The survey found that the basic medical insurance for urban residents and the new rural cooperative medical system (hereinafter referred to as the "new rural cooperative medical system") not only increased the management cost and reduced the management efficiency, but also brought a lot of inconvenience to urban and rural residents, solidified the dual structure of urban and rural areas, and caused serious obstacles and negative effects on realizing fairness and justice and promoting social harmony, which were highlighted as "three disadvantages" and "three disadvantages".
"Three disadvantages": First, it is not conducive to social equity. The separation of urban and rural medical insurance system makes residents passively join the corresponding security system according to their household registration status, which strengthens the concept of urban and rural household registration and solidifies the dual social structure, which can not well reflect the fairness of social insurance. Second, it is not conducive to the flow of human resources. With the rapid development of urbanization in China, the flow of human resources between urban and rural areas is accelerated, and the medical insurance system between urban and rural areas is not connected, information is not shared, and management is not unified, which leads to the difficulty in connecting the medical insurance relationship and treatment of these floating people, especially when migrant workers move between urban and rural areas. Third, it is not conducive to the sustainable development of the medical insurance system. Urban and rural medical insurance systems are managed and handled by different departments respectively, which makes it impossible to plan the long-term development of various insurance systems as a whole, and to evaluate the real performance of the system operation in a unified and scientific way, which increases the system cost and causes a serious waste of social resources.
"Three repetitions": First, residents repeatedly participate in insurance. At present, employees' medical insurance and residents' medical insurance are managed by human resources and social security departments, while the "new rural cooperative medical system" is managed by health departments. Because the management mode and information system are not unified, information can not be shared, and there is a problem of competing for insurance resources in practical work, which leads to the phenomenon of repeated participation of urban and rural residents in various places. In particular, the problem of repeated participation in insurance for migrant workers, employees of township enterprises, rural students studying in cities and towns, landless farmers and other groups is very prominent. After integrating medical insurance management resources in Tianjin, Chengdu, Xiamen and Taizhou, it was found that 450,000, 270,000, 80,000 and 200,000 people participated in the insurance repeatedly through information system comparison. Among the 1 1 10,000 urban residents in Qixia District of Nanjing, 40,000 people also participated in the new rural cooperative medical system. The second is repeated financial subsidies. According to the typical analysis and rough calculation of the areas where unified urban and rural management has been implemented, the proportion of repeated insurance participation accounts for about 10% of the number of urban and rural residents. According to the per capita financial subsidy for urban and rural residents 120 yuan this year, the financial subsidy for about10 million insured residents12 billion yuan has obviously increased the unreasonable burden of finance at all levels. The third is to repeatedly establish institutions and information systems. After more than ten years of efforts, the information system of urban medical insurance agencies has been basically improved. If the new rural cooperative medical system sets up another agency and information system, it will inevitably increase management costs, reduce management efficiency and waste a lot of financial funds. According to the estimation of the Finance Bureau of Xiamen and other cities, if the information system of the new rural cooperative medical system is based on the construction of the urban medical insurance information system, it will cost about 60 million to 80 million yuan (excluding the annual maintenance cost). It is conceivable how much the whole country spends!
How to solve the problems of "three evils" and "three repetitions" and realize the comprehensive, coordinated and sustainable development of the basic medical security system? The central government has pointed out the direction, and the Opinions on Deepening the Reform of Medical and Health System (Zhong Fa [2009] No.6) points out that it is necessary to "effectively integrate the resources of basic medical insurance agencies and gradually realize the unification of urban and rural basic medical insurance agencies". In order to implement the requirements of the central medical reform document and thoroughly solve the problems of "three disadvantages" and "three repetitions", many places have actively explored. For example, since 2004, Guangdong Province has been exploring urban and rural medical insurance as a whole, which is one of the fastest provinces and cities in China. Among 2 1 prefecture-level cities in the province, Shenzhen, Zhuhai, Dongguan and other 10 cities have carried out urban and rural medical insurance exploration, and the municipal governments such as Qingyuan, Yangjiang and Meizhou have decided to hand over the new rural cooperative medical system to the social security department for unified management. Fujian Province has defined the functions of the Department of Human Resources and Social Security in coordinating urban and rural medical security, requiring the new rural cooperative medical insurance information system to rely on the employee medical insurance information system, and the provincial finance arranges 2 million yuan of special funds every year to reward areas that carry out urban and rural medical insurance. At present, more than 20 counties, including Xiamen, Shaowu and Shanghang, have achieved the overall planning of urban and rural medical insurance. The executive meeting of Fuzhou Municipal Government decided to actively create conditions to transfer the new rural cooperative medical system to the social security department for management. Wuxi, Zhenjiang, Suzhou, Changzhou, Taizhou and other cities in Jiangsu Province actively explore urban-rural integration, and all cities attach great importance to system convergence and introduce transfer and connection methods; Simultaneously improve the overall level of medical insurance and improve the fund's economic ability. Chengdu, Leshan, Guangyuan Cangxi and other cities in Sichuan actively explore urban and rural medical insurance co-ordination. According to the statistics of relevant departments, there are three provincial-level administrative regions in Tianjin, Chongqing and Ningxia, 2 1 prefecture-level cities and 103 counties (autonomous regions and municipalities) that have comprehensively developed urban and rural medical insurance. Except Jiaxing, Zhejiang and 33 counties (autonomous regions and municipalities), the medical insurance for urban and rural residents in these areas is managed by the health department (the medical insurance for employees is still managed by the social security department), and the rest areas are managed by the social security department.