Differentiated effects of personal medical account reforms in the outpatient mutual-aid security mecha-nism of employee basic medical insurance on satisfaction levels across different income groups
10.3969/j.issn.1671-332X.2025.05.005
- VernacularTitle:职工医保门诊共济保障中个人账户改革对不同收入群体满意度的差异化影响研究
- Author:
Yaqin REN
1
;
Jun LIU
1
;
Jizhi LI
1
Author Information
1. 重庆市红十字会医院(江北区人民医院) 重庆 400020
- Publication Type:Journal Article
- Keywords:
Employee medical insurance;
Outpatient mutual-aid security mechanism;
Reform of personal accounts;
Dif-ferent income groups;
Satisfaction
- From:
Modern Hospital
2025;25(5):673-678
- CountryChina
- Language:Chinese
-
Abstract:
The article summarizes the differentiated effects of personal account reform on the satisfaction of different in-come groups in the reform of medical insurance outpatient mutual aid.This reform has significantly improved the mutual aid pro-tection offered by medical insurance funds through comprehensive measures such as adjusting the personal account accounting method,promoting coordination of medical treatment in different places,strengthening guidance for first visits at the grassroots level,and expanding the coverage of outpatient coordination.Satisfaction levels varied significantly across income groups,with high-income groups expressing lower satisfaction due to reduced personal account accumulation.The satisfaction of the middle-in-come group increased due to the reduced burden of outpatient expenses.While low-income groups benefited from higher reim-bursement rates,the satisfaction of the above groups was moderated by limited primary care capacity.Interdisciplinary research suggested that differences in economic utility,psychological expectations,and perceptions of social justice are the root causes of differences in satisfaction among different income groups.In the future,it is advisable to fully rely on the big data of medical in-surance electronic vouchers,conduct long-term queue research,construct innovative theoretical models,and establish regional collaborative policy frameworks.This article employed AI-driven predictive modelling to assess policy responsiveness under var-ying scenarios and explored the localization of advanced foreign models,and constructed a three-tier system of"basic protection+differentiated supplements+commercial insurance",so as to promote the precise and sustainable development of the medical in-surance system.
