Medical insurance

Author: Qiu Yulin Sun Shuhuan
Publisher:
Publish Date: 2001-03-01
Features: This book is a comprehensive professional textbook introducing theories and practices related to medical insurance. The main content includes: An Overview of Medical Insurance; Theories of Medical Insurance Demand; Theories of Medical Insurance Supply; Medical Insurance Markets and Operations; The Role of Government in Medical Insurance Markets; Methods for Calculating Insurance Premiums; Medical Insurance Models; The Historical Evolution of China's Medical Insurance System. This book provides a comprehensive and systematic introduction to the relevant aspects of medical insurance. It covers both theoretical and conceptual explanations, as well as practical operational discussions. It includes experiences from foreign medical insurance systems and also addresses the development, existing issues, and reform processes of China's medical insurance system.
Chapter 1 serves as an introduction to the entire book, leading from health and disease risks to the objective need for medical services and medical insurance. It provides a detailed introduction to the relevant theoretical knowledge of medical insurance, helping readers establish a basic understanding of medical insurance.
Chapter 2 discusses the structure and system of medical insurance. Medical insurance is generally composed of three levels: basic medical insurance, supplementary medical insurance, and commercial medical insurance. Basic medical insurance is a social medical insurance system provided by the government, offering broad coverage and ensuring basic medical treatment, characterized by wide coverage and a low level of benefits. Supplementary medical insurance is established by enterprises or units to improve employees' medical insurance benefits, serving as a supplement to basic medical insurance. Commercial medical insurance operates entirely on market economy principles, offering personalized services and high benefits, meeting people's higher medical needs.
Chapter 3 discusses issues related to the medical insurance market. One of the prominent features of medical insurance compared to other social insurances is the existence of a demand side (insured individuals or patients), a supply side (hospitals or other medical institutions), and a third party (medical insurance institutions), forming a certain supply-demand market relationship. Chapter 3 analyzes the relationships among the three aspects of medical insurance from the perspectives of supply and demand, as well as the role of the government in the medical insurance market.
Chapter 4 covers the mathematical aspects of medical insurance, introducing methods for calculating medical insurance premiums using actuarial knowledge, giving readers a preliminary understanding of how medical insurance premiums are determined.
Chapter 5 discusses several typical models of medical insurance systems in the world (including coverage targets, funding sources, benefit levels, and medical service delivery methods), providing an overall summary of the main types of current medical insurance systems, as well as the main issues and reform trends of foreign medical insurance systems.
Chapter 6 briefly describes the sources, collection methods, and related content of medical insurance funds. Medical insurance funds are the material foundation for the operation of the medical insurance system, and the size of the funds is related to the level of medical insurance.
Chapter 7 corresponds to Chapter 6, as they address the same issue from two different perspectives. Chapter 6 explains the sources of medical insurance funds, while Chapter 7 discusses the payment of medical insurance expenses. The payment methods of medical insurance expenses are a critical aspect of the entire medical insurance system. Different payment methods create different economic incentives for healthcare service providers, affecting both healthcare spending and the type of medical services patients receive. The reform of medical insurance payment methods has also become a key focus of medical insurance system reforms in many countries.
Chapter 8 covers the management and supervision of medical insurance. Due to the numerous participants in the medical insurance system, management and supervision of various aspects are of great importance. Countries that implement medical insurance systems place significant emphasis on this issue.
Chapter 9 provides a comprehensive description and analysis of the development, existing issues, and reform process of China's medical insurance system.