People have new expectations for improving the safety level.
Due to the rapid entry into the era of universal health insurance, social psychology has changed. Under the combined effect of psychological changes and welfare effects, people are not satisfied with "security", but expect a higher level of security that reflects social fairness. This change in demand poses a severe challenge to the medical security system. China's existing medical security system is commonly known as "three plus one", which is divided into basic medical insurance for urban workers, basic medical insurance for urban residents, rural new rural cooperative medical system plus urban and rural medical assistance. Throughout the country, there is no small difference in the protection level of the three kinds of medical insurance, so there is a phenomenon of repeated participation.
"According to our survey, the repeated participation rate is around 10%. According to the number of urban and rural residents participating in insurance, 654.38+00% is 654.38+00 million. One person subsidizes 120 yuan, that is, 120 billion yuan of financial funds is equivalent to hitting Shui Piao, which has caused great waste. " Wang Dongjin said.
In addition to repeated participation in insurance, the construction of information network is also repeated, because each kind of medical insurance has its own information network system, and the three kinds of medical insurance have three systems, covering both urban and rural areas. It is understood that a medium-sized city needs to spend 60 million yuan to 80 million yuan to build a medical insurance information network.
In addition, different medical insurance has its own personnel team, and the personnel cost is also a big expense.
Hu Dayang, director of Jiangsu Medical Insurance Fund Management Center, said: "Urban medical insurance management is managed by one department, while rural areas are managed by another department. Social medical assistance is another department, so the system makes our system unable to connect, and the gap between regions is relatively large. "
Medical insurance faces embarrassment: if the three kinds of medical insurance are not integrated and unified, they will be questioned by fairness, but if they are to be integrated and unified, the actual level of economic development will not allow it. "No social security system can exist independently without or beyond the level of economic development." Wang Dongjin said that we should not "increase our appetite" unrealistically, which will lead to chaos in the construction of social security system.
The medical insurance fund has become a government compensation fund.
Hu Dayang, director of Jiangsu Medical Insurance Fund Management Center, said: "Universal medical insurance has come too fast, and we have not made enough preparations."
The most embarrassing thing now is the implementation of the list of essential drugs. Earlier, officials of the Ministry of Health admitted that it was an arduous task to achieve the goal of 60% coverage of the essential drug system by the end of 20 10. Wang Dongjin said yesterday that in many places, even half of the coverage -30% has not been reached.
Hu Dayang introduced that due to the difficulty of government compensation, it is very difficult to implement the list of essential drugs in Jiangsu Province. According to the list system of essential drugs, all the essential drugs listed in the list will be sold with zero difference rate, so as to change the status quo of "taking medicine to support medicine". Regrettably, after the implementation of the zero-difference rate, many government compensation mechanisms are not in place, and the insufficient part actually needs compensation from the medical insurance fund.
"The medical insurance fund is the life-saving money and life-saving money of the insured. Can only be used to purchase basic medical services. If direct subsidies are adopted, it will violate the payment system and operational mechanism. " Wang Dongjin said.
Based on this, experts believe that it is difficult to solve the problem of "difficult and expensive medical treatment" simply by canceling the "prescription" of drug addition. Instead, we should really work hard on the management system and mechanism of public hospitals, adhere to public welfare and mobilize the enthusiasm of medical staff.
How to put the government compensation mechanism in place as soon as possible after the implementation of the zero-difference rate of drugs directly determines the success or failure of the basic drug system.
Universal health care should abandon the will of the Chief Executive.
How to solve the embarrassment after the rapid advancement of universal health insurance? Wang Dongjin said: "We must truly abide by the spirit of the two central documents, strengthen coordination, and truly form a coordinated linkage between medical care, sanitation, drug production and circulation and medical security." It is understood that local social security departments are constantly intensifying reforms and exploring institutional innovation. "But institutional innovation cannot shake the foundation of basic medical security."
Wang Dongjin takes outpatient co-ordination as an example. Any outpatient co-ordination system should not stimulate the massive release of medical needs, let alone let everyone flood into tertiary hospitals like a tide. "It is easy to break through the principle of basic medical security, and the fundamentals of the system will be affected." Experts believe that the policies issued by government departments cannot please the people regardless of the local economic foundation, and any decision without feasibility demonstration is very dangerous.
Fundamentally speaking, the government must reform the management of medical institutions. "It is necessary to change the government's supervision from the past father-son relationship to the government's supervision relationship." Wang Dongjin said, "If the future management still stays at the level of managing people, money and things in the past, it is likely to get worse and worse."
In the era of universal medical insurance, to establish a stable and long-term medical insurance mechanism, it is necessary to change leadership decision-making into institutional decision-making.