›› 2011, Vol. 31 ›› Issue (7): 1012-.doi: 10.3969/j.issn.1674-8115.2011.07.032

• Original article (Public health administration) • Previous Articles     Next Articles

Comparative analysis of children's medical insurance system in Shanghai

WANG Han-song, REN Yi-jiong, ZHANG Yun-ting, LI Li, JIANG Fan, JIANG Zhong-yi   

  1. Quality Control Office, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-07-28 Published:2011-07-27
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 11692105000;Shanghai Municipal Health Bureau Foundation, 2010190

Abstract:

Objective To investigate the current status of children's medical insurance system in Shanghai, and find out ways to improvement. Methods Relevant policies of children's medical insurance in Shanghai were systematically collected and analysed, and comparisons were made with those in Beijing, Tianjin and Chongqing on financing, deductibles, reimbursement proportions and cap lines. Reimbursements of medical expenses of 320 children with leukemia, malignancies and congenital heart diseases were retrospectively analysed. Results Children's medical insurance in Shanghai was “double insurance”, which contained Children's Hospitalization Fund and Basic Medical Insurance for Urban Residents of school students and infants. Compared with the other age groups, the financing of children's Basic Medical Insurance for Urban Resident was relatively lower,  the outpatient reimbursement rate was roughly equal, while the hospital reimbursement rate for children (50%) was less than that of people over the age of 60. Compared with the other municipalities, the individual financing of children's “double insurance” in Shanghai (140 RMB) was the highest, but the reimbursement cap line was not set. Through case analysis, it was found that the actual reimbursement rates of medical expenses of children with leukemia and malignancies (87.76%) and congenital heart diseases (88.18%) were lower than the theoretical level (100%). Conclusion The financing of children's medical insurance in Shanghai has not yet been established organic links with economic development. There is room for improvement in the medical aid system for poverty-stricken children with serious illness. The reimbursement rate of children's medical insurance is not in line with the theoretical level, and needs to be enhanced.

Key words: children, medical insurance, comparative analysis