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The Third Plenary Session of the Eleventh Central Committee of the **** established the main theme of reform and opening up, and in the process of the transformation of the planned economy to a market economy, the institutional background of China's medical insurance began to experience significant changes, and the traditional medical insurance system gradually lost the basis of its own existence. The reform of the urban basic medical insurance system is closely related to the reform of the financial system, the reform of the medical system, the establishment of the modern enterprise system and the changes in the ownership structure. With the reform of all related areas of reform and opening up, it was only natural that the medical security system should be reformed. The public-funded and labor-insured medical care system mainly appeared before the reform and opening-up, so we will not explain it here. Pilot medical security reform. Since the early 1980s, some enterprises and localities have begun to spontaneously explore the reform of the traditional employees' medical security system, such as the fixed lump sum of medical expenses or the reimbursement of only a certain percentage of the overspent portion of the expenses, as well as the implementation of the method of linking the payment of medical expenses with personal interests, etc. The continuous development of these reform practices has also laid down a certain psychological foundation for the workers to bear the medical expenses individually, and has presented a kind of transition from a publicly-funded medical system to a moderately self-funded system.
In order to further solve the increasingly prominent problems in the field of medical security, on April 28, 1984, the Ministry of Health and the Ministry of Finance jointly issued the Circular on Further Strengthening the Management of Publicly-Funded Medical Care, proposing a positive and prudent reform of the system of publicly-funded medical care, and beginning a new stage of the government's exploration of the reform of the traditional publicly-funded medical care system.
The first to intervene in the practice of medical system reform is the local government, the main practice is through the social integration of this way of cost control, for example, Shijiazhuang, Hebei Province, since November 1985, has in six counties and cities to carry out social integration of retirees' health care costs pilot; in May 1987, Beijing City East Vegetable Company pioneered the first "serious illness", which has a significant impact on the health care system. The first of its kind in Beijing's Dongcheng District Vegetable Company in May 1987, the "medical co-ordination", which provides a relatively easy-to-operate solution to the thorny problem of huge medical expenses.
March 25, 1988, approved by the State Council, set up by the Ministry of Health, led by the National Reform Commission, the Ministry of Labor, the Ministry of Health, the Ministry of Finance, the General Administration of Pharmaceuticals and other eight departments to participate in the study of the medical system reform program and guide the pilot medical reform. In July of the same year, the group launched the Concept of Employee Medical Insurance System (Draft).In 1989, the Ministry of Health and the Ministry of Finance issued the Circular on the Measures for the Administration of Publicly-funded Medical Care, which explained the specific 13 out-of-pocket expenses within the scope of public-funded medical care expenditures. In March of the same year, the State Council approved the "National Reform Commission in 1989, the main points of the economic system reform", pointing out that in Dandong, Siping, Huangshi, Zhuzhou, a pilot reform of the medical insurance system, while in Shenzhen, Hainan, a comprehensive reform of the social security system pilot.
Under the guidance of the relevant policies, Siping City, Jilin Province, took the lead in the pilot medical insurance, Bishan County, Chongqing Municipality, also with reference to the pilot program to carry out some attempts to reform the April 1990, Siping City, the introduction of public health care reform program; November 1991, Hainan Province, Hainan Province promulgated the "Interim Provisions on Employee Medical Insurance," which took effect in 1992; September 1991, Shenzhen City established the Medical Insurance Bureau, and the implementation of a comprehensive reform of social security system in Shenzhen and Zhuhai. In September 1991, the Shenzhen Municipality set up a medical insurance bureau and promulgated the Interim Provisions on Medical Insurance for Employees of Shenzhen Municipality and the Implementing Rules for Medical Insurance for Employees in May 1992. 1994, the National Reform Commission, the Ministry of Finance, the Ministry of Labor, and the Ministry of Health*** formulated the Pilot Opinions on the Reform of the Employee Medical Care System, which was approved by the State Council, and piloted the reforms in Zhenjiang City in Jiangsu Province, and Jiujiang City in Jiangxi Province, the famous "Two Rivers Pilot Project". The famous "two rivers pilot".
New Rural Healthcare Reform
Based on the "Two Rivers Pilot", the General Office of the State Council in April 1996 forwarded the "Opinions on the Expanded Pilot Reform of the Employee Healthcare Security System" to four ministries and commissions, namely, the National Reform Commission (NRC), the Ministry of Finance (MOF), the Ministry of Labor (MOL), and the Ministry of Health (MOH), to carry out the pilot program on a wider scale.
According to the unified deployment, 58 cities were selected nationwide for the 1997 medical insurance pilot work, and by early August, more than 30 cities had already launched expanded pilot projects for medical reform. By the end of 1998, 4.017 million employees and 1.076 million retirees nationwide had participated in the reform of combining social coordination and individual accounts for medical insurance, and the income of the medical insurance fund for that year amounted to 1.95 billion yuan. By 1999 all of the 58 cities identified as pilot areas had carried out the pilot work.
The "Two Rivers Pilot Program" initially established a medical insurance model for urban workers that combines "unification of accounts" (a combination of social coordination and individual accounts). This model has been well received by the expanding society after the pilot program. At the same time, a number of cities throughout the country have carried out some reforms and explorations of the payment mechanism in accordance with the principle of "integrating the accounts". In addition to the "three-channel" model of the "Two Rivers Pilot", the specific models of the "combined accounts" include the following: Shenzhen mixed model, i.e., different levels of insurance for different types of people, including comprehensive medical insurance, hospitalization medical insurance, special medical insurance and three levels of medical insurance. Hainan's "dual-track parallel" model adopts the approach of separate management of individual accounts and social integrated funds, with the latter used to pay hospitalization costs and not being able to overdraw on the former, and managed and operated by the Social Security Bureau; Qingdao's "three golds" model is based on the basic approach of "three golds" and "three golds", with the latter used to pay for hospitalization costs. Qingdao's "three funds" model is based on the establishment of a unit transfer fund between the individual account fund and the coordinated medical fund, to be paid by both the enterprise and the individual employee***, with the unit transfer fund and the individual account fund managed by the enterprise. In December 1998, the State Council convened a national conference on the reform of the medical insurance system and issued the Decision of the State Council on the Establishment of a Basic Medical Insurance System for Urban Workers, which clearly defined the objectives and tasks of the reform of the medical insurance system, the basic principles and the policy framework, and called for the establishment of a basic medical insurance system covering all urban workers nationwide by 1999, and the establishment of a basic medical insurance system for all urban workers. system. With the release of this document, the establishment of China's medical insurance system for urban workers entered a stage of comprehensive development.
The establishment of China's urban basic medical insurance system has played a very important role in safeguarding the health of urban workers and promoting social harmony and stability. Since the system's official implementation in 1999, its coverage has been expanding, and it has achieved good social effects. Exploration of a multi-level medical insurance system for towns and cities. First, the expansion of the basic medical insurance system. Since the establishment of the urban basic medical insurance system it has continued to expand, adding a number of new people to its coverage. For example, in 1999, the General Office of the State Council and the General Office of the Central Military Commission jointly issued the Interim Measures of the Chinese People's Liberation Army on Medical Insurance for Military Personnel on Retirement, and stipulated that the state would implement a medical insurance system for military personnel on retirement, and set up a medical insurance fund for military personnel on retirement to subsidize the medical expenses of military personnel after they left active service; in 1999, the Ministry of Labor and Social Security made a Notice on Issues Related to the Participation of Employees in the Railway System in Basic Medical Insurance, which was issued by the Ministry of Labor and Social Security. The notice of the relevant issues", the program to guide the railroad system employees from the original labor insurance medical system to social health insurance change.
As early as 1996, Shanghai first introduced the "Shanghai Children and Youth Hospitalization Mutual Aid Fund", and on September 1, 2004, the Beijing Municipal Primary and Secondary School Students, Infants and Children Hospitalization Mutual Aid Fund was officially launched. Hebei, Guangdong, Jiangsu, Zhejiang, Jiangxi, Jilin, Sichuan and other provinces have corresponding policies.
The Ministry of Labor and Social Security issued the "Guiding Opinions on the Participation of Urban Workers in Flexible Employment in Medical Insurance" in May 2003 and the "Opinions on Promoting the Participation of Employees of Mixed-Ownership Enterprises and Non-Publicly Owned Economic Organizations in Medical Insurance" in May of the following year, which included flexibly employed persons, employees of mixed ownership enterprises and non-publicly owned economic organizations, as well as workers who had migrated to cities in rural areas, in medical insurance. In 2004, Jiangxi Province introduced the "Trial Measures for Participation in Basic Medical Insurance by Flexibly Employed Persons in Cities and Towns in Jiangxi Province" to include flexibly employed persons in urban areas of cities and county towns in the scope of basic medical insurance.On May 24, 2004, Jiujiang City, Jiangxi Province, further improved its policy on medical insurance for flexibly employed persons, and the policy came into effect on July 1, 2004. On May 24, 2004, Jiujiang City in Jiangxi Province further improved its medical insurance policy for flexibly employed persons, and on July 1, 2004, the policy was implemented. Wuhan City, Hubei Province, issued the Measures for Basic Medical Insurance for Flexibly Employed Persons in Wuhan City in November 2004, which came into effect on December 1 of the same year. Guangzhou City, Guangdong Province, included flexibly employed persons in the scope of inpatient medical insurance in December 2005, realizing "full coverage" for the local household working-age population. Cities such as Nanjing, Guiyang, Chongqing, Taiyuan, Baoding, Zhangjiakou, Shantou, Mudanjiang and Shenyang have also introduced related policies.
Beginning in 2006, the medical insurance system has included migrant workers as a covered group, and on March 27, 2006, the State Council issued the Opinions of the State Council on Solving the Problems of Migrant Workers, which proposes to solve the problem of social security for migrant workers in a positive and steady manner.
In May 2006, the Ministry of Labor and Social Security issued the Circular on the Special Expansion of Rural Migrant Workers' Participation in Medical Insurance, proposing to "focus on provincial capitals and large and medium-sized cities, and on industries such as processing and manufacturing, construction, extractive industries, and services where rural migrant workers are more concentrated, and on rural migrant workers who have established labor relations with urban employers, and to coordinate the planning and implementation of the plan, focusing on rural migrant workers who have established labor relations with urban employers. focusing on migrant workers, coordinating planning, classifying and guiding, and implementing step by step to comprehensively promote the participation of migrant workers in medical insurance".
Secondly, the development of a medical assistance system. before 2005, China did not have a nationwide medical assistance system. in July 2005, the General Office of the State Council forwarded to the General Office of the State Council the "Opinions on the Establishment of a Pilot Medical Assistance System for Cities" issued by the Ministry of Civil Affairs, the Ministry of Health, the Ministry of Labor and Social Security, and the Ministry of Finance in April 2005, which pointed out that, starting from 2005, it would take two years to establish a pilot medical assistance system for cities in provinces, autonomous regions, and municipalities directly under the central government. In all provinces, autonomous regions and municipalities directly under the central part of the county (city, district) to carry out a pilot, and then spend another 2-3 years to establish a nationwide management system, operation standardization of urban medical assistance system.
The Opinions pointed out that the pilot areas should be carefully selected, and an urban medical aid fund should be set up. The Opinions also stipulated that the objects of the aid should be mainly the people who have not participated in the basic medical insurance for urban workers among the objects of the Minimum Subsistence Guarantee for Urban Residents, the people who have participated in the basic medical insurance for urban workers but whose personal burdens are still relatively heavy, and the other people in special difficulties.
Third, the development of supplementary medical insurance. China has always encouraged employers to establish supplementary medical insurance systems for their employees. Article 75 of the Labor Law states that "the State encourages employers to establish supplementary insurance for their workers in accordance with the actual situation of the employer". The State Council's Decision on the Establishment of a Basic Medical Insurance System for Urban Workers also states that "medical insurance expenses exceeding the maximum payment limit (of basic medical insurance) may be resolved through commercial medical insurance, etc." Chengdu City, Sichuan Province, was an early adopter of supplemental medical insurance in China in 1996. There are several forms of supplemental medical insurance that have emerged in China:
One is the state-imposed medical subsidy for civil servants. According to the Decision on the Establishment of a Basic Medical Insurance System for Urban Workers and Employees, state civil servants are entitled to a medical subsidy policy on the basis of their participation in basic medical insurance. This medical subsidy policy is in fact a kind of supplementary medical insurance applicable to civil servants. The purpose of the introduction of this supplementary medical insurance is to ensure that the level of medical treatment for national civil servants does not decline compared with that before the reform.
The second is the supplementary medical insurance carried out by social medical insurance organizations. This is a form of voluntary supplementary medical insurance run by social medical insurance agencies on the basis of the compulsory "basic medical insurance", with the starting line of insurance linked to the "ceiling line" of basic medical care, and with a higher percentage of medical expenses being paid to some employees who have suffered high medical expenses. The supplementary medical insurance, with its insurance thresholds linked to the "ceiling line" of the basic medical care regulations, provides a higher percentage of compensation to some employees who have encountered high medical costs, and can truly play a role in spreading out the risks and reducing the burdens of employers and sick employees. Since social medical insurance organizations have certain advantages in the collection, management and control of medical costs of the supplementary medical insurance fund, this form is a good way to solve the problem of supplementary medical insurance for employees. It should be noted that the supplementary medical insurance fund and the funds of the "basic medical insurance" should be independent of each other and should not be overdrawn. At the same time should actively expand the scale of supplementary medical insurance to improve the supplementary medical insurance fund's ability to resist risks.
Third, the supplementary medical insurance run by commercial insurance companies. Supplementary medical insurance run by commercial insurance companies are divided into two cases: one that is the case by the units and individuals who have participated in the "basic medical insurance" to commercial insurance companies to compensate for the high cost of medical insurance, such as the Xiamen model. The "cap line" of the "basic medical insurance" is the starting line of the commercial supplementary medical insurance, and the commercial medical insurance will cover the high medical expenses above the starting line, but the commercial insurance companies generally still stipulate a payment ceiling, such as the annual compensation amount not exceeding RMB 150,000 or RMB 200,000. RMB 15 million or RMB 200,000 per year. At present, some domestic commercial insurance companies have actively intervened in the supplementary medical insurance market, but due to the high risk and management difficulty of high-cost medical insurance (i.e., commercial supplementary medical insurance), only China Pacific Insurance Company and Ping An Insurance Company of China have carried out some preliminary explorations in certain regions. It is estimated that there is still a process for commercial insurance companies to underwrite such business on a large scale. Another situation is that the major commercial insurance companies provide commercial insurance for certain special diseases, such as "major disease insurance" and "cancer insurance", which can also cover the high medical expenses of employees exceeding the "ceiling line". They can also provide a certain degree of compensation for the high medical expenses incurred by employees in excess of the "ceiling line".
In addition, the supplementary medical insurance system also includes employees' mutual insurance operated by trade union organizations, that is to say, it mainly makes use of the original trade union organization system to carry out mutual insurance business. The exploration of the supplementary medical insurance system is conducive to raising the level of protection for the insured, thereby fending off the risk of greater medical expenses, and thus forming a medical insurance system for urban workers in China that is multi-layered in its methods of protection, multi-channel in its funding, scientific in its payment methods, and effective in its management methods. Pilot medical insurance system for urban residents. The resolution on the general direction of "expanding the coverage of basic medical insurance" was put forward at the Third Plenary Session of the 16th Central Committee of the People's Republic of China, and the Decision of the Central Committee of the People's Republic of China on Certain Major Issues Concerning the Construction of a Harmonious Socialist Society, adopted at the Sixth Plenary Session of the 16th Central Committee of the People's Republic of China in 2006, further explicitly put forward the proposal to "establish a medical insurance system for urban residents, mainly focusing on the coordination of major diseases. The Sixth Plenary Session of the Sixteenth Central Committee in 2006 adopted the "Decision of the Central Committee on Certain Major Issues in Building a Harmonious Socialist Society", which further explicitly proposed "the establishment of medical insurance for urban residents with the main focus on the coordination of major illnesses. Discussions on the establishment of a medical insurance system for urban residents began in the second half of 2004, and in 2005 a year-long study and design of a program was undertaken. At the same time, a number of locally-led pilot programs are being launched.
In April 2007, Premier Wen Jiabao presided over an executive meeting of the State Council, which decided to carry out a pilot program of basic medical insurance for urban residents, and made it clear that one or two municipalities would be selected in 2007 in provinces with the conditions to carry out a pilot program of establishing a basic medical insurance system for urban residents based on a comprehensive plan for major diseases. The urban residents of the basic medical insurance pilot from the second half of 2007 to start, in 2008 to summarize the pilot experience, continue to promote, is expected to 2009 in the nationwide push.