First, the top ten hot and difficult issues of medical insurance
1 medical insurance for socially disadvantaged groups 6 medical insurance cost control issues
2 difficult enterprises to participate in insurance 7 to speed up the legislation of medical insurance
3 increasing the proportion of retirees, the pressure on the medical insurance fund, and the participation of flexible employees.
4. Supervision of designated medical institutions and designated pharmacies 9. Construction of medical insurance computer information system.
5 Personal burden 10 Formulate scientific and reasonable settlement methods for medical expenses.
1, which is scientific, authoritative and practical, and faces the hot spots and difficulties directly. This survey was designed and implemented in strict accordance with sociological research methods, summed up the most prominent hot and difficult issues in various places, and screened out ten hot and difficult issues according to the frequency of selection.
The subjects of this survey are the persons in charge of medical insurance management and handling in 30 provinces, and their answers have increased the authority of the top ten hot and difficult questions.
After several years of hard work, the medical insurance reform has accumulated rich experience. The choice of provincial medical insurance leaders is the revelation of the key points of the next medical insurance reform. The top ten hot and difficult issues of national medical insurance are of great practical significance for summing up historical experience and deepening medical insurance reform.
2. Feel the impact of development, face the reality sincerely and call for deepening reform. Ten hot and difficult issues reflect the medical security problems involved in China's social and economic development. The content of the problem is mainly to improve the construction and management of medical insurance system, and it also involves the construction of medical security system. The person in charge of medical insurance clearly put forward the problem of participating in insurance for all kinds of people, especially the medical security for the disadvantaged. The choice of questions reflects that the person in charge of provincial medical insurance is open-minded and has no selfish departmentalism. Answering questions is based on the overall situation of gradually improving the medical security system and promoting the healthy development of social economy, feeling the fierce impact brought by social economic development, reflecting real life and grasping social needs.
Fairness, efficiency, accessibility, quality and sustainability are the core guiding principles of social security reform. The determination of ten hot and difficult issues provides a basis for improving the security system and determining strategic priorities, and the overall plan for deepening medical insurance reform is ready to come.
3. Attitude is objective and rational, positive and pragmatic, based on sustainable development. The challenges brought by the reform are extensive, and the impact of development is diverse. Vulnerable groups, difficult enterprises and flexible employees are social phenomena accompanied by development and reform, and they are the shocks and challenges that the whole society must face. Fund pressure, heavy personal burden and cost control of retirees are unavoidable problems in the transformation of insurance system. The proposal of speeding up legislation, information system construction and formulating scientific and reasonable cost settlement methods reflects the willingness of medical insurance leaders to realize scientific and modern management according to law. Ten hot and difficult problems can be screened out from the complicated problems, which shows that the person in charge of medical insurance can maintain an objective, rational, positive and pragmatic attitude and have the ability to choose a long-term and sustainable development position.
Second, the judgment of the current situation of medical insurance reform
In order to understand the current situation of medical insurance reform in various places, this questionnaire designed 1 1 questions, including 2 questions related to system construction, 4 questions related to management effectiveness of medical insurance institutions, 4 questions related to medical reform, and the external environment of medical insurance reform-questions related to medical and health system reform 1 question. The answer from the person in charge of medical insurance shows that:
1, generally agree with the current system. The level of fund-raising and the proportion of unified accounts are the core contents of the basic medical insurance system, and the evaluation of the core contents reflects the basic attitude of the medical insurance leaders in the basic medical insurance system. In this survey, 63.3% people think that the current financing level is moderate; 83.3% people think that the proportion of unified accounting is reasonable. It shows that the person in charge of medical insurance agrees with the current system model.
2. Highly affirmed the effectiveness of management. The evaluation of management effect reflects the basic attitude of the person in charge of medical insurance to the current management policies and measures. In this survey, 70% people think that the current cost settlement method can meet the basic needs of medical insurance management; 83.3% people think that the control method of medical expenses is effective. The person in charge of medical insurance positively evaluated the effectiveness of medical insurance management.
3. The understanding of the difficulties in reform is relatively concentrated. The judgment on the difficulties of reform determines the focus of the next step. This survey shows that 66.7% of the enterprises in difficulty are "existing and serious" and 23.3% are "existing but not too serious", making a total of 90%; 83.3% think that the increase in the proportion of retirees has a "great" and "great" pressure on the medical insurance fund. The person in charge of medical insurance locked in the problem and revealed the goal of deepening reform.
4, calling for the reform of medical and health system to become a * * * knowledge. Supporting the "three reforms" is the only way to solve the contradiction between doctors and patients. In this survey, 45% people think that the reform of medical and health system is "lagging behind" and 50% people think it is "relatively lagging behind", totaling 95%. The majority of medical insurance leaders strongly call for speeding up the reform of the medical and health system.
Third, the degree of social concern about hot issues.
In the survey, we gave six social hot issues, and asked the person in charge of medical insurance to judge the degree of public concern about these issues. The results show that the public pays more attention to personal burden, social vulnerable groups' medical security, retirees' medical security and other issues, and pays less attention to relaxing the scope of personal accounts.
Serial number hot issues serial number hot issues
1 medical security for socially disadvantaged groups and four major personal burdens
2 flexible employment insurance 5 insurance, convenient medical treatment.
3 Retirees' medical insurance 6 Relax the scope of personal accounts
Fourth, the prospect of solving ten hot and difficult problems.
In the survey, we used "the length of time required to grasp the most important hot and difficult problems as the main problems" to reflect the views of medical insurance leaders on the prospects of solving these problems. Pay attention to 1-2 years, indicating that the problem can be solved quickly; Three years and five years show that it can be solved within a government term; More than six years have shown that it will take a long time to solve this problem. The results show that the person in charge of medical insurance is very optimistic and confident in solving the top ten hot and difficult problems.
The prospect of solving the hot and difficult problems of medical insurance
The time needed to pay attention to this problem
1 year -2 years
3 to 5 years
More than 6 years
Insurance of flexible employees
83.3%
1 1. 1%
5.6%
Personal burden problem
78.9%
2 1. 1%
0%
Difficult enterprises are difficult to participate in insurance.
70%
26.6%
3.4%
Supervise the designated pharmacies of designated medical institutions.
60%
Thirty percent
10%
Medical Security for Vulnerable Groups
54.8%
45.2%
0%
Formulate scientific and reasonable settlement methods for medical expenses
53.3%
40%
6.7%
Accelerate the legislation of medical insurance.
26.3%
68.4%
5.3%
The difficult problem of medical insurance cost control
26.3%
52.7%
2 1%
The pressure of increasing the proportion of retirees on medical insurance fund
38%
42.8%
19.2%
Construction of medical insurance computer information system
26.7%
46.6%
26.7%
Verb (abbreviation of verb) The results and limitations of this survey
1. There are some differences in the choice of hot and difficult issues between medical insurance managers and managed people. In addition to the two types of responsible persons who are most concerned about the medical insurance problem of socially disadvantaged groups and the difficulty of participating in insurance for difficult enterprises, the administrative responsible persons are particularly concerned about the relatively macro and long-term problems such as fund pressure and cost control brought by retirees, and the handling responsible persons are particularly concerned about the settlement methods and the problems encountered in the management of specific affairs with heavy personal burden. This difference may be related to the functional difference between the administrative organ and the agency: the function of the administrative organ is to formulate policies and macro-management, while the agency is to manage specific affairs. Of course, a comprehensive explanation of this difference needs further in-depth analysis.
Selection frequency (%) Differences in problem selection between administrative personnel and those in charge of handling.
question
serial number
1 medical security for socially disadvantaged groups 2 insurance for enterprises in difficulty
3.4. The increase in the proportion of retirees puts pressure on the medical insurance fund. The cost of medical insurance is difficult to control.
5. Flexible employment insurance. Accelerate the legislation of medical insurance.
7. Supervision of designated medical institutions and pharmacies 8. Overburden on individuals.
9 medical insurance computer information system construction 10
Formulate scientific and reasonable settlement methods for medical expenses
2. There are also differences in the choice of hot and difficult issues among the medical insurance leaders in the three places. The medical insurance problem of social vulnerable groups in the eastern region is the most prominent, and the difficulties of enterprises in the central region are the most prominent. The choice of the western region is relatively scattered, and there are no particularly prominent hot and difficult issues. One possible reason for this difference is the regional differences in economic development: the eastern region is relatively developed, with fewer difficult enterprises, and most enterprises and units have the ability to participate in insurance, thus making the medical insurance problem of socially disadvantaged groups prominent; The economy in the central region is underdeveloped, and there are many difficult enterprises, and the problem that difficult enterprises are difficult to protect is very prominent; Due to the backward economy in the western region, various problems exist and are difficult to solve, which leads to the dispersion of hot and difficult issues. Of course, the accurate explanation of this regional difference needs comprehensive and in-depth investigation and study.
Problem serial number
1 medical security for socially disadvantaged groups
2. Difficult enterprises to participate in insurance.
3. The pressure of the increase in the proportion of retirees on the medical insurance fund
4 medical insurance costs are difficult to control
5 flexible employment insurance issues
6. Accelerate the legislation of medical insurance.
7. Supervision of designated medical institutions and pharmacies
Eight people are overburdened.
9 problems in the construction of medical insurance computer information system
10 Formulate scientific and reasonable settlement methods for medical expenses.
3. There is a contrast between the person in charge of medical insurance and the public's understanding of personal burden. The person in charge of medical insurance thinks that personal burden is not a serious problem, but they all think that the public is most concerned about personal burden. This cognitive contrast reminds us that we can't take personal burden too simply. The problem of personal burden deserves further discussion.
4. The answer of the person in charge of medical insurance to the problem of fund collection is far from the judgment of scholars at home and abroad. The person in charge of medical insurance thinks that the problem does not exist in 5.0%, basically does not exist in 16.7%, but it is not serious in 65.0%. However, experts at home and abroad think it is very difficult to raise funds. This cognitive contrast needs further discussion.
5. The affirmation of the effectiveness of medical insurance management is only the "self-evaluation" of the person in charge of medical insurance, which is likely to be one-sided. At present, 63.3% of places have no unified information system construction standard, which shows that the modernization level of medical insurance management in China is still very low. Therefore, the comprehensive evaluation of medical insurance management needs to further understand the judgment and understanding of the insured, medical institutions and doctors.
Preliminary plan for further study of intransitive verbs
1. We will conduct in-depth interviews and field surveys on the top ten hot and difficult issues in China. For each problem, we will go to the area where the problem is most prominent or well solved, interview the local medical insurance leaders, combine with field research, deeply analyze the background and difficulties of these problems, sum up the experience and lessons of solving, and explore the ideas and methods of effective solution.
2. This survey is only the "one-sided story" of medical insurance managers. Although the judgment of the person in charge of medical insurance is authoritative, it does not represent the judgment of other social groups. We hope to further investigate the insured and medical workers to understand their understanding and judgment on the hot and difficult issues of medical insurance, so as to form a comprehensive and objective evaluation of medical insurance.