Example of a research report on basic medical insurance for urban residents in a community
Example of a research report on basic medical insurance for urban residents in a community
Part 1: Research and analysis of basic medical insurance for urban residents in a community in China
Basic situation
xx community of the total population of 2,767, of which the urban population of 1,217, as of December 31, XX, the community of urban residents to participate in the work of medical insurance. 31, the community's urban residents to participate in medical insurance 346 people, including 274 low-income people, 76 people over the age of 60, (39 low-income households, low-income 10 people, the normal payment of 27 people), people with disabilities, 8 people, underage enrollees 56 people, the general population of 72 people. *** collection of urban residents health insurance premiums 8674 yuan, low-income households accounted for 80 % of the community's participation rate, low-income households other than those under 50 years of age, 540 people, 35 people, the participants are the total number of 6 %.
Part II: Social Survey Report Survey Report on the Status of Urban Residents' Health Insurance
The medical insurance system is an important part of the social insurance system, China's pilot reform of the medical insurance system has made a stage-by-stage results, but there are still problems that can not be ignored, such as bias in the understanding of the mind of the individual, the development of the imbalance between the regions However, there are still problems that cannot be ignored, such as the bias in the individual's ideological understanding, the development of regional imbalance, the "three reforms" are not synchronized, the analysis of the lagging behind, these problems will seriously hinder the improvement of China's medical insurance system and accelerate the process of building a high-level well-off society. In this paper, through the form of questionnaire survey, to understand the current situation of China's urban residents' medical insurance, to accelerate the improvement of China's medical insurance system to provide a basis for reality, in order to achieve the goal of building a moderately prosperous society in an all-round way, and basically realize the goal of modernization. I. Questionnaire design, survey respondents and methodology:
1. Questionnaire preparation
The questionnaire design is divided into three parts: First, the respondents' personal background information, including gender, age, education, occupation, income level, etc.; second, the respondents' current situation of medical insurance, including the respondents' understanding of medical insurance, participation in the basic situation of medical insurance, the current situation of medical insurance for urban residents. The second is the respondents' current situation of medical insurance, including the respondents' knowledge of medical insurance, basic situation of medical insurance, satisfaction with medical insurance, and hope for the government's policy on medical insurance, etc.; the third is the respondents' opinions and suggestions on medical insurance.
2. Questionnaire collection and analysis
This questionnaire valid questionnaire **** 27, mainly from Yingze District, Xiaodian District, Tsimshatsui District District, the survey object for the residents living in the town. This questionnaire using EXCEL programming statistics.
A survey of the basic situation
Urban residents of medical insurance awareness
The statistics in the table above show that most of the current urban residents of medical insurance have a basic understanding of this part of the population reached 66.7%. The public has gradually come into contact with and understood medical insurance. At the same time, we should see that 29.6% of the residents still know something about medical insurance, and even 3.7% of the residents do not know about medical insurance, which is not optimistic, indicating that the government's publicity for medical insurance is not strong enough, and that the coverage of medical insurance still needs to be expanded.
The medical insurance is not a good idea.
The lower the degree of closeness between medical insurance and the residents, the less the residents know about all aspects of medical insurance, and the less they care about medical insurance. Associated with Table 1, up to 44.5% of the residents do not care much about medical insurance, very concerned about medical insurance residents accounted for only 18.5%. 2. Participation of urban residents in medical insurance
From the statistics in Table 2, we can see that the coverage of medical insurance among urban residents is only 77.8%, and 22.2% of the residents are still outside the medical insurance system. The main reasons for not taking part in medical insurance are: economic conditions do not allow (33.3%), the role is not big (33.3%), the employer does not care (22.3%), and others: such as have been laid off, do not know how to take part in medical insurance (11.1%). From this, it shows that the main reasons affecting urban residents' failure to participate in medical insurance lie in the limitations of economic conditions and insufficient awareness of medical insurance. At present, China's basic medical insurance for urban workers follows the basic principle of mutual responsibility and integration of accounts, with individual workers paying medical insurance premiums of 2% of the average monthly salary of the previous year, but for residents who are not in a good financial situation and are not wealthy enough, medical insurance premiums equivalent to 2% of their monthly salary are still a burden. In addition, some residents do not know enough about the medical insurance system and have a cognitive bias, believing that they are younger and less sick and that they are at a disadvantage by taking out medical insurance. Therefore, universal health insurance is bound to be impossible to achieve overnight.
From the point of view of the people who have participated in medical insurance, 61.9% of the residents participated in the general medical insurance, medical insurance accounted for less than 10% of the family expenditure of 61.9%, 11% to 20% of 38.1%, indicating that the proportion of expenditure on medical insurance costs at this stage is not very large, which is consistent with China's implementation of the united account of the combination of the basic medical insurance system. As the structure of insured patients is still relatively young, 47.6% of the residents believe that medical insurance for individuals to reduce the burden of medical care for less than 15% or even 0, that reduce the burden of medical care for more than 60% of only 9.5%.
3. Urban residents' views on the impact of China's medical insurance
The statistics in Table 3 show that urban residents believe that the main reason for the impact of China's medical insurance is the hospital profiteering and the government's responsibility is not in place. Hospital profiteering is manifested in hospitals prescribing large prescriptions, favored parties, more tests, and even receiving red packets, on the one hand, take more money from the state, on the other hand, continue to earn more money from the market, resulting in out-of-control medical expenses, "difficult to see a doctor" "expensive to see a doctor", and the "medical insurance". As a result, medical expenses are out of control, "it is difficult" and "expensive" to see a doctor, and residents complain a lot. It is difficult to reduce the operating costs of the medical insurance system, and the situation of supporting doctors with medicines is relatively serious, which greatly affects the development and improvement of the medical insurance system. Secondly, medical insurance is "three parts policy, seven parts management", the government has continued to consolidate and improve the system, refine and strengthen the management, but this is a gradual process, there is still not enough strength, spend money on the phenomenon of irrationality, this bottleneck for the establishment of a perfect medical insurance public **** service system is a great constraint.
On the other hand, 32% of the residents said they did not know what factors affect our medical insurance, which is consistent with 33.3% of the residents do not have a deep understanding of medical insurance, and also shows that some parts of the current medical insurance system in China are not transparent and open enough.
4. Urban residents' satisfaction with medical service organizations
From the statistics in the above table, we can see that 47.6% of the residents are dissatisfied with the services of the designated medical service organizations of the medical insurance, and the main reasons for this are the unreasonable charges and the bad service attitude. At present, the medical service organizations still have the phenomena of inflated drug pricing and unstandardized medical service charges, so that their image is greatly reduced in the hearts of the residents. Of course, there may be residents who are not familiar with the operating procedures of medical service organizations, resulting in a lack of understanding of medical service organizations. In addition, the residents as a recipient of services, the service provider's attitude is not good, will inevitably lead to the residents of the medical service organization's dissatisfaction. This is mainly manifested in the staff of medical service organizations can not patiently, carefully and accurately answer all kinds of questions of the service recipients and fail to actively remove the difficulties of the service recipients. It can be seen, in which to effectively serve the people, health care institutions must be better for the insured patients to provide quality and efficient service.
5. Urban residents' opinions and suggestions on medical insurance
As 33.3% of the population do not know enough about medical insurance, 25.9% of the residents did not put forward their own opinions and suggestions on medical insurance, and only 74.1% of the residents expressed their own views. Overall, the opinions and suggestions that appeared most frequently are shown in Table 5 below.
From Table 5, it can be seen that, as the living standard of our people has only basically reached the well-off level, the prices of medicines are unreasonable, and there is a general wish to reduce the prices of medicines. Certain provinces and cities, especially in the western part of the country, also have a large number of people who lack medical insurance, such as freelancers, students, and family members of employees are not covered by insurance, so expanding the coverage of medical insurance has also become a major expectation of the people. And another high call is for medical service organizations to be able to improve their service quality. In addition, the statistics in Table 6 show that people most want the government to increase the implementation of comprehensive medical insurance.
2. A few suggestions for the survey results
1. Medical insurance is a new thing, in the reform of the medical insurance system should be increased publicity, such as the establishment of basic medical insurance patient guide service desk, improve people's level of awareness to enhance the recognition of medical insurance, eliminate the phenomenon of mutual grievances, etc., for the medical insurance system to provide the ideological basis for the increasing improvement of the system.
2 . Coverage object expansion. At present, the basic medical insurance system in China's urban institutions and enterprises has been fully implemented, and has achieved remarkable results, but the coverage of the population is too small, from the accelerated completion of the requirements of a high-level well-off society is still a gap. Therefore, it is necessary to accelerate the transition from employee medical insurance to social medical insurance and to expand the scope of coverage. First, we must speed up the study and improvement of medical insurance that accommodates flexible employment methods, and fully include self-employed businessmen, hourly workers, and self-employed workers in the scope of urban workers' medical insurance; second, we must speed up the implementation of medical insurance for students in response to the trend of malignant illnesses at a younger age, and raise the level of students' medical care, so as to effectively reduce the burden on the families of the patients; and third, we must strengthen the management of the foreign population of the cities and break down the various boundaries between urban and rural areas, such as ownership, and establish a system that covers the entire population of the cities. The third is to enhance the management of the foreign population in the city, breaking the boundaries of urban and rural areas, and establishing an integrated medical insurance system covering all urban and rural residents.
3. Diversification of fund sources. Although China's medical insurance system, like the pension insurance system, adopts the model of combining the unified account, with the construction of a well-off society, the growth of people's health needs, and the increase in the number of people's health care services. Completion, the growth of people's health needs, the degree of population aging, medical insurance fund income and expenditure situation will become more and more serious, medical insurance fund from the unit and individual contributions to the diversification of financing channels will become an inevitable trend. As to how to realize the diversification of financing channels, the relevant scholars believe that, in addition to insuring as much as possible, firstly, it is necessary to increase the financial input and establish a medical insurance risk reserve; secondly, it is necessary to appropriately increase the contribution rate of the basic medical insurance according to the level of economic development and people's health needs, as well as the financial capacity of the unit and the individual and use it to enlarge the total amount of the medical insurance fund; thirdly, it is necessary to open up social collection channels and to provide the medical insurance fund with the necessary financial resources. Third, to open up social collection channels, announced to the community to set up medical insurance social collection account, accepting Chinese and foreign enterprises, people from all walks of life donations, mainly for patients with serious illnesses and vulnerable groups in need of social medical assistance.
Part III: Investigation Report on Basic Medical Insurance for Urban Residents
Yanta District is located in the southern part of Xi'an City, east of Chan River and Baqiao District; south and west of the neighboring Chang'an District; north of the second ring road as the boundary, respectively, connecting the new city, Beilin District, Lianhu District and Weiyang District. The district has a total area of 152 square kilometers, with a population of 1,178,500, governing 8 street offices, 97 urban communities, 102 administrative villages. As the first large district of Xi'an, but also the fastest economic and social development of the administrative region, do a good job of urban residents health insurance work difficulty can be imagined, I chose the topic of this social survey also want to make a basic understanding of this.
The establishment of medical insurance for urban residents
In 1998, China began to establish a basic medical insurance system for urban workers, in order to achieve the basic establishment of the goal of covering all urban and rural residents of the medical security system, from 2007 onwards to carry out the pilot project of basic medical insurance for urban residents. In 2007, two to three cities were selected in provinces with the conditions to launch the pilot program, and the pilot program was expanded in 2008, with the aim of reaching more than 80% of the pilot cities in 2009, and then being rolled out across the country in 2010, gradually covering all urban non-working residents.
Provisions and Management of Medical Insurance for Urban Residents
Pilot Principles
1, the pilot work should adhere to the low level of the start, according to the level of economic development and the ability to afford, and reasonably determine the level of financing and standards of protection, focusing on the protection of the urban residents of non-employment
2. Adhere to the principle of voluntarism and fully respect the wishes of the masses;
3. Clearly define the responsibilities of the central and local governments, with the central government determining the basic principles and main policies, the local government formulating specific measures, and the implementation of territorial management of the insured residents;
4. Adhere to the overall coordination of all types of medical insurance systems, and do a good job in the coordination of the basic policies, standards, and management measures, etc., between various types of medical insurance systems. policies, standards and management measures.
Scope of Participation
Students in primary and secondary schools (including vocational high schools, junior colleges and technical schools), children and teenagers, and other non-employed urban residents who are not covered by the basic medical insurance system for urban workers can voluntarily participate in the basic medical insurance for urban residents.
The scope of medical insurance is very broad, and medical expenses are generally differentiated according to the characteristics of their medical services, which mainly include doctors' outpatient costs, medicine, hospitalization costs, nursing costs, miscellaneous hospital expenses, surgical costs, and various examination costs. Medical expenses are the various costs incurred by the patient for treatment, which includes not only the doctor's medical and surgical fees, but also hospitalization, nursing care, hospital equipment and other costs.
Contributions and Subsidies
The basic medical insurance for urban residents is based on family contributions, with appropriate government subsidies. Participating residents pay the basic medical insurance premiums in accordance with the provisions of the basic medical insurance, enjoy the corresponding medical insurance treatment, the conditions of the employer unit can be subsidized for employees' family members to participate in the insurance premiums. The state of individual contributions and unit subsidies to develop tax incentives.
For insured residents of the pilot cities, the government subsidizes them at no less than 40 yuan per capita per year, of which the central government has been paying through special transfers every year since 2007. On this basis, belonging to the low-income objects or severely disabled students and children to participate in the family contribution required, in principle, the Government will be no less than 10 yuan per capita each year to give subsidies; other low-income objects, loss of the ability to work for the severely disabled, low-income families with elderly people over 60 years of age, and other residents in difficulty to participate in the family contribution, the Government will be no less than 60 yuan per capita each year to give subsidies.
System Management
(a) Organizational management: the management of basic medical insurance for urban residents, in principle, with reference to the implementation of the relevant provisions of the basic medical insurance for urban workers. Each region should make full use of the existing management service system, improve management methods, improve management efficiency. Areas in a position to do so are encouraged to further integrate basic medical insurance management resources in conjunction with the actual management of basic medical insurance for urban workers and new rural cooperative medical care. It is necessary to explore the establishment of a sound medical insurance social supervision organization with representatives from government agencies, insured residents, social groups, and medical service organizations, so as to strengthen the supervision of the management, service, and operation of basic medical insurance for urban residents. It has established medical insurance professional and technical standards organizations and expert consulting organizations, and improved professional and technical standards and business norms for medical insurance services and management. In accordance with the needs of the development of the medical insurance cause, the construction of medical insurance management service organizations and teams shall be effectively strengthened. The establishment of a sound management system, improve the operation mechanism, and strengthen the construction of medical insurance information system.
(b) Fund management: the basic medical insurance fund for urban residents should be included in the unified management of social security fund financial account, separate accounts. Pilot cities should be in accordance with the social insurance fund management and other relevant provisions, the strict implementation of the financial system, to strengthen the management and supervision of the basic medical insurance fund, to explore the establishment of a sound fund risk prevention and transfer mechanism, to ensure the safety of the fund.
(C) service management: the urban residents of the basic medical insurance medical service management, in principle, with reference to the implementation of the relevant provisions of the basic medical insurance for urban workers, the specific measures by the pilot city labor security departments in conjunction with the development and reform, finance, health and other departments to develop. The scope of medical services shall be reasonably determined by comprehensively considering the basic medical needs of the insured residents and the affordability of the basic medical insurance fund. Through the conclusion and implementation of designated service agreements, the management of designated medical institutions and designated retail pharmacies is standardized, and the rights and obligations of medical insurance agencies and designated medical institutions and retail pharmacies are clarified. Medical insurance agencies should simplify the approval procedures to facilitate residents' enrollment and reimbursement of medical expenses; clarify the settlement of medical expenses, and settle with medical institutions in a timely manner in accordance with the regulations. They should strengthen the management of medical expenses and explore the establishment of a reward and punishment mechanism for medical insurance management services. Actively implement the settlement methods of paying medical expenses according to the type of disease and prepaying according to the total amount, and explore the method of determining the standard of medical expenses by agreement.
(d) Give full play to the role of urban community service organizations and other: integration, enhancement, broaden the function of urban community service organizations, strengthen the construction of community service platforms, and do a good job of basic medical insurance management services. Vigorously develop community health services, qualified community health service organizations into the scope of medical insurance; the insured residents to the community health service organizations to meet the medical costs incurred, to appropriately increase the proportion of medical insurance fund payment.
Deepening the relevant reforms
(a) Continue to improve the various medical insurance systems: further improve the basic medical insurance system for urban workers, and take effective measures to incorporate employees of mixed ownership, non-public economic organizations, and flexibly employed persons into the basic medical insurance for urban workers; vigorously promote the participation of rural migrant workers in basic medical insurance for urban workers, with a focus on the participation of urban workers, with a focus on the participation of urban workers in basic medical insurance, with a focus on the participation of urban workers in basic medical insurance. Participate in basic medical insurance for urban workers, with an emphasis on solving the problem of coordinating major illnesses; continue to focus on solving the problem of medical insurance for employees and retirees of state-owned enterprises in difficulty and those that have closed down or gone bankrupt; encourage urban residents of working age who are capable of working to take up employment in a variety of ways and participate in basic medical insurance for urban workers; further standardize the current payment policies for basic medical insurance for urban workers and strengthen the management of healthcare services. Accelerating the implementation of the new rural cooperative medical care system. Further improve the urban and rural medical assistance system. Improve the multi-level medical insurance system, and improve the articulation of various medical insurance systems.
(2) synergistically promote the reform of the medical and healthcare system and the drug production and circulation system: in accordance with the overall requirements of deepening the reform of the medical and healthcare system, coordinate the reform of the medical and healthcare, drug production and circulation, and medical security system and the convergence of the systems, and give full play to the role of the medical security system in mobilizing healthcare funds, improving the quality of healthcare and controlling healthcare costs, etc. The government has further changed its functions and strengthened the regional medical security system. It will further transform government functions, strengthen regional health planning, and improve the medical service system. A sound system of health industry standards will be established and supervision of the medical services and pharmaceutical markets will be strengthened. It will regulate the behavior of medical services, and gradually establish and improve such technical standards as clinical operation norms, clinical diagnosis and treatment guidelines, clinical medication norms, and standards for entering and leaving hospitals. Accelerate the construction of urban community health service system, give full play to the role of community health services and traditional Chinese medicine services in the medical services, the conditions of the region can be explored to implement a graded medical care for insured residents.
This practice allows me to have a certain understanding of urban health insurance, and at the same time feel as a newly transferred military, to adapt to the expectations of society and the needs of the workplace, will be the driving force of their own good work. I will be in the valuable time in school, serious and hard work, for the future work to lay a solid foundation.
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