The free medical security model, also known as universal medical care and universal medical security model, refers to a system in which the medical security funds mainly come from taxes, and the government allocates the medical security funds formed by taxes to relevant departments in a planned way or directly to public hospitals through budgetary allocations, and the medical security objects basically do not need to pay fees for medical treatment. In countries that implement the free medical security model, hospitals are basically run by the state to provide medical services. The salaries of medical staff working in public hospitals are paid directly by the state. The publicly-funded medical care once implemented in China, as well as the welfare universal medical security system implemented by developed countries such as Britain, Canada, Sweden, Ireland and Denmark and developing countries such as Malaysia and Vietnam, all belong to this category. Except that China's free medical system is limited to urban workers, countries that implement free medical system usually include all citizens, and of course all rural residents.
Malaysia Malaysia's public health expenses such as health and epidemic prevention, maternity and child care. Be borne by the state. Medical expenses are very low. 1 outpatient service only charges 1 ringgit (Malaysian currency, 1 USD is about 2.47 ringgit), and 1 hospitalization only charges 3 ringgit including treatment, medication and meals.
All medical services provided by the government in rural areas are free, and the meals for inpatients are very small. Farmers in poor areas and areas with poor medical conditions can reduce or exempt them, but the medical technology is average and there are few kinds of drugs. The main problems are as follows: First, the medical and health expenses are completely borne by the state fund, and the financial burden is heavy. Second, the level of medical services provided is relatively low, and it is still difficult to see a doctor.
Commercial medical insurance
Commercial medical insurance is a medical insurance model that regards medical insurance as a special commodity and operates freely according to market rules. In the medical insurance market, the seller refers to a profit-making or non-profit private medical insurance company or private medical insurance company; The buyer can be an enterprise, social organization, government or individual. The funds for commercial medical insurance mainly come from the insurance premiums paid by the insured individuals and their employers. Generally speaking, government finance does not contribute or subsidize.
The United States is a typical representative of implementing the commercial medical insurance model. Although the American government has organized social medical insurance plans such as medical care system, medical assistance system and free medical care for ethnic minorities, it does not occupy a major position in the whole medical insurance system and its coverage is very limited. In the United States, more than 80% of national civil servants, employees of private enterprises and farmers are not protected by social insurance, but participate in the commercial insurance system. There are more than 800 commercial medical insurance institutions in China.
Commercial medical insurance in the United States is divided into non-profit and for-profit types. The former can enjoy preferential tax treatment, while the latter does not enjoy relevant treatment.
The characteristic of American commercial medical insurance model is that medical insurance is mainly operated and managed by the market, and the government is only responsible for medical insurance for the elderly and the poor. Insurance funds are mainly borne by individuals and enterprises, and the government basically does not. The outstanding problem of this model is poor social equity, and there are still quite a few low-income workers, self-employed workers and peasant families in small enterprises who do not enjoy medical insurance.
medical insurance
The model of community cooperative medical security refers to a comprehensive basic medical security measure, which is based on the principle of "sharing risks, helping each other and helping each other". By raising funds from the masses and relying on the strength of the community, a centralized medical fund (usually subsidized by the government) is established within the community to pay the medical, preventive and health care services of the insured and their families in advance. The traditional rural cooperative medical system in China and the medical insurance card system in Thailand are the representatives of the community cooperative medical security model.
Thai farmers in Thailand mainly participate in community cooperative medical insurance by purchasing health cards. Thailand's health insurance card system 1983 began to be implemented in rural areas in June, with the participation of families (households), 1 household 1 card, and L card for more than 5 people. Children over 50 years old1under 2 years old enjoy free medical care. Each card costs 500 baht (1 baht is about 0.0264 USD), and the family pays for it at its own expense, and the government subsidizes 500 baht. In order to promote the issuance of health cards, the government stipulates that subsidies will only be given if more than 35% families in the village participate. The funds raised by the health card are managed by the provincial administrative committees (the country is divided into 76 provinces), of which 90% is used to pay the medical care expenses, and 10% is used to pay the management expenses. Health cards can be used for medical treatment, maternal and child health care and planned immunization.
The community cooperative medical system combines the collection of medical funds, the sharing mechanism of economic losses caused by illness and the provision of medical and health services in a region, which can provide better basic medical care and preventive health care in grassroots units and effectively protect the health of grassroots farmers. Its limitations are limited funds, small population coverage and poor ability to resist the risk of serious diseases.
Social medical insurance
Social medical insurance refers to the system that the state organizes itself in the form of social insurance to provide farmers with medical services and economic compensation necessary for illness, injury or childbirth. It has the characteristics of compulsory, mutual assistance, welfare and sociality of social insurance. The funds of social medical insurance come from three aspects: the state, the collective and the individual. Usually, individuals only need to bear a small part of the cost.
South Korea passed the first medical insurance law in 1963. Due to the difficult social and economic situation in Korea at that time, the national medical insurance plan was voluntary insurance, and the number of participants was very small. South Korea's economy developed rapidly in the late 1970s, and the state decided to implement compulsory medical insurance. 1988 has been extended to rural areas throughout the country, covering 90% of the rural population, and the remaining 10% of farmers below the poverty line are provided with medical assistance by the government.
Fund raising for rural medical insurance in Korea: 50% for farmers' families and 50% for the government. There are three ways to share the cost of medical services: one is deductible. Patients pay $4 for each visit. The second is the proportion of out-of-pocket expenses. The outpatient pays 30% and the inpatient pays 50%. The third is to cap hospitalization. The insurance department shall pay the hospitalization fee of 180 days at most every year, and the rest shall take care of themselves. The law stipulates that medical services should be referred gradually.
The main problems are as follows: First, the uneven distribution of health resources has become more and more serious in Heng Yue, with excess cities and insufficient rural areas. Second, the level of primary medical institutions is low, and people are unwilling to see a doctor. The utilization rate of primary medical institutions is only 25%. Third, the farmers' medical insurance fund is difficult (young people go to cities to make a living, while old people and children stay in the countryside, with high incidence and high medical expenses). Fourth, only 10% poor farmers are provided with low-quality free medical services.
New policy of urban and rural serious illness medical insurance: the proportion of personal burden compensation is not less than 50% (including the new rural cooperative medical system)