Analysis of Drug Medical Insurance Access Pricing Based on the Perspective of Binary Equilibrium

Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.

Inspiration of Foreign Innovative Drug Pricing Methods and Medical Insurance Payment Standards to China

Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.

The Impact of Population Aging on the Expenditure of Medical Insurance Fund for Urban Workers in China

Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through analyzing the impact of the population aging,the income and accumulated balance of the medical insurance fund,and other related factors on the expenditure of the medical insurance fund,development status of the medical insurance fund for urban employees in China since 2003 was obtained.Stata 16.0 was used to perform multiple linear regression analysis on related factors to determine the correlation between population aging and the change in medical insurance expenditures.Results and Conclusion The factors that have a greater impact on the expenditure of the medical insurance fund are the amount of income from the medical insurance,followed by the number of people over the age of 65 in China and the urban retired employees participating in medical insurance.We should focus on the sustainable development of the urban employee medical insurance fund to deal with the threat of aging.

Research on Social Medical Insurance of College Students in Shenyang

Objective To discuss the methods of improving the social insurance of college students by taking the application of college students’social insurance in Shenyang as an example.Methods The investigation and literature method were applied mainly.Results and Conclusion Through the questionnaire,the main problems for college students’medical insurance were analyzed in this paper,and proposals such as compulsory insurance,improving the level of medical services in colleges and hospitals,and strengthening commercial insurance and publicity were finally put forward.

Research on social medical insurance of migrant workers --A case of Suqian city in Jiangsu province

City migrant workers, as one part of the city＇s development, economic development and other aspects of urban to make a great contribution, but the delay with the local residents do not enjoy the same level of medical care treatment is always blocked in outside the city＇s health care system, have less relevant departments, there is no practical system introduced regulations and policies, these things tell us to pay attention to the people, and the introduction of appropriate medical insurance of migrant workers possibly things, and timely medical security system of such groups and the local people medical protection for long support. Make medical insurance system can cities try it＇s best to help foreign workers Medicare, Medicare for the development of China has made a modest contribution.

Analysis of inpatient payments of breast cancer patients with different medical insurance coverages in China(mainland) in 2011–2015

Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.

Software Process Modeling with UML in Development of Medical Insurance MIS

This paper describes how to use the Unified Modeling Language (UML) to modeling software processes in medical insurance MIS, and compares UML Modeling method with classic PO(Process Oriented) Modeling method. It indicates that the whole performance of application system model described by UML is much better than the one described by PO.

An Ensemble Methods for Medical Insurance Costs Prediction Task

The paper reports three new ensembles of supervised learning predictors for managing medical insurance costs.The open dataset is used for data analysis methods development.The usage of artificial intelligence in the management of financial risks will facilitate economic wear time and money and protect patients’health.Machine learning is associated withmany expectations,but its quality is determined by choosing a good algorithm and the proper steps to plan,develop,and implement the model.The paper aims to develop three new ensembles for individual insurance costs prediction to provide high prediction accuracy.Pierson coefficient and Boruta algorithm are used for feature selection.The boosting,stacking,and bagging ensembles are built.A comparison with existing machine learning algorithms is given.Boosting modes based on regression tree and stochastic gradient descent is built.Bagged CART and Random Forest algorithms are proposed.The boosting and stacking ensembles shown better accuracy than bagging.The tuning parameters for boosting do not allow to decrease the RMSE too.So,bagging shows its weakness in generalizing the prediction.The stacking is developed using K Nearest Neighbors(KNN),Support Vector Machine(SVM),Regression Tree,Linear Regression,Stochastic Gradient Boosting.The random forest(RF)algorithm is used to combine the predictions.One hundred trees are built forRF.RootMean Square Error(RMSE)has lifted the to 3173.213 in comparison with other predictors.The quality of the developed ensemble for RootMean Squared Error metric is 1.47 better than for the best weak predictor(SVR).

Quantifying social vulnerability for flood disasters of insurance company

Social vulnerability assessments are largely ignored when compared with biophysical vulnerability assessments. This is mainly due to the fact that there are more difficulties in quantifying them. Aiming at several pitfalls still existing in the Hoovering approach which is widely accepted, a suitable modified model is provided. In this modified model, the integrated vulnerability is made an analogy to the elasticity coefficient of a spring, and an objective evaluation criterion is established. With the evaluation criterion, the assessment indicators of social vulnerability are filtered and their weight assignments are accomplished. There is an application in the city of Changsha where floods occur often. With the relative data from the PICC Hunan Province Branch, a generalized regression neural network model is established in Matlab 7.0 and used to evaluate a company's flood social vulnerability index (SoVI). The results show that the average flood social vulnerability in Yuhua district is the highest, while Yuelu district is the lowest. It is good for disaster risk management and decision-making of insurance companies.

Sensitivity of Personal Account Accumulated Value of New Rural Social Pension Insurance to Variation of Uncertainties

The personal account of new rural social pension insurance raises funds in the form of individual premium-paying,collectively pooled subsidy and government subsidy.The personal account accumulated value has a decisive influence on the payment level of personal account pension.The personal account accumulated value has a direct or indirect relationship with the income level of farmers,premium-paying level,the insured period,investment return rate of funds and other factors.Analysing the impact of infinitesimal variation of these factors on accumulated value of personal account pension,is of great significance to improving and consolidating personal account,and achieving sustainable development of new rural social pension insurance.

Analysis of the effect of medical insurance on cancer inpatients: A 10-year retrospective study on a large hospital in Northeast China

Objective The aim of the study was to analyze hospital costs for cancer inpatients availing different methods of payment and the influencing factors, to provide inputs to improve the medical insurance payment policy. Methods We analyzed the information related to length of hospital stay, hospitalization cost, and self-pay cost, collected from one large-scale, Grade A, Class Three hospital in Shenyang, China, during 2004–2013.Results The number of cancer inpatients with different payment types(medical insurance group and non-medical insurance group) presented a rising trend. Further, the ratio of medical insurance inpatients increased rapidly(from 22.2% to 48.7%); however, this group was still a minority. The length of hospital stay became shorter(21 d vs. 17 d; P = 0.000) while the gap got narrower; the hospitalized expense showed an upward trend and the difference was remarkable($24048.6 ± $4376.28 vs. $20544.36 ± $4057.01; P = 0.000). Conclusion Along with normalization of cancer therapy, the influence of payment on treatment has been getting weak, the policy has impact on controlling hospitalization cost, lightening burden of cancer patient, as well as allocating medical resources in a reasonable way, becoming an important defray pattern of hospitalization cost.

Optimization of Actuarial Model for Individual Account of Rural Social Pension Insurance

This paper firstly analyzes different payment methods of individual account and the pension replacement rate under the pension payment method.Results show that it will be more scientific and reasonable for the individual account of new rural social pension insurance to adopt the actuarial model of payment according to proportion of income and periodic prestation at variable amount.The Guiding Opinions on New Rural Social Pension Insurance sets forth individual account should be paid at fixed amount,and the insured voluntarily selects payment level as per criteria set by the State.The monthly calculation and distribution amount of pension is the total amount of individual account divided by139.Therefore,it should start from continuation of policies and make adjustment of payment level in accordance with growth of per capita net income of rural residents.When condition permits,it is expected to realize transition to payment as per income proportion and periodic prestation at variable amount.

The sustainability study of medical insurance fund in China under the background of aging

the arrival of the aging means being able to direct production value to reduce the proportion of people, the elderly population gradually become pure consumer groups, and the elderly because of its body function gradually blurred, risk is higher than that of other age members of society, medical consumption occupy a large proportion in the consumption structure. As the degree of aging, the country＇s medical expenses will be bigger, that is to say, in an aging society, may because the elderly medical consumption spending huge, and affect the sustainable development of society. And as countries deeper levels of population aging in our country, can very good deal with the impact of the aging of medical insurance fund, guarantee the sustainability of the medical insurance fund, also determines the sustainable and stable development of our country. Therefore, under the background of aging degree deeper, the development of the medical insurance fund is to seek new paths, to cope with increasing aging population is particularly important

The study of basic medical insurance system for urban residents in China

The basic medical insurance system for urban residents is an important part of China＇s social security system.This article analyzes the problems which existing in the basic medical insurance system for urban residents and puts forward the corresponding countermeasures.

A Study of Medical Insurance With Big Data in Taiwan

The structures of numerous industries, including the insurance industry, have been altered by the ongoing development of associated technologies. As the insurance industry undergoes this period of technology transformation, it is important to recognize the key role that big data play in the industry. Most critically, the industry could not function without the utilization of big data, which explains to a large extent why every insurance company maintains its own numeric database. Relatedly, Taiwan＇s Bureau of National Health Insurance recently established the Information Integration Application Service Center, to which qualified companies and institutions can submit applications for permission to analyze the bureau＇s collected disease data according to stipulated regulations. In effect, access to the center＇s data provides insurance companies with a further means of improving their operational effectiveness through the analysis of big data, with targets for potential improvements including the various strategies utilized to react to changes in the environment, such as those involved in marketing, administrative management, and product pricing and services. The foundation of the present study consisted of a literature review and survey, with the key objective being to determine and discuss the effects of big data analysis on the medical insurance industry, including the changes that the utilization of big data results in for the customers of medical insurance companies. With the issues discussed above in mind, the survey was designed to determine whether medical insurance consumers know about and understand the effects of big data. The survey data indicated the following key findings： （1） The two concepts exhibit clear differences in terms of population statistic wxiables; （2） The two concepts exhibit clear differences in terms of insurance purchasing variables; and （3） The two concepts exhibit clear differences in terms of the level of understanding regarding big data.

An Empirical Study on the Effects of Social Endowment Insurance Reform in China

In recent years,China,the world’s largest population country,has also become an aging society.Social endowment insurance is not only a major source of income after retirement but also plays a major role in social stability.In 2005,large-scale social endowment insurance reform was conducted in China.Through this reform,the social endowment insurance became unified and normalized,and the participation of the social endowment insurance was obligated for an employee.In addition,the government has issued various welfare policies so that the unemployed,free job and rural residents can join social endowment insurance.Then,this paper analyzes the effect of the reform of China social endowment insurance on the amount of Insurance premium of social endowment insurance and the distribution of family expenditure by using the DID model and the fixed effect model.

The Initial Exploration of The Catastrophic Medical Insurance in Shanghai

Developing the catastrophic medical insurance for urban and rural residents positively is the key action to keep the new round of reform for medical system into deep. However this insurance is the ＇shortage＇ of the national health system, so the Shanghai government carries out The Trial Measures for Catastrophic Medical Insurance of urban and rural residents in 2014. In this thesis, we will describe the current situation of the catastrophic medical insurance in Shanghai from aspects of financing, level of compensation, the way to undertake and regulatory. What＇s more, we expect to explore the weakness of catastrophic medical insurance in actual motion, and offer proposals for progressively realizing the integration of urban and rural in medical insurance, improving the basic health care directory, enhancing cooperation with commercial medical insurance.

The Empirical Study of Social Insurance for Migrant Workers

The social insurance problem of migrant workers is one of the main social problems that need to be solved in the city modernization and industrialization construction in China. The outstanding reflections are that attaching less importance to social insurance system, too high insurance fee and not perfect security system and other phenomena. This paper focuses on the empirical study and analysis of this type of problems, in order to put forward the feasible solution of social insurance for migrant workers. The migrant workers generally refer to the labor workers of household registration as farmers working in towns for non-agricultural occupation. At present, China＇ s migrant workers has exceeded 2.6 billion, and this group has been long in the city and rural edge, difficult to get the social insurance policy. According to the National Bureau statistics data, the migrant workers of not buying industrial injury insurance, endowment insurance, medical insurance and unemployment insurance are respectively 67.64%, 73.37%, 73.77% and 84.65%. In order to guarantee the interests of vulnerable groups in the marginalized position, the social insurance problems of migrant workers have become the our focus.

Based on the human capital perspective to explore the social insurance premium is influence on the behavior of enterprises to participate in social insurance

To participate in social insurance is a major social responsibility of enterprises, even it is a mandatory social policy, companies still escaped pay society insurance. The serious consequences of this phenomenon become increasingly prominent.it not only damaged the justice of labor market, but also violated the staffs interest. Various factors influence enterprise to participate in social insurance behavior .Human capital is the impact of insurance companies. This paper is mainly focusing on the theory analysis of different human capital participating behavior of enterprises. From the perspective of human capital, using the cost-benefit theory and rational choice theory in economics to explore participating behavior, enterprise employees of different human capital differences in attitude to attend social insurance. No matter enterprises with higher or lower human capital, enterprises and employees choose to participate in social insurance act consistently. But, it can improve participate of low human capital enterprise behavior when payment rate reduced. So, it is suggested that establishing a lower level of social insurance system is helpful to expand coverage, it can through e^tahllgh the sunnlementarv insurance system meet the needs of more people.

Literature review of the basic medical insurance of urban and rural integration

To set up the nation＇s covering medical insurance syslem and to the realization of the basic medical insurance of urban and rural integration, is the inevitable trend in the development of China＇s medical insurance reform, as well as it is also a key step. In recent years, the state promulgated a series of policies in promoting urban and rural medical insurance and many cities took the lead to reform form the medical insurance pattern with local characteristics. All of these are helpful for our country to realize the integration and providing valuable experience. The target of the article is to maintain the public cause of medical and health, to solve the problem of high cost of urban and rural residents to see a doctor. As well as to realize the objections of disease pro^ection, convenience, cure spends less.