What is the current status of the analysis of the reform of China's medical insurance system at home and abroad

China's public medical care and labor insurance medical care established in the early 1950s is collectively known as employees' medical insurance, which is an important part of the national social security system and one of the important items of social insurance. With China's reform and opening up and the development of the socialist market economy, the current medical insurance system is far from being able to adapt to the new situation, the needs of the new situation. Therefore, how to reform and improve China's medical insurance system, as it relates to China's socio-political and economic stability and healthy development, has become an important topic in the social security system. This paper intends to put forward the idea of how to reform and improve the medical insurance system by briefly introducing and analyzing the medical insurance system in China.　First, the concept of medical insurance system and the emergence of the concept of medical insurance, there is no uniform definition of the concept of medical insurance in the domestic and foreign academic circles, and there are different understandings of the reference, expression and content of medical insurance. From the point of view of the size of the scope of medical insurance, it can be divided into broad medical insurance and narrow medical insurance. China's previous and current employee medical insurance system, on the surface, only pays for medical expenses, but in fact also compensates for lost wages caused by illness through other systems, that is, a kind of medical insurance in the broad sense. The medical insurance system that China plans to build should be in the direction of "health insurance"; however, due to the reality of China's national conditions, medical insurance in the short term can only be an effort to improve the insurance or compensation for medical expenses. Therefore, the essence of medical insurance referred to in this paper is medical insurance in the narrow sense. Here, it is necessary to distinguish between medical insurance and sickness insurance.　　The establishment of social insurance system in western countries, mostly from the beginning of medical insurance. Medical insurance began in Germany in 1883, the enactment of the Labor Sickness Insurance Act, which stipulates that certain industries in the wage less than the limit of workers should be mandatory to join the medical insurance foundation, the foundation mandatory collection of workers and employers should contribute to the fund. This act marked the emergence of health insurance as a compulsory social insurance system. Especially after the world economic crisis from 1929 to 1933, medical insurance legislation entered into a period of comprehensive development, and the legislation of this period not only stipulated the object, scope and treatment items of medical insurance, but also legislated and regulated the medical services related to medical insurance. At present, all developed countries and many developing countries have established medical insurance systems.　　Second, the emergence and development of China's medical insurance system According to the different sources of medical insurance costs, China's medical insurance system can be divided into two periods: one is the period of national medical insurance, and the other is the period of social medical insurance.　　1. The period of national medical insurance. China's national medical insurance period of insurance, according to different objects, can be divided into public medical and labor insurance medical insurance system. Publicly-funded medical care system is a kind of medical insurance system in China for the staff of institutions and organizations as well as students of colleges and universities. Publicly-funded medical care in China began in the early 1950s, when it was only practiced in some areas and in certain disease-endemic zones; in 1952, the State Council promulgated the Measures for the Implementation of Publicly-Funded Medical Care for State Employees of the People's Government, Parties and Organizations throughout the Country, and the system has been in place nationwide since that time. As the number of people enjoying publicly-funded medical care continued to increase, the cost of publicly-funded medical care showed a tendency to grow considerably, and the Circular on Improving the Management of Publicly-Funded Medical Care, issued in October 1965, further stipulated that "outpatient registration fees and clinic fees for treatment of illnesses for those enjoying publicly-funded medical care should be paid by individuals, and should not be reimbursed out of the publicly-funded medical care funds. " Since 1966, a series of restrictions on medicines have been introduced; in 1960, six types of medicines were not reimbursed; in 1966, the number reached 102; in 1975, it reached 175; and in 1982, it was further stipulated that all medicines labeled with the word "health" would not be reimbursed. In short, the public medical care system enables every employee, regardless of position or income, to enjoy free medical care whenever he or she is sick, relieving employees from the worry of illness and effectively safeguarding people's health.　　2. The period of social medical insurance: In the late 1970s, China began to reform and open up, and with the deepening of the reform, the problems existing in the traditional medical insurance system became more and more prominent, such as the medical fee that the state and the enterprises underwrote too much, exceeding the national productivity level; the lack of an effective mechanism for controlling the medical cost, and the rapid growth of the medical cost; the coverage of the medical insurance was narrow, covering only 20%-25% of the population; the degree of socialization of the management and service was low; and the medical insurance system had a low level of socialization. ; low degree of socialization of management and services; uneven burden on enterprises; poor mobility of labor; pursuit of high cost of medical services, resulting in waste of medical resources; duplication of public medical care and labor insurance medical care, and so on. Since 1984, under the guidance of the government, some minor reforms have been carried out on a trial basis in various places. on December 14, 1998, the State Council issued the Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Workers, thus, the reform of China's medical insurance system entered into a new period - the social medical insurance period. -On January 14, 1999, the State Council issued and implemented the Interim Regulations on the Collection and Payment of Social Insurance Premiums, and the Ministry of Labor and Social Security and other relevant ministries and commissions formulated a series of operational rules on specific issues related to the reform of the medical insurance system, which, together with a variety of local policies and regulations, as well as the pilot experience, constitute the basic principles and frameworks of China's medical insurance legislation. Together with various local policies and regulations and pilot experiences, these have formed the basic principles and framework of China's medical insurance legislation.　　Problems and Countermeasures of China's Medical Insurance System Since China is currently in a period of transition of medical insurance, there are many problems in the medical insurance system in terms of the scope of medical insurance, the way and channels of raising medical insurance premiums, the way of paying medical expenses, and the management of medical insurance organizations. Its outstanding problems are mainly as follows: 1. Narrow insurance coverage and low degree of socialization. The existing medical insurance, due to the system is not uniform, so that some of our citizens have medical insurance, some do not have protection, resulting in social inequity. National health insurance is not balanced, start more cities, covering less population; medium-sized cities more insurance, large cities less insurance; institutions more insurance, difficult to participate in the enterprise (continued on the page of the letter) less insurance. This is contrary to the provisions of the Constitution of China on "citizens in old age, illness or loss of labor capacity, have the right to material assistance from the state and society". Due to the lack of a unified transfer mechanism, the degree of socialization of medical insurance management and services is extremely low, which affects equal competition in the market economy of enterprises, hinders the reasonable mobility of the labor force, and is not conducive to the long-term coexistence and development of various forms of the economy.　　2. Lack of a reasonable medical financing mechanism and a stable source of medical expenses. Due to the increase in the number of people enjoying the benefits, the increase in the number of elderly workers, the change of diseases, the development of medical technology, the adjustment of medicines and all kinds of medical expenses, the introduction of all kinds of high-technology medical equipments, and the change of workers' demand for medical treatment as people's living standard improves, the medical expenses are constantly increasing. At the same time, the proportion of medical expenses withdrawn is lower than the actual expenses, making the proportion of actual medical expenses paid by individuals too high and the burden too heavy.　　3. Lack of effective constraints on the services of fixed-point medical institutions. Due to the lack of an effective regulatory mechanism for the behavior of medical service providers or designated medical insurance pharmacies, a situation has arisen in which each one of them goes its own way for its own economic benefits. With regard to the way in which medical expenses are paid, due to mismanagement, some people have been billed indiscriminately for medical expenses or have used their personal accounts in medical insurance to buy daily necessities. These phenomena have caused new medical insurance corruption and the reduction of medical insurance fund.　　In view of the above problems, the author believes that they can be solved by the following countermeasures: 1. Implementing the "combination of partial co-ordination and unit self-management". That is, hospitalization and major diseases to implement the co-ordination, at the same time, individuals also have to bear part of the cost, in order to benefit from the interest mechanism to promote the unit, individuals care about saving medical costs; and general outpatient, emergency medical care by the management of the unit, the units can be based on the specific circumstances of the use of different management methods, do not force the uniform. This approach has several obvious advantages: firstly, the financing ratio is low, and it is easy to get the funds in place. Secondly, it is conducive to the proper use and management of the pooled funds. Since the integrated system only manages easily defined types of diseases, its operation is relatively simple, its supervision costs are low and its control is convenient. Again, within a certain period of time, it recognizes and allows for a certain difference in the level of medical protection enjoyed by employees in different units on the premise of guaranteeing basic medical care, which is easy to accept by the units and the employees. In addition, it is conducive to the role of self-managed medical institutions in each unit and improves the efficiency of supervision.　　2. The collection of premiums can try to "cost inversion", that is, from the hospital side of the medical income inverted calculation of each unit should pay the premiums. This has the following advantages: First, it is simple and easy to operate. Second, it reflects the principle of fairness. The basic principle of social insurance is that the insured amount is the same as the amount of payment, i.e., rights and obligations are reciprocal. Third, it is conducive to expanding the coverage of medical insurance, creating a "multi-win" pattern.　　3. Establishing two forms of individual accounts at the same time. (1) Individual accounts based on the actual savings system, which allow workers to reserve a certain amount of money when they are young for their health in old age. (2) A pay-as-you-go personal account to encourage employees to economize on medical expenses other than those covered by the centralized system. This account is managed by each unit, and the specific form, management method, and percentage of out-of-pocket payments can be determined by the unit according to its own situation. Both types of account are paid by the State at an interest rate not lower than that of bank deposits for the same period, and both can be carried forward and inherited. In short, it is necessary not only to restrain unreasonable medical consumption by adjusting the individual's out-of-pocket ratio, but also to enable employees who save on medical expenses to receive appropriate benefits on their individual accounts.　　4. Adopting the method of fixed payment according to standard disease types (DGR), that is, no matter how many times a patient has visited outpatient or emergency clinics, and no matter how many days he or she has been hospitalized, he or she will be paid a fixed amount of money according to the type of illness. Internationally, Germany has been engaged in medical insurance for more than 100 years, and has changed to pay according to the standard disease type since 1996, and the United States began in 1983. The use of this method can avoid most of the shortcomings of the flat-rate payment for services by unit, is conducive to the diagnosis and treatment of difficult and complicated diseases; is conducive to the improvement of the technical level of hospitals; is conducive to the role of hospitals at all levels, and effectively change the phenomenon of patients in the big hospitals to see a doctor, "three long and one short"; is conducive to the enhancement of competition between hospitals, reduce costs, improve service quality It is also conducive to the supervision of medical behaviors and costs by the management. Of course, the implementation of the standard payment for diseases is relatively complex, but China has accumulated a large number of case data over the past few decades, and there are international mature experience for reference, with the help of modern computers and other tools to carry out statistical calculations, it is fully equipped to measure the standard cost of each type of disease.　　References: 1. Qin Youtu, Fan Qirong. Social Security Law. Beijing: law press, 1997 2. Wang Xianlin, Li Kungang. Labor and social security arbitration and litigation. Beijing: Law Press, 2002 3. Zeng Xianshu. Social insurance and social insurance dispute handling practice. Beijing: People's Court Press, 1997 4. Hu Suyun. The Role of Public **** and Market Mechanisms in Medical Services and Insurance. Population and Economy, 2000 (6) 5. Wang Longxing. The practice of reforming Shanghai's medical insurance system. Chinese Journal of Hospital Management, 2000(5)