Effect of policy implementation of China SIMI system on reducing hospitalization expenses of residents - A case study of Nan Ning city

Abstract

This thesis is to study the effect and relevant policy of the implementation of Serious Illness Medical Insurance System(SIMI system) on alleviating the hospitalization expenses residents in Guangxi's Nanning City (Capital of Guangxi).In this study design, 22 public hospitals in Nanning were selected as subjects. This includes a sample survey of （1）relevant policies, （2）inpatient SIMI system reimbursement data, （3）a methodology for strategic planning of SIMI systems, and（4）a description of the local context in which local SIMI systems were developed. Three main primary data collection methods were used in this study: SIMI system literature research collection, questionnaire-based quantitative data collection of inpatients, and qualitative interviews (mainly qualitative). The data collection process from August 2023 to November 2023.

This study found the SIMI system has shown significant performance in reducing （1）the medical costs of hospitalized patients.However, SIMI systems also exhibit some problems： 1.1 the slowdown of economic growth has affected the participation of SIMI system in Nanning、1.2 The “aging” population increases the pressure of financing and payment of SIMI system in Nanning、1.3The rapid growth of medical expenses affects Nanning SIMI system fund operates steadily、There are still many defects in the specific policies of SIMI system management, and there are still insufficient management staff of SIMI system.While affirming that the SIMI system has achieved remarkable results in promoting "social business cooperation" and alleviating the inpatient medical burden of urban and rural residents, This paper also deeply reflects on the existing problems of Nanning's current system from four aspects: theoretical understanding, system design, SIMI system actual payment rate and operation practice, and puts forward further reform plans and development strategies for the SIMI system.

This research suggests that,The further reform of the SIMI system should focus on the construction of a multi-level medical security system in Nanning, and explore the connection between BMI（Basic Medical Insurance）and SIMI system, as well as between SIMI system and MA（Medical Assistance）. The plan must makes a more scientific and accurate calculation of parameters such as "starting line", "capping line" and "compensation ratio" of each system, so as to provide a foundation for building a multi-tier medical insurance system of Nanning City with clear division of labor and clear tiers.

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