Uninsured status and its influential factors among residents in Hunan Province / 中南大学学报(医学版)

Objective:To investigate the insured and uninsured status of medical insurance among residents in Hunan province and the influential factors for uninsured status.Methods:A stratified,muti-stage,cluster sampling was used to select 7 rural counties and 7 urban districts from 122 counties/districts.In each selected county/district,5 towns were chosen at random.2 villages (or communities) were further selected in each given town randomly.At last,households were selected from sample villages (or communities) using systematic sampling and all members of selected households were surveyed through face-to-face interview.Complex sampling weights were considered to estimate the coverage rate of medical insurance and 95％ confidence interval.We used logistic regression to identify significant factors for not purchase insurance.Results:The overall coverage rate of medical insurance was 95.76％(95％ CI 93.04％ to 98.49％) in Hunan residents,and 4.24％ (95％ CI 1.51％ to 6.96％) of surveyed residents did not participate in any medical insurance program.Particularly,the proportion of residents not participating in any medical insurance program approached 10.17％ among urban residents under 18 years.Age,household income per capita,without chronic disease,were found being associated with uninsured status of medical insurance.Conclusion:To achieve the goal of universal health coverage by 2020,social medical insurance department should take measures to raise the coverage rate of medical insurance among residents.

An empirical study on the payment effect of hospitalization expense under the urban employee basic medical insurance in Guangzhou / 中华医院管理杂志

Objective To evaluate the payment effect of hospitalization expense under the urban employee basic medical insurance in Guangzhou.Methods Analyze the differences between the expenses paid by medical insurance with actual hospitalization expenses of the 22 settlement units from 1 5 tertiary hospitals,and the expense settlement data of the insured patients,based on the early,the mid-term,and the recent periods since the urban employee basic medical insurance was implemented since 2002.Results The ratio of good payment effect units reduced to 9.09%(the recent)from 42.86%(the earlier).The ratio of poor payment effect units was 42.86% in the early,to mid-term 18.18%,and sharply increased to 77.27%in the near term.The settlement units which exceeded its flat standard accounted for 52%,50%, and 91%respectively(in the early,the mid-term,and the recent).The medical insurance agency and the hospital shared the overrun costs by 52.88%and 47.12%respectively in 201 1.Conclusion The payment effect of the urban employee medical insurance was greatly influenced by the adjustment of medical insurance policy and the payment ability of the pooling fund.It should improve the payment effect of the medical insurance timely,so as to ensure the hospitals’operation normally.The hospitals should take the effective cost management measures so as to deal with the increasing cost control pressure.

Evaluating the Compensation Level of Urban Basic Medical Insurance in Jiangsu / 中国卫生经济

Objective: To evaluate the compensation level of the Urban Employee Basic Medical Insurance ( UEBMI ) and Urban Resident Basic Medical Insurance ( URBMI ) in Jiangsu province . Methods: Take catastrophic health expense as the bottom line of compensation ratio for the basic medical insurance, the benefit of hospitalization expenses of those joining the insurance as the actual line of compensation ratio, and quartile division was used to comparatively analyze the differences between the bottom line of compensation ratio and the actual line of compensation ratio. Results: Take 10%as the critical value of catastrophic health expense, the actual line of compensation level is higher than the bottom line of compensation level in UEBMI, and there is reverse in URBMI. Conclusion: In some extent, the compensation level of UEBMI has relieved the economic burden of the poor jointed group because of sickness, while limited compensation level of UEBMI is in need of further improvement.

Study of the Urban Workers' Basic Medical Insurance Appraisal Index of Our Country / 中国医学伦理学

A lot of problems have turned up with the development of the urban employee's basic medical system. So we need to establish a set of scientific medical evaluation index system to weigh it. This article discusses the evaluation index of the medical insurance from the respects of fairness, efficiency and development.