A comparative study on children's basic medical insurance system and policies in four municipalities in China / 上海交通大学学报（医学版）

ABSTRACT

Objective·To analyze the basic medical insurance policies for children in Shanghai in 2011 and 2017, and compare with those of the other three municipalities to understand the basic medical security status of children in four municipalities in China and analyze the existing problems. Methods?·?The current effective children's basic medical insurance policies and child critical illness insurance policies and related insurance systems in four municipalities were collected systematically. The types of basic medical insurance for children in various municipalities and their funding standards, their own expenses and the proportion of government subsidies, the proportion of outpatient emergency payoff lines and reimbursement at all levels of medical institutions, and the coverage and coverage of major illness insurance reimbursement were collected and compared mainly. Results?·?The basic medical insurance for children in Shanghai is a "double insurance" system, which contained children's hospitalization fund and basic medical insurance for urban and rural residents. The basic medical insurance for children in other municipalities mainly consisted of basic medical insurance for urban (rural) residents. Compared with 2011, the level of financing and the reimbursement of the basic medical insurance for urban and rural residents and of the children's hospitalization fund in Shanghai in 2017 was increased. In 2017, the level of financing of basic medical insurance for urban and rural residents in Shanghai was 1?100 yuan, which was slightly lower than that of Beijing medical insurance for urban residents and new rural cooperative medical insurance and was higher than that of basic medical insurance for urban and rural residents in Tianjin and Chongqing, and the individual payment level of Shanghai was the lowest. The hospitalization payoff lines in Shanghai were lower than those of other municipalities. Shanghai's outpatient and inpatient reimbursement levels were higher those of than other municipalities. There wasn't a capping line in Shanghai. There were capping lines in other municipalities. There was a great difference in the insurance policy of the major diseases in four municipalities. Conclusion?·?According to their own actual conditions, models for children's medical care systems that suited each municipalities’ social and economic development have been established. Shanghai children's basic medical insurance basically meets the needs of children's growth but needs improvement in terms of the type and level of medical security for major illnesses.