Background:
The identity of the benefits of medical insurance system (IBMIS) can reflect the quality of the implementation of medical insurance policies and is valuable feedback during the deepening reform phase of medical insurance system(MIS). This research aims to analyze the factors affecting IBMIS from the perspective of medical insurance-related professionals and to propose corresponding policy recommendations.
Methods:
In 2021, we conducted a cross-sectional questionnaire survey (n=1829) in Heilongjiang Province to obtain the data. Interviewees were selected by multi-stage stratified cluster random sampling. A binary logistic regression model was used to determine the factors affecting the IBMIS.
Results:
Overall, 66% (1,207) of medical insurance-related professionals had a high IBMIS. The logistic regression model showed that high IBMIS was positively correlated with the following dimensions: policy capacity (OR=1.562), financial burden (OR=1.512), and convenience (OR=1.300). The seven significant influencing factors (P<0.05) of the high IBMIS include: “Relief of financial burden for people with serious diseases”(OR=2.341), “Medical insurance's ability to solve major problems that people expect” (OR=1.604), “Governance capacity of the medical insurance administrative agencies and management Institution” (OR=1.499), “Effectiveness of governance for off-site medical reimbursement issues”(OR=1.436), “Effectiveness of medical insurance Payment Reform” (OR=1.399), “The extent of information construction of medical insurance” (OR=1.361), “Equity of medical insurance system policies” (OR=0.753)。
Conclusion:
The government should focus on reforming the medical insurance system in the following three areas: First, the management sector of medical insurance needs to continue to enhance its policy capacity, especially its ability to address the difficulties of the insured and its ability to collaborate in governance; second, it should continue to improve the affordability of out-of-pocket expenses for patients with serious diseases and expand the scope of reimbursement under the MIS to relieve the insured's financial burden; third, by strengthening the medical insurance infrastructure, the settlement service for medical treatment in other places will be made more convenient.