Financial input is still insufficient
Although the three-year new health care reform has achieved significant results, but many historical problems have not been completely resolved, China's investment in health care is still relatively low, the public health care burden is still heavy. By international standards, the way to measure the burden of medical expenses on a country's residents is usually to look at the proportion of residents' personal health expenditures in the total cost of health, and the smaller the indicator is, the smaller the burden on the residents, and vice versa, the larger the burden on the residents. In the 1980s, the proportion of residents' personal health expenditures in the total health costs was only 20%, but in 2000, the proportion of residents' personal health expenditures in the total health costs was as high as 60%, and the burden of residents' medical and health expenditures has become increasingly heavy, while at the same time, the government's investment in the proportion of the total health costs was seriously insufficient, and in 2000, it was only 15%, with the rest of the total health costs being the burden of society. The remaining 25% is the burden of society. By any standard, the proportion of China's residents' personal health expenditure is far beyond the international level. After the outbreak of SARS in 2003, China began to increase investment in health care and gradually reduce the burden of medical costs on the public, especially after three years of the new health care reform, the proportion of the individual's burden fell rapidly to about 35%, in accordance with the "Twelfth Five-Year Plan" of China's medical and health care program, the proportion of the individual's burden has fallen to about 35%. According to the "Twelfth Five-Year Plan" of China's medical and health program, by the end of the "Twelfth Five-Year Plan", the proportion of personal health expenditure in the total cost of health will be reduced to less than 30%. Although this ratio has dropped considerably compared with the peak of 60% around 2000, because the total cost of health includes both medical and public health expenditures, if public health expenditures are deducted, even if the proportion of personal health expenditures is reduced to 30%, it still accounts for a very high proportion of medical expenditures. If compared with international standards, 30% is still a high proportion, there is still room for further decline in the future, which obviously need to continue to tilt the national financial. With the rapid development of China's economy, the people's demand for health has also risen, China's government investment in health care still has a lot of room for improvement, if the total cost of health as an indicator to judge the degree of a country's investment in health care, China's ranking in the world is in the downstream level. In terms of the proportion of total health expenditure to GDP, this indicator has been at a low level for a long time in China, and barely exceeded 5% in 2011. In other countries, the average proportion of total health expenditure to GDP in low-income countries was 6.2% in 2010, and in high-income countries, it was 8.1% on average, and the proportion of Brazil and India in the BRICS was 9% respectively. In the BRIC countries, the proportion of Brazil and India is 9% and 8.9%, respectively. The main reason for the low total cost of health in China is that the government's financial investment is insufficient. To China's 2011 data, China's financial expenditure on health care investment of 642.9 billion yuan, accounting for only 1.36% of the proportion of the year's GDP, accounting for the proportion of the year's financial expenditure of 5.9%, these two sets of data in fact, has been China's new high for decades, but even so, from the international level there is still a considerable distance. At present, the international level is usually, developed countries of the government health care expenditures as a proportion of GDP is generally 6% to 8%, most of the developing countries is 2% to 6%, developed countries of the government health care expenditures accounted for the proportion of financial expenditures is usually in the proportion of 15-20%, the proportion of developing countries are also more than in 10% or so. In this way, China's financial investment in health care in recent years, although the rapid growth, but the level of investment still has a lot of room for improvement. National financial investment in health care is not just a concept of input without output, in addition to directly stimulate the development of related pharmaceutical industry, more importantly, to build a sound social security system, which is not only related to people's livelihood, but also related to the transformation and upgrading of the Chinese economy. China's economic transformation from investment to consumption is difficult, a very important reason is that the social security system is incomplete, if China's social security system is further improved, people no longer have to worry about old age and medical care, it is possible to stimulate greater consumer vitality. In this regard, the government's financial investment in the social security system on every point, for the future transformation of China's economy may have a greater multiplier effect.How sustainable is major medical insurance?
At the end of August, the National Development and Reform Commission (NDRC), the Ministry of Health (MOH), the Ministry of Finance (MOF), and other ministries and commissions issued the "Guiding Opinions on Carrying out Work on Major Disease Insurance for Urban and Rural Residents," which determined that the percentage of payment for major disease insurance should not be less than 50 percent. While the policy on major disease insurance has received a lot of favorable comments, the source of funding has also raised questions, and many people are worried about whether it will increase the burden on the insured. According to the approach of the "Guiding Opinions", the major medical insurance will not increase the participants' contribution standard, the source of funds is mainly urban residents' medical insurance fund and the New Rural Cooperative Fund, from which a certain proportion or amount as the funds for major medical insurance, through the purchase of major medical insurance from commercial insurance institutions to be resolved. In 1998, China began to implement the basic medical insurance system for urban workers, which was used to replace the original public medical care and labor insurance medical system, changing the disadvantages previously covered by the state and enterprises and public institutions, and in 2003, China began to implement a new type of rural cooperative medical care system (New Rural Cooperative Medical Care), and in 2007 began to implement the basic medical insurance for urban residents, the main object of urban minors and residents without work, and now the basic medical insurance for urban residents, the main object of urban minors and residents without work, and now the basic medical insurance for urban residents. At present, a basic medical insurance system has been set up, focusing on basic medical insurance for workers, basic medical insurance for urban residents and new rural cooperative medical insurance. Among them, the basic medical insurance for urban workers adopts a combination of social coordination and individual accounts, with employers and employees paying the basic medical insurance premiums in accordance with state regulations*** and establishing a medical insurance fund, while the new rural cooperative medical insurance and basic medical insurance for urban residents implement a combination of individual contributions and government subsidies. What needs to be made clear is that the much talked about urban and rural residents' major medical insurance, the object of its protection is the urban residents' medical insurance and the new rural cooperative insurance participants, that is, urban minors and unemployed people and rural residents, and does not include urban workers. The source of funds for major medical insurance is also mainly the urban residents' medical insurance fund and the new rural cooperative fund, the urban residents' medical insurance and the new rural cooperative fund has a balance of the region, the use of the balance of funds to raise funds for major medical insurance, the balance is insufficient or there is no balance of the region, in the urban residents' medical insurance, the new rural cooperative annual increase in the financing of the overall solution to the source of funds, and gradually improve the urban residents' medical insurance, the new rural cooperative multi-channel financing mechanism. But this funding arrangement, whether the sustainability of time to verify. In August of this year, the National Audit Office issued the "new rural cooperative medical urban residents basic medical insurance fund audit", as of the end of 2011, the national new rural cooperative medical insurance, urban residents medical insurance and urban and rural residents medical insurance three residents medical insurance fund cumulative balance of 136.378 billion yuan, an increase of 25.98 times more than the end of 2005, of which the cumulative balance of the fund of the New Rural Cooperative Medical 82.442 billion yuan, the urban residents medical insurance The accumulated balance of the New Rural Cooperative Fund is 82.442 billion yuan, that of the Urban Residents' Medical Insurance Fund is 41.357 billion yuan, and that of the Urban and Rural Residents' Medical Insurance Fund is 12.579 billion yuan. So from the current point of view, China's medical insurance fund still has a large balance, which is also the source of funds for the major medical insurance fund expenditure is the main reason. But the large balance of the health insurance fund itself is a controversial topic, in the pay-as-you-go system, under normal circumstances, the health insurance fund should be paid in full or a small balance, a large balance of the health insurance for the residents of the reimbursement ratio is not enough, the large balance of the health insurance fund will bring other negative issues, such as how to avoid depreciation, how to prevent misappropriation, and so on. In addition, with the health insurance reimbursement catalog continues to expand, as well as China's aging degree continues to increase, etc., now seems to have a balance of the health insurance fund, may not be sustainable in the future, for example, Guangzhou City, residents of the health insurance fund in recent years there has been a continuous loss of the situation, 4 years of cumulative losses of 280 million yuan. Therefore, in the long run, the health insurance fund balance as the main source of funds for major medical insurance is not very reliable, the government also needs to play a more important role in finance. China's urban workers' health insurance funds mainly rely on individuals and employers to pay, while the new rural cooperative medical care and basic medical insurance for urban residents are mainly individual contributions and government subsidies, of which government subsidies account for the main part, according to the Audit Office in August this year released a report on the 2011 New Rural Cooperative Medical Care and basic medical care for urban residents in the income of the fund, the financial input, individual contributions and other inputs accounted for 82.09%, respectively. Other inputs accounted for 82.09%, 15.83% and 2.08% respectively, if we look at it from this point of view, the source of funds for the major disease insurance depends on the balance of the medical insurance fund, in a sense, it is still mainly dependent on the financial subsidies, but if we take into account that the new rural cooperative medical care and the urban residents' medical insurance are the participants of the group of people who have a lower income or even no source of income, even if there is a small increase in the individual contribution, it is also a big burden to a lot of people. Even if there is a small increase in individual contributions, it will still be a great burden for many people. In recent years, although the government's subsidy for the New Rural Health Insurance and the urban residents' health insurance has risen from 80 yuan to 240 yuan per person per year, the individual contributions have also risen, and this year's per capita financing has reached about 300 yuan, while in 2003, the per capita financing for the New Rural Health Insurance was only 30 yuan. Not only these two groups of people, but also urban workers with relatively high incomes have maintained a high rate of growth in health insurance financing, with the rate of growth reaching 25 percent in 2011. With the implementation of the major medical insurance into the stage, gradually engulfed the existing health insurance fund balance, the future of the insured people's contribution level or the possibility of increasing, so, in the major medical insurance, just rely on the balance of the health insurance fund may not be enough, the financial input still need to improve the strength, as far as possible to reduce the burden of the contributions of the insured people.Financial compensation for public hospital reform
The new health care reform launched in 2009 is now more than three years old, and the five key tasks identified at the time - accelerating the construction of the basic medical insurance system, the initial establishment of the national basic drug system, improve the grass-roots medical and health service system, and promote the basic public health care system - are now more than three years old. Medical and health service system, promote the gradual equalization of basic public **** health services, and promote the pilot reform of public hospitals, of which the first four have achieved staged results, while the public hospital reform is still basically stagnant, and has become China's health care reform on the road to the most difficult to overcome the bunker. China's health care reform in the establishment of the "basic health care system as a public **** product to all people" concept, many public hospitals are still difficult to get rid of the pursuit of maximizing economic benefits, as the provision of more than 90% of the country's public hospitals, as long as the pursuit of economic benefits of the nature of the change As a public hospital providing more than 90% of the nation's medical and health services, as long as the nature of its pursuit of economic benefits does not change, China's health care reform can hardly be said to be successful, unable to achieve the basic health care system as a public **** product to provide the basic objectives of the whole population. The difficulty of reforming public hospitals, in the final analysis, or the problem of profit distribution, in the existing model, more than half of the income of public hospitals from drug sales, doctors through the way of drug mark-up to realize the medicine to support the doctor, and ultimately increased the burden of medicine on the residents, distorting the nature of the public welfare of the hospital. At present, China's pilot approach to break the medicine to support many, through the abolition of the drug markup, improve the price of medical services and financial subsidies to be compensated gradually become the most mainstream model. In China's public hospital reform has been stagnant for many years, the situation, the Shenzhen Municipality took the lead to break the deadlock, and become a public hospital reform of the crab eaters. In July of this year, Shenzhen began to start the reform of the separation of medicine, the full abolition of more than 60 public hospitals in the city 15% to 25% markup on medicines, and at the same time to raise the outpatient clinic fees and inpatient consultation fees of public hospitals, outpatient clinic fee per person per time to increase an average of 12 yuan, inpatient consultation fees per person per time to increase an average of 37 yuan, as a result of the abolition of the drug markup on the compensation of hospitals, Shenzhen has become the first large-scale abolition of drug markups in the country. Shenzhen has become the first large city to completely abolish the drug markup, and has become a pioneer in public hospital reform. This breaks the model of medicine to support the doctor seems to have a great feasibility, but in the actual operation of the process also faced a lot of problems. First of all, after the abolition of the drug markup, the price of drugs fell, but the price of medical services rose, and the increase in consultation fees from the existing health insurance fund expenditure, which is only a kind of leveling mechanism, in common parlance, is the wool out of the sheep, the patient actually did not enjoy too much of the benefits. And for hospitals, medical services prices often do not fully cover the decline in drugs brought about by the loss of financial subsidies are not in place, many pilot hospitals are in the red, making further promotion of public hospital reform is facing great resistance. Shenzhen health care reform for more than a month, the price of drugs has dropped significantly, but because the government financial inputs did not follow up in time - according to local media reports, the government financial is still zero inputs - Shenzhen public hospitals have seen a significant drop in revenue. If the government financial input can not be timely in place, Shenzhen's public hospital reform will encounter great resistance, as the national attention of the health care reform pioneer, Shenzhen public hospital reform undoubtedly has a strong demonstration effect, if Shenzhen's public hospital reform fails, for the country's health care reform will also be a small blow. If the financial inputs can not follow up in time, Shenzhen's public hospital reform may be caught in the embarrassing situation of both sides do not please, patients did not enjoy too much of the benefits of price reductions, the doctor's motivation is also affected by the decline in income. From the technical means, public hospital reform there are many breakthrough paths, such as the reform of the public hospital management system and operation of the regulatory mechanism, the implementation of the separation of government affairs and management, in accordance with the principle of separation of the functions of medical services supervision and medical institutions to hold functions, and to promote the government's health and other departments, state-owned enterprises and institutions belonging to the hospitals of the territorialization of the management of the public hospitals to gradually realize the unified management of public hospitals; for example, to promote the diversified management pattern, to promote the diversification of medical services, to promote the diversified management pattern, to promote the diversified management pattern, to promote the diversified management of medical services. Promote the diversified pattern of running medical institutions, encourage social capital to enter the field of medical services, and encourage social forces to organize non-profit hospitals. But no matter what means, if we want to return to the health care as a social public **** the nature of this, increase the national financial input is always the core of the problem: the more the national financial input, the public hospitals, the weaker the profit-seeking nature; Conversely, the weaker the national financial input, the public hospitals, the stronger the market sex will be.