An example of community investigation report on basic medical insurance for urban residents
The first part: the investigation and analysis report of basic medical insurance for urban residents in China.
At present, "it is difficult and expensive to see a doctor", and participating in medical insurance has become a top priority and hot topic for community residents. Implementing the basic medical insurance for urban residents is an important measure to improve the social security system, alleviate the difficulty and high cost of medical treatment for residents, improve people's basic life and build a harmonious society, and it is also a popular project that benefits thousands of families. In order to further promote the smooth start and coverage of urban medical insurance in our county, community workers in our county went deep into the community to publicize the medical insurance policy and the benefits brought by participating in medical insurance, and to eliminate their ideological concerns.
Basic situation
The total population of xx community is 2767, including urban residents 1, 2 17. By the end of June, 1, 3 1, 346 urban residents in the whole community had participated in medical insurance, including 274 low-and middle-income residents and 76 elderly people over 60 (39 low-income households and low-income population 10). * * * The medical insurance premium for urban residents is 8674 yuan, and the low-income households account for 80% of the whole community. There are 540 people under the age of 50 living outdoors, and 35 people are insured, accounting for 6% of the total number.
Chapter two: social investigation report: investigation report on the present situation of medical insurance for urban residents
Medical insurance system is an important part of social insurance system. The pilot reform of China's medical insurance system has achieved initial results, but there are still some problems that cannot be ignored, such as personal ideological deviation, unbalanced development among regions, unsynchronized "three reforms" and lagging analysis and research, which will seriously hinder the improvement of China's medical insurance system and accelerate the process of building a high-level well-off society. Through questionnaire survey, we can understand the current situation of medical insurance for urban residents in China, and provide realistic basis for speeding up the improvement of China's medical insurance system, realizing the goal of building a well-off society in an all-round way and basically realizing modernization. First, the questionnaire design, survey objects and methods:
1. Questionnaire writing
This questionnaire design is divided into three parts: first, the personal background information of the respondents, including gender, age, education, occupation, income level and so on; Second, the respondents' medical insurance status, including their understanding of medical insurance, their basic situation of participating in medical insurance, their satisfaction with medical insurance and their hopes for government medical insurance policies. Third, the respondents' opinions and suggestions on medical insurance.
2. Questionnaire collection and analysis
There are 27 valid questionnaires, mainly from yingze district, xiaodian district and jiancaoping district, and the respondents are residents living in cities and towns. This questionnaire uses EXCEL programming statistics.
First, investigate the basic situation.
Urban residents' understanding of medical insurance
The statistics in the above table show that most urban residents have a basic understanding of medical insurance at present, and this group of people has reached 66.7%. The reason is that since the founding of the People's Republic of China, after decades of efforts, China has initially established a free medical system with the characteristics of planned economy, covering public institutions and taking social owners as the main body.
With the establishment of the market economy system and the rapid progress of urbanization,1In March 1994, the State Council began to reform the medical security system, and even the new rural cooperative medical system was fully implemented. People gradually came into contact with and understood medical insurance. At the same time, we should see that 29.6% of the residents are still in a state of "I don't know, I don't know" about medical insurance, and even 3.7% of the residents know nothing about medical insurance. This situation is not optimistic, indicating that the current government's propaganda on medical insurance is not enough, and the coverage of medical insurance needs to be expanded.
The lower the intimacy between medical insurance and residents, the less residents know about all aspects of medical insurance and the less they care about medical insurance. Associated with the table 1, up to 44.5% of the residents don't care much about medical insurance, and only 18.5% of the residents are very concerned about medical insurance. 2 urban residents to participate in medical insurance.
As can be seen from the statistics in Table 2, the medical insurance coverage rate of urban residents is only 77.8%, and 22.2% of the residents are still outside the medical insurance system. The main reasons for not participating in medical insurance are: economic conditions are not allowed (33.3%), the effect is not significant (33.3%), employers don't care (22.3%), and others: they don't know how to participate in medical insurance if they are laid off (1 1. 1%). It can be seen that the main reasons that affect urban residents not to participate in medical insurance are the limitation of economic conditions and the lack of medical insurance awareness. At present, the basic medical insurance for urban workers in China follows the basic principles of combining the burden of both parties and the unified account. Self-employed workers pay medical insurance premiums at 2% of the average monthly salary of the previous year, but for residents with poor economic conditions and poor living conditions, the medical insurance premiums equivalent to 2% of the monthly salary are still a burden. In addition, some residents do not know enough about the medical insurance system, and there is a misunderstanding. They think that they are young, less sick, and they have suffered from participating in medical insurance. Therefore, universal health insurance is doomed to be impossible overnight.
Judging from the people who have participated in medical insurance, 6 1.9% of the residents have participated in general medical insurance, 6 1.9% of them have medical insurance accounts for less than 10% of their household expenditure, and the proportion of medical insurance accounts for1/kloc-0% to 20% of their household expenditure. Because the personnel structure of insured patients is still relatively young, 47.6% residents think that the medical burden reduced by medical insurance for individuals is below 15% or even zero, and only 9.5% people think that the medical burden has been reduced by more than 60%.
3. Urban residents' views on the impact of medical insurance in China.
The statistics in Table 3 show that urban residents believe that the main reasons that affect China's medical insurance are hospital profiteering and inadequate government responsibility. The hospital profiteering is manifested in the large prescriptions, more inspections and even red envelopes. On the one hand, they take more money from the state, on the other hand, they continue to earn more money from the market, which leads to out-of-control medical expenses, "difficult to see a doctor" and "expensive to see a doctor", and residents complain a lot, making it difficult to reduce the operating cost of the medical insurance system. The situation of supporting doctors with medicine is more serious, which greatly affects the development and perfection of the medical insurance system. Secondly, medical insurance is a "three-point policy and seven-point management". Although the government continues to consolidate and improve the system, refine and strengthen management, it is a gradual process, and there are still insufficient efforts and unreasonable expenditures. This bottleneck is a huge constraint to establish and improve the medical insurance service system.
On the other hand, 32% of the residents can't tell which factors have affected China's medical insurance, which is consistent with 33.3% of the residents' ignorance of medical insurance, and it also shows that some aspects of the current medical insurance system in China are not transparent and open enough.
4. Satisfaction of urban residents with medical service institutions
As can be seen from the statistics in the above table, 47.6% of the residents are dissatisfied with the services provided by the designated medical institutions with medical insurance. The main reasons are unreasonable fees and poor service attitude. At present, there are still phenomena such as inflated drug pricing and irregular medical service charges in medical service institutions, which greatly reduces their image in the hearts of residents. Of course, there may also be residents who are not familiar with the operation process of medical service institutions, resulting in their incomprehension of medical service institutions. In addition, as service recipients, the poor attitude of service providers will inevitably lead to residents' dissatisfaction with medical service institutions. This is mainly manifested in the fact that the staff of medical service institutions can't answer all kinds of questions of clients patiently, meticulously and accurately, and can't actively eliminate the difficulties of clients. It can be seen that if medical service institutions want to serve the people effectively, they must better provide high-quality and efficient services for insured patients.
5. Opinions and suggestions of urban residents on medical insurance
Because 33.3% people don't know enough about medical insurance, 25.9% residents didn't put forward their own opinions and suggestions on medical insurance, and only 74. 1% residents expressed their opinions. Overall, the opinions and suggestions with the highest frequency are shown in Table 5 below.
As can be seen from Table 5, because the living standard of our people has basically reached a well-off level and the drug price is unreasonable, people generally hope to reduce the drug price. In some provinces and cities, especially in the western region, there are still a large number of people who lack medical insurance, such as freelancers, students and family members of employees, who are not covered by insurance, so expanding the coverage of medical insurance has become a great expectation. There is also a voice that medical service institutions can improve service quality. In addition, the statistical results in Table 6 show that people most want the government to strengthen the implementation of comprehensive medical insurance.
Second, some suggestions on the survey results.
1. Strengthen publicity. Medical insurance is a new thing. While carrying out the reform of the medical insurance system, we should increase publicity efforts, such as setting up a service desk for patients with basic medical insurance to improve people's ideological level, so as to enhance their recognition of medical insurance, eliminate mutual complaints and provide an ideological basis for the improvement of the medical insurance system.
2. The overlay object is enlarged. At present, the basic medical insurance system has been fully implemented in China's urban organs and institutions, and has achieved remarkable results, but the coverage is too small, which is still far from the requirements of accelerating the construction of a high-level well-off society. Therefore, we must speed up the transformation from employee medical insurance to social medical insurance and expand the coverage. First, it is necessary to speed up the research and improvement of medical insurance that adapts to flexible employment methods, and fully incorporate individual industrial and commercial households, hourly workers and self-employed workers into medical insurance coverage; Second, in view of the trend of younger malignant diseases, accelerate the implementation of student medical insurance, improve the overall medical level of students, and effectively reduce the family burden of patients; Third, we should strengthen the management of floating population in cities, break down various boundaries such as urban and rural ownership, and establish an integrated medical security system covering all urban and rural residents.
3. Diversified sources of funds. Although China's medical insurance system, like the old-age insurance system, adopts the mode of combining unified accounts, with the completion of a well-off society, the growth of people's health needs and the improvement of the aging population, the income and expenditure situation of medical insurance funds will become more and more severe, and it will become an inevitable trend for medical insurance funds to change from unit and individual contributions to diversified financing channels. Regarding how to diversify financing channels, relevant scholars believe that besides ensuring all insurance coverage, it is also necessary to increase financial input and establish medical insurance risk reserve; Second, according to the level of economic development and the improvement of people's health needs, as well as the economic affordability of units and individuals, the contribution rate of basic medical insurance should be appropriately increased, mainly to increase the total amount of medical pooling funds; Third, it is necessary to open up social donation channels, announce the establishment of social donation accounts for medical insurance to the public, and accept donations from Chinese and foreign enterprises and people from all walks of life, mainly for social medical assistance for seriously ill patients and vulnerable groups.
Part III: Investigation report on basic medical insurance for urban residents.
Yanta District is located in the Cheng Nan plate of Xi City, facing Baqiao District across the Chan River in the east. South and west adjoin Chang 'an District; The north is bounded by the Second Ring Road, which connects the new city, Beilin District, Lianhu District and weiyang district respectively. The total area of the region is 152 square kilometers, and the population is 1 178500 people. It has jurisdiction over 8 sub-district offices, 97 urban communities and 102 administrative villages. As the largest district in Xi, it is also the administrative district with the fastest economic and social development. It is difficult to do a good job in medical insurance for urban residents. I want to have a basic understanding of this topic in this social survey.
Establish medical insurance for urban residents
From 65438 to 0998, China began to establish the basic medical insurance system for urban workers. In order to achieve the goal of basically establishing a medical security system covering all urban and rural residents, the basic medical insurance for urban residents began to be piloted in 2007. In 2007, two or three cities were selected to start the pilot project in qualified provinces, and the pilot project was expanded in 2008. The goal is to reach more than 80% of the pilot cities in 2009, and the pilot cities will be fully promoted throughout the country in 20 10, gradually covering all urban non-employed residents.
Provisions and management of medical insurance for urban residents
Pilot principle
1, the pilot work should adhere to a low level, reasonably determine the financing level and security standards according to the level of economic development and the affordability of all aspects, focus on ensuring the medical needs of urban non-employed residents for serious illness, and gradually improve the security level;
2. Adhere to the principle of voluntariness and fully respect the wishes of the masses;
3, clear the responsibilities of the central and local governments, the central determine the basic principles and main policies, local formulate specific measures to implement territorial management of insured residents;
4, adhere to the overall coordination, do a good job in the basic policies, standards and management measures between the various medical security systems.
Scope of insurance liability
Students, children and other non-employed urban residents in primary and secondary schools (including vocational high schools, technical secondary schools and technical schools) not covered by the basic medical insurance system for urban workers may voluntarily participate in the basic medical insurance for urban residents.
The scope of medical insurance is very wide. Generally, medical expenses are distinguished according to the characteristics of medical services, including doctor's outpatient expenses, medicine expenses, hospitalization expenses, nursing expenses, hospitalization miscellaneous expenses, operation expenses, and various inspection expenses. Medical expenses are all kinds of expenses incurred by patients to treat diseases, including not only doctors' medical expenses and operation expenses, but also hospitalization expenses, nursing expenses and hospital equipment expenses.
Payments and subsidies
The basic medical insurance for urban residents is mainly based on family contributions, and the government gives appropriate subsidies. Insured residents are required to pay the basic medical insurance premium and enjoy the corresponding medical insurance benefits. Conditional employers can subsidize employees' families to pay insurance premiums. The state formulates preferential tax policies for individual contributions and unit subsidy funds.
For the insured residents in the pilot cities, the government gives subsidies every year according to the standard that the per capita is not lower than that of 40 yuan, and the central government has made special transfer payments every year since 2007. On this basis, the government will, in principle, grant a subsidy of not less than 10 yuan per capita to students and children with minimal living allowance or severe disability. For other low-income residents, severely disabled people who have lost their ability to work, elderly people over the age of 60 from low-income families and other residents in need of insurance payment, the government gives subsidies according to the standard of not less than 60 yuan per capita every year.
systems management
(1) Organization and management: In principle, the management of basic medical insurance for urban residents shall refer to the relevant provisions of basic medical insurance for urban workers. All localities should make full use of the existing management service system, improve management methods and improve management efficiency. Encourage qualified areas to combine the basic medical insurance for urban workers and the actual management of new rural cooperative medical care, and further integrate the management resources of basic medical security. It is necessary to explore the establishment and improvement of social supervision organizations for medical insurance composed of representatives of government agencies, insured residents, social organizations and medical service institutions, and strengthen supervision over the management, service and operation of basic medical insurance for urban residents. Establish medical insurance professional technical standards organizations and expert consultation organizations, and improve medical insurance service management professional technical standards and business norms. According to the needs of the development of medical insurance, strengthen the construction of medical insurance management service institutions and teams. Establish and improve the management system, improve the operation mechanism, and strengthen the construction of medical insurance information system.
(2) Fund management: The basic medical insurance fund for urban residents should be brought into the financial special account of social security fund for unified management and separate accounting. Pilot cities should strictly implement the financial system, strengthen the management and supervision of basic medical insurance funds, and explore the establishment and improvement of fund risk prevention and adjustment mechanisms in accordance with the relevant provisions of social insurance fund management to ensure the safety of funds.
(3) Service management: In principle, the medical service management of the basic medical insurance for urban residents shall be implemented with reference to the relevant provisions of the basic medical insurance for urban workers, and the specific measures shall be formulated by the labor and social security departments of the pilot cities in conjunction with the departments of development and reform, finance and health. It is necessary to comprehensively consider the basic medical needs of the insured residents and the affordability of the basic medical insurance fund, and reasonably determine the scope of medical services. Through the conclusion and performance of the designated service agreement, the management of designated medical institutions and designated retail pharmacies will be standardized, and the medical insurance agencies and designated doctors will be defined.
Rights and obligations of medical institutions and retail pharmacies. Medical insurance agencies should simplify examination and approval procedures to facilitate residents' participation in insurance and reimbursement of medical expenses; Clarify the settlement method of medical expenses and settle with medical institutions in a timely manner according to regulations. Strengthen the management of medical expenses and explore the establishment of a reward and punishment mechanism for medical insurance management services. Actively promote the payment of medical expenses according to diseases and the total amount in advance, and explore ways to determine the standard of medical expenses by agreement.
(4) Give full play to the role of urban community service organizations: integrate, upgrade and broaden the functions of urban community service organizations, strengthen the construction of community service platforms, and do a good job in the management and service of basic medical insurance. Vigorously develop community health services and bring qualified community health service institutions into the designated scope of medical insurance; For the medical expenses incurred by insured residents in community health service institutions, the proportion of medical insurance fund payment shall be appropriately increased.
Deepen relevant reforms.
(1) Continue to improve various medical security systems: further improve the basic medical insurance system for urban employees and take effective measures to include mixed ownership, non-public economic organizations and flexible employees in the basic medical insurance for urban employees; Vigorously promote migrant workers to participate in the basic medical insurance for urban workers, focusing on solving the problem of serious illness; Continue to focus on solving the medical security problems of employees and retirees such as state-owned enterprises with difficulties and closed bankrupt enterprises; Encourage urban residents of working age who have the ability to work to find jobs in various ways and participate in the basic medical insurance for urban workers; Further standardize the current payment policy of basic medical insurance for urban workers and strengthen the management of medical services. Accelerate the implementation of the new rural cooperative medical system. Further improve the urban and rural medical assistance system. Improve the multi-level medical security system and do a good job in the connection of various medical security systems.
(B) to promote the reform of the medical and health system and drug production and circulation system: according to the deep
The overall requirements of medical and health system reform, overall coordination of medical and health, drug production and circulation and medical security system reform and system convergence, give full play to the role of medical security system in raising medical funds, improving medical quality and controlling medical expenses. Further transform government functions, strengthen regional health planning and improve the medical service system. Establish and improve the health industry standard system, and strengthen the supervision of medical services and drug markets. Standardize medical service behavior, and gradually establish and improve technical standards such as clinical operation norms, clinical diagnosis and treatment guidelines, clinical medication norms, and admission standards. Accelerate the construction of urban community health service system, give full play to the role of community health service and Chinese medicine service in medical services, and explore the implementation of graded medical care for insured residents in areas where conditions permit.
This practice has given me a certain understanding of urban medical insurance, and at the same time, it also makes me feel that as a soldier who has just changed jobs, adapting to social expectations and work needs will be the driving force for me to do a good job. I will study hard in my precious school time to lay a solid foundation for my future work.
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