;②In respect of hospitalization actual compensation rate, in the whole, the urban benefited more.Suggestion: (1) To develop rural economy and promote the rural residents’income can strengthen their willing to participate in the new medical insurance. (2) Strengthening advertising the new integrated medical insurance to inspire the rural participating positively.(2) To improve the financing levels of the two and the lower’s policy compensation rate and gradually decrease disparities existing between the two level’s compensation in an appropriate degree. (3) Integrating medical resources of urban and rural areas can promote people’s medical utilization equity. (4) To control inappropriate increase of medical service expenses, with improving the beneficiaries’compensation rate. Conclusion: (1) An area where urbanization is relatively high can pilot integrating urban and rural medical insurances into one. (2) The compensation result of the integrated medical insurance of Jiangbei was not equitable for its beneficiaries, but it had been improved. The urban residents and those chosen the higher financing level benefited more.(3) Because of more proportion of the rural compared to that of the urban selected the lower financing level whose political compensation is obviously lower than that of the higher level, as a whole the urban residents benefited more. (4) Moral hazard and adverse selection were serious, restricting the new medical insurance’s sustainable development.Innovation and limitation: Innovation: (1) practically analyzing equity of compensation result of an integrated medical insurance for urban and rural in a typical area. (2) Using net profit per capita to judge the result of compensation’s equity for the beneficiaries chosen different financing levels, avoiding the influence from different premiums of different financing levels.Main limitation: Because the data from 2008 and 2009 of Jiangbei gathered only emphasized the whole situation, with no household survey, lacking the information of the four types of beneficiaries’characteristics of demographics, health status and economic income, the thesis cannot analysis more deeply.

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