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Research on the design of serious illness insurance scheme in Shanghai based on micro-simulation by Yang Li; Guangfeng Duan; Linping Xiong is a Health Professions article available to read on EtoBox.

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## Abstract ## Background Urban and rural residents’ basic medical insurance (URRBMI) is an institutional arrangement for rural residents and unemployed urban residents in China. The serious illness medical insurance system (SIMIS) was established to provide additional medical cover. At present, the SIMIS payment method in China is based on large expenses, and only a few areas, such as Shanghai, pay according to the treatment of serious diseases. This study aims to simulate and analyse the effect of the two payment methods on SIMIS in Shanghai. ## Methods We developed a micro-simulation model to predict the number and characteristics of SIMIS participants among urban and rural residents in Shanghai and to simulate the process of medical treatment, medical consumption, and medical insurance payments for each insured person from 2020 to 2025. We then summarised and analysed the payment compensation effect, and compared it with Shanghai’s current policies. ## Results The payment of SIMIS according to high expenses, the total medical expenses of seriously ill patients show an increasing trend, with an average annual growth rate of 3.56%. The URRBMI fund payment covers 56%–58% of total

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Author

Yang Li; Guangfeng Duan; Linping Xiong

Publisher

Springer Science and Business Media LLC

Published

2022

Language

EN

Field

Health Professions (Health Sciences)