The basic direction of the development of social medical insurance is as follows:
①To seek a proper balance between equality and economic efficiency, i.e., "injecting some reasonableness into equality, and some humanity into efficiency".
②A comprehensive universal insurance system.
③Low-level, multi-level medical treatment.
④ Diversified financing channels.
⑤Cancel the personal account of medical insurance, and leave this part of the money to the unit or individual to freely choose the direction of investment, such as purchasing supplementary medical insurance from commercial insurance companies.
6 Multi-party check and balance mechanism under total control.
7 A moderately competitive market under active government intervention.
Medical characteristics:
1. Universality
The object of medical social insurance coverage should in principle be all citizens, because the risk of disease is difficult for everyone to avoid, while the object of old age pension, unemployment, work injury, maternity risk is mainly workers, not everyone will encounter unemployment, and the probability of work-related injuries is even smaller. Therefore, medical social insurance is the social insurance system in the widest coverage and the most frequent role of the insurance.
2. Wide coverage and complexity
Medical social insurance is not only related to the country's stage of economic development and the level of development of productive forces, but also involves the demand for and supply of health care services. In order to ensure the rational use and normal operation of the medical insurance fund, medical social insurance also has the problem of designing the necessary institutional mechanisms in order to provide reasonable guidance and control over the behavior of the enjoyers and providers of medical services. These are not found in other social insurances.
3. Short-term and recurrent insurance
Since the occurrence of diseases is random and sudden, the compensation provided by medical social insurance can only be short-term and recurrent, unlike other social insurances, such as pension insurance or maternity insurance, which are long-term, predictable, or disposable. Therefore, medical social insurance is also different from other social insurance in terms of financial treatment.
4. Medical costs are difficult to predict and control
Medical costs are affected by a variety of factors, and their costs vary greatly, making them difficult to grasp.
5, the fund to achieve earmarked
Medical insurance fund raised in a certain way, only when the insured person is sick, not due to work-related injuries, etc., need to pay the medical expenses, only in accordance with the relevant provisions of the treatment of the settlement, and at the same time to enjoy the medical services, and enjoy the medical services and treatment of the level of their wages has nothing to do with the actual condition, and may not be withdrawn from the use of, truly realize the dedicated
The medical insurance fund.
Medical insurance is a kind of insurance to compensate for the medical expenses caused by diseases. It is a social insurance that provides necessary medical services or material assistance by the society or the enterprise in case of illness, injury or maternity of an employee. Basic medical insurance includes general medical insurance, hospitalization insurance, surgical insurance, comprehensive medical insurance, and special disease insurance.
General medical insurance: General medical insurance provides the insured with general medical expenses related to the treatment of diseases. It mainly covers outpatient expenses, medicine and examination costs. This type of insurance has a lower premium cost and is more applicable to the general public. Because of the difficulty in controlling expenditures for medicine and examination costs, this type of policy generally has a deductible and cost-sharing provision, whereby the insurer pays a certain percentage of the portion above the deductible, and the cost of insurance is set once a year. The insurer is no longer responsible for expenses incurred for each illness that cumulatively exceed the insured amount.
Hospitalization insurance: Since the costs incurred for hospitalization are often high, hospitalization expenses are covered as a separate insurance policy. The main cost items covered by hospitalization insurance are daily hospital fees (bed charges), the cost of utilizing hospital equipment, surgical costs, and medical expenses. The length of the hospitalization period will have a direct impact on its cost, therefore, the amount of this type of insurance should be based on the patient's average hospitalization cost. In order to control unnecessarily long hospitalization, hospitalization insurance generally stipulates that the insurer is only responsible for a certain percentage of all costs, not all of them.
Surgical insurance: This type of insurance provides for all costs incurred as a result of a necessary surgery required by the patient.
Comprehensive medical insurance: Comprehensive medical insurance is a type of comprehensive medical expense coverage provided by the insurer for the insured, which covers all expenses incurred for medical treatment and hospitalization, surgery, and so on. This type of policy has a higher premium. A low deductible is generally established along with an appropriate sharing ratio.
Specialty Disease Insurance: Certain special diseases often bring catastrophic cost payments to the patient, which are difficult for the average residential family to bear. Examples are cancer, heart diseases, etc. Therefore, people usually require such policies to have a relatively large sum insured to be sufficient to cover the various expenses incurred by them. Provide coverage for policyholders, can be a single item, such as malignant tumors, or even malignant tumors in a certain number of cancers; can also be more than one, the agreed upon several kinds of one by one, such as malignant tumors, myocardial infarction, uremia, important, quadriplegia, and so on.
To sum up: without the ability to work as well as the source of livelihood, increasing the economic burden of the family, the state will give social insurance premiums as a guarantee, nevertheless, but if encountered a major disease, social security premiums are but a drop in the bucket, and have the conditions of the family can choose commercial insurance.
Legal basis:
The People's Republic of China*** and State Social Insurance Law
Article 24
The State establishes and improves the new rural cooperative medical system. The administration of the new rural cooperative medical care shall be regulated by the State Council.