ABSTRACT
The practice of catastrophic disease insurance in China is an important attempt to decentralize administration and build a service-oriented government.Under the developing model of governmental service purchase, an efficient supervision is the key part of ensuring and upgrading the effectiveness of catastrophic disease insurance system.Starting from theoretical analysis on the service outsourcing of the operating mechanism and its features, this paper discusses the legal attributes and supervision responsibilities of catastrophic disease insurance in China, and then explores the main problems of the current regulation system in view of regulatory responsibilities, supervisory subjects, as well as supervision contents, methods and means, etc.For these problems, it's urgent to re-draw a definite boundary of government responsibilities for the system, determine the supervisory subject as human resources and social security departments, and develop unified standards at provincial level for the bidding process.It's also necessary to establish a scientific performance evaluation system, promote multi-sector joint supervision among different government sectors involved, practice information sharing and means of digital regulation, in order to achieve efficient supervision of catastrophic disease insurance in China.
ABSTRACT
Objective: This study aims to analyze the effects of catastrophic disease insurance (CDI), especially to evaluate the influences of CDI on the discrepancy of benefits between the patients covered by the Employee's Medical Insurance (EMI) and the Resident's Medical Insurance (RMI).Methods: The data used in the study are collected from the health insurance database of Zhuhai City in the years of 2012 and 2014.A descriptive analysis is made to depict the general situation of CDI in the city, and a logistic regression model is used to analyze the factors that affect the probability to get the benefits of CDI.Moreover, a triple difference model is built up to probe into the CDI's effects on the discrepancy of reimbursement ratio between patients covered by EMI and RMI.Results: The benefits of CDI favor the patients with old age, high medical expenditures and chronic diseases.When other factors are controlled, patients covered by EMI have lower probability to get CDI benefits than those covered by RMI.Within the patients with high medical expenditures who have gotten the CDI benefits, those covered by EMI enjoy higher reimbursement ratio than those covered by RMI, but CDI decreases the discrepancy by 3.2%.Conclusions: Since the CDI gives more favor to the vulnerable population and narrows the gap of the benefits between EMI and RMI, the policy improves the equity of health security.
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Objective:This paper designs to analyze compensation patterns and compensation effects of cata-strophic disease insurance in L City, and put forward feasible suggestions to improve the compensation patterns of cat-astrophic disease insurance. Methods:We combined the relevant policy documents to analyze compensation patterns, and used benefit rate, OOP and The effective reimbursement rate to analyze compensation effects of catastrophic dis-ease insurance. Results:Catastrophic disease insurance benefit rate in L city in 2013 was 3. 2%; Rates of NCMS fund unilization was 92%, which diversed from county to county. Patients' OOP decreased significantly after reim-bursement of catastrophic disease insurance;Catastrophic disease insurance and NCMS total effective reimbursement rate reached 84.8%;The NCMS compensation rate reached 68. 9%, while fund incurred a financial deficit at the same time. Conclusion:Set deductibles, compensation rate and compensation range scientifically, and cancel ceiling level,improve the program of catastrophic disease insurance. Take measures to reduce the unfair between the districts and counties at city level. Establish effective link-up between catastrophic disease insurance and NCMS.
ABSTRACT
The Balanced Score card ( BSC) is a new set of performance measurement and strategic management tools. Based on the basic theory of BSC, and on the basis of establishing the basic framework for performance evaluation of four dimensions, namely satisfaction, financial, internal operation, and growth and development, this paper systematically designs specific evaluation indexes from the 4 dimensions in order to construct the performance evaluation index system for catastrophic disease insurance. The objective of this study is to provide a more scientific and reasonable reference for the operational performance evaluation of catastrophic disease insurance offered to urban and rural residents.
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Objective: To analyze the effects of the catastrophic disease insurance of New Rural Cooperative Med-ical Scheme ( NRCMS) on alleviating the economic burden of patients in Beijing, and evaluate the effect of the policy implementation. Methods: Based on high, middle and low economic development levels and the implementation pro-ceedings of catastrophic disease insurance of NRCMS, this paper selects 3 districts of Beijing, from which it chooses two or three villages and towns with the highest numbers of catastrophic disease patients, in order to understand the opera-tional status quo of the catastrophic disease insurance through in-depth interviews with managers. This paper conducts questionnaire survey among all catastrophic disease patients from the sampled villages and towns, and uses 497 valid questionnaires received to understand patients' subjective feelings and collect relevant data of family income and medical expenditure of catastrophic disease patients in 2013. Then it carries out data docking with the platform of NRCMS man-agement centers and measure the economic burden of catastrophic disease patients. In this paper, quantitative and qualitative data are analyzed using statistical and thematic analyses, respectively. Results: The catastrophic disease in-surance of NRCMS has significantly played an important role in reducing the average medical expenditure of catastroph-ic disease patients and improving the actual compensation ratio in varying degrees. However, the incidence of cata-strophic health expenditures has not significantly improved. Conclusion: This paper suggests to increase deductibles and reimbursement ratios of catastrophic disease insurance in order to broaden reimbursement directory and other initiatives to improve the compensation level and focus on alleviating the economic burden of catastrophic disease patients.
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Objective:To analyze the benefit incidence and evaluate the implementation effects on catastrophic disease insurance under the New Rural Cooperative Medical System ( NRCMS) in Jilin Province and put forward sug-gestions to perfect the catastrophic disease insurance under NRCMS. Method: In-depth interviews with related staff were conducted to gain an understanding of the operating status of catastrophic disease insurance under NRCMS;cat-astrophic disease patient data of Jilin Province from 2013 were collected, with a comparative analysis of implementa-tion effects among nine districts;the benefit incidence was analyzed by means of the Sperman rank correlation analy-sis; Results: The policy of catastrophic disease insurance under the NRCMS exhibited sound implementation effects and played an important role in reducing the economic burden of catastrophic disease patients. The average individual expenditure decreased by 4336. 52 yuan, while the reimbursement rate increased by 11. 15% after NRCMS cata-strophic disease insurance reimbursements. Additionally, statistical analysis results showed that there was a weak cor-relation between benefit incidence and economic level, the benefit equality of catastrophic disease insurance under NRCMS was relatively good, but the benefit level of rich patients was slightly higher. Conclusion:The reimbursement scheme of catastrophic disease insurance under NRCMS should be refined and improved, and the benefit fairness of different districts must be ensured, thus achieving the goal of relieving the“poverty caused by illness” phenomenon.