Analysis on the Influencing Factors of the Reimbursement Effects of Critical Illness Insurance for Urban and Rural Residents from the Perspective of New Institutionalism

Corresponding author: WANG Yan-zhong, wangyanzhong01@163.com

DOI: 10.12201/bmr.202110.00038

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  Abstract: New Institutionalism believes that institutional factors are important variables that could influence the behavioral choices of participants and lead to different results. From this perspective, we couldshould look for the reasons and influencing factors of the unsatisfied operational and reimbursement effects of the Critical Illness Insurance for urban and rural residents from itsthe institutional framework first. The lack of clear system positioning of the Critical Illness Insurance System has led to certain implementation deviations. The misuse of key concepts hinders the realization of accurate protection and adequate reimbursement. The design of quasi-insurance reimbursement policies limits the reimbursement space of Critical Illness Insurance. The inability of the financing mechanism to meet the guarantee needs directly leads to insufficient reimbursement. Due to the limits of institutional framework,Therefore, to solve the critical illness protection problem of urban and rural residents better, it is necessary to carry out a fundamental rebuilding of the institutional framework of the Critical Illness Insurance System. In the short term, a comprehensive critical illness security system should be built covering fundamental medical insurance, medical assistance and supplementary medical insurance based on the different needs of different population groups. In the medium and long term, when the actual reimbursement level of fundamental medical insurance reaches 70% or even higher, introduce capping mechanism for individual out-of-pocket payment and solve the critical illness protection problem thoroughly.

  Key words: New Institutionalism, Critical Illness Insurance for Urban and Rural Residents, reimbursement effects, influencing factors

  Submit time: 21 December 2021

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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