Research on medical insurance data sharing mode based on " City-customized Medical Insurance" / 中华医院管理杂志

With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.

Exploration of the transformation of medical insurance system to health security system under Healthy China / 中国卫生政策研究

The national strategy of Healthy China clearly establishes the health insurance system,which would control health risk factors and enhance hygiene factors to safeguard the citizens's; health. There are some difference in goals,forces,contents, and compensation mechanism between health insurance system and medical insurance sys-tem. The conversion from medical security system needs to take actions including of extending the security contents, health-centered medical insurance,a combination of medical treatment and endowment. Health-centered medical in-surance reform needs to start with extending health contents and payments reform,enhancing the controlling and guid-ing the health delivery system. This is also the inevitable direction for the development of medical insurance.

Research on Obstacles and Countermeasures of the Citizenization about the Health Rights and Interests of the Agricultural Transfer Population in the Perspective of New Urbanization / 中国医学伦理学

This paper concluded the health status of the population migrated from agriculture areas as well as the existing problems of health rights and interests in the process of new urbanization, and proposed the following suggestions:it must strengthen the government responsibility, adhere topeople-oriented, and firm social ethics construction. It also should plan health resource allocation, adjust the medical security policy, improve service quality according to the characteristics of population migrated from agriculture areas, and build up a multi-level and joint health service system.

Research on the medical insurance system and operating mode in South Korea / 中国卫生政策研究

Objectives To provide reference for the improve of health care system and healthcare insurance con-trolling method, through researching on the value-based healthcare paying system in South Korea. Methods The basic characteristics of the Korean health care system was researched, Specifically, its reform experiences of value-based health insurance review and assessment paying system,which government took. Results South Korea’s health care pay-ing system had achieved both good social and policy effects. Conclusions Value-based health care paying system is the main reason for the reducing of health care expenditures and making of scientific health policy.

Present development and thoughts on China's health system / 中华医院管理杂志

This paper made an analysis of China's health system,regarding the present development and questions in the medical security system,the health service system,the health financing system and health management system.Based on the studies,the author proposed overall planning and accelerated reform in an effort to distinguish the role boundaries of the government and the market,streamline the health management system and enhance service functions.Furthermore,the author recommended to build a sustainable health financing system,build and better the urban-rural health security system,and promote health service system reform centering on public hospital reform,achieving the Pareto improved efficiency.

How to better the medical insurance compensation mechanism in China / 中华医院管理杂志

Given the significant improvement in terms of its coverage and compensation depth,China's basic medical insurance system has inherent setbacks in its structure as held by the authors.They hold that the medical insurance as the most important source of compensation for medical institutions,should further reform its structure of financing and reasonably raise the percentage of compensation; adjust the time reference and space reference for prepayment estimation such as the total prepaid amount; deepen supportive reforms for the payment manner.All these measures aim at minimizing impact of the payment control mechanism on routine medical activities and exploring diversified payment manners that are feasible.

On the constraint factors of the medical security system in Chinese urban and rural coordination / 中华医学教育探索杂志

It is inevitable that the construction of urban and rural medical security system is the law of economic and social development,but there are still more constraints in this social system engineering.Deep analysis and research were carried out from six aspects in this paper such as the constraints of traditional thought and economy,obstruction of the existing household registration system,constraints of the existing land system,legal obstacles and institutional barriers; and ways to solve the problems were trying to be found in order to methods for the construction of the urban and rural medical security system in our country.

ASSOCIATION WITH THE US FEDERAL MEDICAL HEALTH SYSTEM / 现代医院

Issues of Chinese medical health reform are analyzed and approached associated with the US federal medical health system. We made the suggestions that establish the public health service system covering both urban and country residents, push on the reform of medical insurance, drug circulation and medical system. We advocate that implement the scientific development view and hold the opportunity, impel the medical health reform in general.

Probe into and reflection on cooperative medical care for laborers in Shenzhen / 中华医院管理杂志

In order to set up a medical security system suitable for laborers and solve for them the problem of inadequate and expensive medical services,the city of Shenzhen started on March 1,2005(apilot) cooperative medical care for laborers in the four neighborhoods of Buji,Longgang,Longhua and Shajing on the basis of an earlier model.The new model,which stipulated that each person paying 12 yuan each month,with the employer paying 8 yuan and the individual laborer paying 4 yuan,was entitled to both outpatient and inpatient medical services,was popular with both businesses and laborers.At present the number of people participating in the new model of cooperative medical care for laborers exceeded 1 million,the number of designated medical institutions was gradually increasing,and medical expenses were put under control.

Perfecting the medical security system: the fundamental solution to the issue of inadequate and overly expensive medical services / 中华医院管理杂志

In light of the connotations of inadequate and overly expensive medical services,the paper analyzes solutions to the issue and their features under different circumstances.Then based on data about studies and establishment of medical security systems at home and abroad,it concludes that the establishment of a medical security system,with joint sharing of risks in bearing the burden of medical expenses,is the fundamental solution to the issue.It also puts forward suggestions for perfecting the medical security system in China.

On the Poor′s Right for Health Care and Government′s Choice of Behaviors under the Circumstances of New Health Reform / 中国医学伦理学

The poor population suffers high disease-related economic risk,while holds weak anti-risk capacity,thus is easy to be in the vicious circle of disease-poorness-disease.For many years,disease-related economic risk of the poor remained unsolved,as a result of insufficient health resource and limited medical security capacity.It concludes that the establishment of a medical security system,with joint sharing of risks in bearing the burden of medical expenses,could be a fundamental solution to the disease-related economic risk of poor population.