The main problems of the French social insurance system for the sick are: ① the government's excessive burden on medical costs, the annual growth rate of 10%, more than the rate of increase in production, the absolute value of the country's national defense budget; ② the insurance fund to use the form of reimbursement for the patient's behalf of the payment and to a period of time, the individual economic turnover as well as by the prices of the greater impact. Therefore, in recent years, France has taken a series of medical costs and reduce the insurance deficit situation, including: the implementation of the general budget method of hospital management, increase the amount of insurance contributions, expanding the scope of tax payments, rigorous random checks on the reasonableness of the prescriptions, the evaluation of new technologies to limit the redundant and unnecessary tests to limit the addition of medical equipment to reduce the rate of subsidies for non-essential drugs (reduced from 70% to 40%).
Fifth, the U.S. health insurance system
The U.S. health insurance in the form of two major categories:
First, social health care, and the second is private health insurance U.S. health care system. The main problem is the implementation of non-organized management system of the health care market, that is, the implementation of the "non-managed care" (non-managed care), the lack of a unified and effective management measures in the country, and therefore prominently reflected in the following three aspects: ① third-party payment system is prone to cause excessive demand for medical care, the insured pays a certain amount of money to the insurance company every month. After paying a certain amount of insurance money to the insurance company each month (including the employer's portion), the insured can freely choose a physician or hospital to visit when they are sick, and then report to the insurance company, with the insurance company paying most of the money. This system is a fee for service system, and belongs to the type of post payment system. Advantages are convenient for patients to meet the needs of patients to choose freely, the disadvantage is that it is difficult to control health insurance premiums; ② the lack of incentives to control health care costs, doctors and hospitals in order to increase revenue there will be two prominent situations, one is to induce patients to expand the demand for medical care, resulting in large prescriptions, indiscriminate testing; the other is to push unprofitable or difficult patients to non-profit medical care, the former increase the expenditure of the insurance company, and the latter increase government expenditure. ③ Inequality in access to health care, with a wide gap between the poor and the rich, and more than 27 million people in the country still not enjoying any health insurance.
Sixth, Canada's universal health insurance system
Canada's basic approach to universal health insurance includes supply-side, demand-side and third-party: ① supply-side, i.e., hospitals and doctors, due to the government-run hospitals in Canada, regardless of the doctor's license to practise medicine in public hospitals, the doctor and the hospital only business collaboration between the hospitals, there is no economic relationship; ② demand-side (nationals), employees and employers as long as (ii) the demand side (nationals), employees and employers only need to pay a small amount of health insurance premiums, the poor and incapacitated individuals and families can apply for partial or full exemption from health insurance premiums, and all seniors over 65 years of age are entitled to free health insurance; (iii) the third party, the direct third party is the Provincial Department of Health, which is responsible for the direct management of the inpatient health care insurance sector (including the development of budgetary subsidies, approval of hospital investment, control of the bed utilization rate and health care costs, and inspection of the quality of health care) and the outpatient health care program (including setting standards for medical services, reviewing medical records, setting fee schedules, limiting doctors' income, issuing and revoking licenses to practice medicine, and guaranteeing the quality of care, etc.), while the indirect third party is the Federal Ministry of Health and Welfare, which is mainly responsible for formulating the national health care program and the regulatory documents on health insurance, determining the amount of funding subsidies to the provinces, formulating the training program for doctors, and carrying out health reforms, etc. The federal government and the provincial health departments are both strict and strict in their management of health insurance. Both the federal government and the provincial health departments strictly enforce the "hospital integrated budget system", which means that after the hospital and the government agree on a budget amount, the hospital's costs must be limited to it, and the province will not guarantee any additional costs in excess of the budget, resulting in the hospital having a strong sense of responsibility for controlling the total costs. Therefore, Canada is the current western developed countries in both the control of excessive increases in medical costs, but also to address the fairness of health services better management model, which is the implementation of the market economy and strengthen the government's participation in the management of the combination of management models.
Seven, Australia's universal health insurance system
Australia's universal health insurance system is based on the provisions of the Health Insurance Act 1973, which began on July 1, 1975, so that all nationals enjoy the same opportunity to enjoy the health insurance, the insured person to pay 1.25% of the salary as premiums, I and my family members can be reimbursed for 85% of the cost of medical care, living in a public hospital general ward costs can be reimbursed for 85% of the cost of medical care. In September 1981, the Health Insurance Law was further amended so that insured persons were required to pay the same amount as everyone else as an "insurance fund," 3% of their wages as a "basic premium," and a "progressive premium," which was to be paid in addition to the basic premium. They have to pay 3% of their salary as "basic insurance premium" and another "progressive insurance premium", with the high-income earners paying 5%, the middle-income earners 3% and the low-income earners 1% of their salary, and it is clear that the government will only subsidize 30% of the cost of the health insurance. This is the idea of the Australian government to require the "rich to contribute more" and "do their best", low-wage income class, in 1993-1994, where the annual income of an individual is less than 12,662 Australian dollars, and the couple's combined income is less than 21,320 Australian dollars (for each child), an additional 2,100 Australian dollars can be added to the premium. 1 child can also increase 2100 Australian dollars), can not pay health insurance premiums. Australia's health insurance clearly stipulates that: ① every resident must participate in health insurance; ② all residents are free of charge in public hospitals to get the same quality of basic medical services; ③ in public hospitals do not have the right to choose a doctor and wards, and do not enjoy priority hospitalization and treatment.
Australia in addition to universal health insurance, there are 40% of the residents at the same time to buy private health insurance, divided into single insurance and family insurance in two ways, private health insurance only provides hospital services, can go to private hospitals, can also go to public hospitals to self-funded patients as a medical treatment, but you can choose the engineers and hospitalization priority, the government is responsible for paying 75%. Australia expressly prohibits the sale of medicines to patients in private clinics and hospitals, and therefore implements the Pharmaceutical Benefits Scheme (PBS) at the same time. The government publishes the PBS medicines list once a year (about 500 types of medicines), and all retirees and recipients of social assistance (including their children) who purchase medicines within the scope of the PBS are entitled to a subsidy for each prescription, regardless of the actual price of the medicines. All retirees and social assistance recipients (including their children) who purchase drugs within the scope of the PBS, regardless of the actual price of the drugs, pay AUD 2.6 per prescription, and when their expenditure for the year exceeds AUD 135.2, they can receive a free card, with which they can purchase drugs free of charge for the year. For the rest of the people (including those who are not covered by health insurance) who pay A$16 per prescription (less than A$16 is paid according to the actual price of the medicine), and when the expenditure on medicines in the year is more than A$312.3, they can apply for a discount card, and they will only pay A$2.6 per prescription for purchasing medicines in the year.
VIII. Japan's health insurance system
There are three forms of health insurance organizations in Japan: social health insurance organizations, medical aid organizations and public **** health care organizations. Of these three types of health insurance organizations, the social health insurance organization is the core; the medical aid organization was established under the Life Protection Law of 1950 to provide medical care, maternity, occupational, and death assistance to the poor, as well as assistance for living, education, and housing; the public **** health care organization is a health insurance for certain diseases or persons with disabilities, and is mainly based on the Infectious Diseases Prevention Law ( 1897), the Leprosy Prevention Law ( 1897), and the Leprosy Prevention Law ( 1897), and the Public Health Care Organization ( 1898). 1897), the Leprosy Prevention Law (1907), the Mental Hygiene Law (1950), the Tuberculosis Control Law (1951), the Elderly Welfare Law (1963), and 13 other laws make the health insurance system.
The basic approach to health insurance in Japan is that it is financed by individual contributions (8% to 10% of wages, with the individual and the employer each contributing half of the cost), one-time or proportional subsidies from the state and local governments based on the number of people enrolled in each health insurance organization and the use of the medical fee (originally full reimbursement, but since 1984 80% of the reimbursement has been provided, with individuals contributing 20%). ); all health insurance participants have the right to choose any hospital or outpatient clinic they want with their credentials, but not all of them can go to a medical practitioner; in addition to reimbursement of medical expenses after a medical consultation, they can also receive a certain amount of medical subsidies, including sickness absence subsidies (60% of the salary starting from the fourth day and up to six months), childbirth subsidies, unemployment subsidies, and death and burial subsidies; and they can apply for subsidies for the excess portion of the medical expenses when they exceed a certain amount; all participants can apply for subsidies for the excess portion of the medical expenses. If the medical expenses exceed a certain amount, one can apply for a subsidy for the excess amount; patients suffering from structural diseases or mental illnesses and their supporting family members are entitled to a special state subsidy; participants who have reached the age of 70 are entitled to free medical treatment and a certain amount of subsidy from the local government; children with disabilities (under the age of 6) are entitled to free medical treatment; and family members of the participants are entitled to a reimbursement of 70% (for outpatient treatment) and 80% (for inpatient treatment).
Nine, Korea's universal health insurance system
degree in South Korea, all the insured who participate in health insurance must pay health insurance premiums, which account for a proportion of personal income varies, corporate workers category for 3% of wages (employers and employees each pay 1.5%); government employees and private school teachers category of the self-payment of 2.3% of wages, the government employees of the Government to pay 2.39%, teachers school and the government each pay 1 percent of wages. The government pays 2.3% of salary for government employees and 2.39% for private school teachers, and 1.38% and 0.92% for teachers from the school and the government respectively. Farmers and urban residents are categorized into 15 grades according to their family income and land area, and they pay premiums in different grades, of which 50% is paid by the insured families and the other 50% by the government, and the government also provides certain financial subsidies every year due to the large loss of this type of insurance fund.
Korea's health insurance system, the main problems are: ① government subsidies are increasing; ② the number of national plan too many associations, resulting in a very uneven ability to integrate risk; ③ uneven use of health resources, especially in rural areas, the lack of doctors and lack of equipment is more serious. Therefore, in recent years, Korea has taken two major reform measures: first, to try to gradually adjust and reduce the number of plan associations in order to expand their ability to independently balance the risk of operating; second, to take the graduates of medical schools must go to the rural or mountainous areas of the two years of service is mandatory, otherwise not issued medical licenses.
Ten, Singapore's universal Medisave
Singapore's Medisave scheme has made several changes in the payment method, in 1991, as a provident fund Medisave, each person contributes 23% of their monthly income, plus the employer's contribution of 22% of their monthly income (i.e., the total provident fund is equal to the employee's monthly income of 45% of the fixed amount), and from the provident fund, the equivalent of 6% of monthly income (the employee, the employer, and the employer, each), and the employer's contribution of 6% of monthly income. From this provident fund, an amount equivalent to 6% of the monthly income (3% for the employee and 3% for the employer) is allocated to the Medisave Account. The "deposits" in the Medisave Accounts are tax-free and earn interest, and are subject to a ceiling on the amount of "deposits" (up to $7,500 for employees who are entitled to an annuity upon retirement and up to $15,000 for non-annuitants). Effective July 1, 1992, the Medisave contribution rate was increased from 6% to 7% for insured employees over 35 years of age; effective July 1, 1993, the contribution rate was increased to 8% for insured employees over 45 years of age. The contribution rate for self-employed persons without an employer remained at 3%, but was increased by 1% each year until it was equal to the other contribution rates (6%-8%); and from January 1, 1994, it was made mandatory for self-employed persons such as taxi drivers, hawkers, or shopkeepers to produce a certificate of Medisave contributions when applying for and renewing their business licenses.
Singapore's Medisave program is accompanied by the Medishield scheme, a medical insurance scheme for serious illnesses that require long-term treatment. The general public is willing to participate in this kind of shelter scheme. 1990 December statistics, the health care savings plan insured people have 88% of the health care shelter scheme, they and including their families (under 70 years old) as long as the monthly payment of SGD 1 to 11 yuan of the premium can participate in this plan, the maximum limit of payment of the medical expenses of 20,000 yuan per year, a lifetime of the maximum neighboring limit of 70,000 yuan. However, the Health Care Shelter Plan is not responsible for the following conditions: (1) hospitalization expenses prior to enrollment; (2) cancer, coronary heart disease, stroke, chronic cirrhosis of the liver, systemic lupus erythematosus, localized ischemic heart disease, and degenerative diseases that have been treated within 12 months prior to the effective date of the insurance; (3) congenital anomalies; (4) out-of-area visits; (5) psychiatric treatments; (6) infertility treatments; (7) childbirth expenses; (8) AIDS; (9) suicide; (10) drug addiction and alcoholism; (10) medical expenses; (11) medical expenses; and (12) medical expenses. suicide; (10) drug addiction and alcoholism treatment; (11) cosmetic surgery; and (12) war injuries.