In fact, medical insurance adopts the "mutual insurance" model, which realizes and maintains the allocation of medical resources through financing and effective transfer of funds. In order to realize the effective allocation of medical resources, there are two kinds of medical insurance systems, one is compulsory social insurance and the other is commercial medical insurance.
What are the current problems of commercial medical insurance in China?
Generally speaking, social medical insurance bears the responsibility of fair distribution of basic medical resources, while commercial medical insurance pays more for different levels of optional medical services. The two complement each other and **** exist together. However, the development of commercial medical insurance has been greatly reduced due to the existence of the national medical insurance system.
China's current national medical insurance system consists of three major systems: basic medical insurance for urban workers, basic medical insurance for urban residents and new rural cooperative medical insurance.
In the medical insurance system, there are several important modules:
1. Health care catalogs: clinic catalogs, drug catalogs, and service facility catalogs
2. Individual sharing mechanisms: these include deductibles, also known as the starting line, reimbursement ratios (e.g., for Class B drugs), and reimbursement toplines. The existence of this mechanism leads to the individual need to bear the medical costs, we call the "personal out-of-pocket" part;
3, the individual's responsibility for the three health insurance catalog outside the scope of the medical costs is called "personal out-of-pocket" part;
4. Health insurance reimbursement = medical expenses - personal expenses - personal expenses; medical expenses are paid from the coordinated account, which corresponds to the personal account.
5. Individual account expenses: this part is the balance of the medical insurance card. Outpatient or medical insurance designated pharmacy can be paid directly by card.
What is its history?
As the name suggests, basic medical insurance can only provide the most basic medical insurance. So, from 2004, the state began to encourage enterprises to choose to take out supplementary medical insurance (commercial group medical insurance) according to the wishes of their employees. Coupled with the fact that this part of the premium expenditure can be included in the cost of the enterprise, many large-scale enterprises concerned about the welfare of their employees began to purchase it, and the group medical insurance has been developed very quickly.
However, insurance companies chose to rely on the three types of medical insurance as a cost-control tool out of concern for their ability to control medical risks. As a result, most group supplemental medical insurance is only designed to cover the individual out-of-pocket expenses (the personal out-of-pocket portion of the catalog) mentioned above. Many medicines, equipment and medical services necessary to treat illnesses are not covered. Which is the best insurance company, I just happened to organize the relevant content, I hope it will help you: the latest list! The top ten insurance companies in the country
In addition, almost all enterprises are supplemental medical insurance, with personal accounts to pay for medical expenses (purchase of drugs, outpatient) all borne by the enterprise, disguised as a "personal account cash". Enterprises not only give us money to insure the basic social medical insurance, but also insure the enterprise supplemental medical care if only brush the medical insurance card to pay for medical expenses, you can use the enterprise supplemental medical insurance reimbursement from the medical insurance card to withdraw. This is undoubtedly a serious violation of the basic wind control logic of commercial medical insurance. Moreover, the portion of the card that can be directly consumed by swiping the card is mainly outpatient medical expenses. For individuals, the security is of little value due to the small amount involved. For insurance companies, due to the high frequency of occurrence, it is easy to induce moral hazard and greatly increase the cost of operation and management.
In summary, corporate supplemental medical insurance has seen some development, but its own shortcomings are also very obvious. The risk control of these products relies almost entirely on the ability to manage the medical insurance catalog, and their own value as a third party for medical expenses is almost lost.
*BA
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