Medical insurance now consists of three main insurance systems: publicly-funded medical care, labor insurance medical care and social medical insurance.
1. Publicly-funded medical care
The publicly-funded medical care system was established in accordance with the relevant national regulations and has been in effect nationwide since 1952. Employees of state organs, institutions, and social organizations, as well as students in colleges and universities, are entitled to publicly-funded medical treatment. The outpatient and inpatient medical expenses of those who are entitled to publicly-funded medical treatment are paid for out of public funds, with the exception of the portion that the individual is responsible for himself or herself in accordance with the regulations. Publicly funded medical treatment is financed from the government budget.
2. Labor Insurance Medical Care
The labor insurance medical care system was established in accordance with the relevant state regulations and has been in effect nationwide since 1951. Employees of state-owned enterprises are entitled to labor insurance medical treatment. The outpatient and inpatient medical expenses of those who are entitled to the labor insurance medical treatment are paid for by the labor insurance medical funds, except for the part of the expenses borne by the individual in accordance with the regulations. Labor insurance medical expenses mainly come from the enterprise's welfare fund.
3. Social medical insurance
The social medical insurance system was established on the basis of a reform of the public medical care and labor insurance medical care systems, with inpatient medical insurance and outpatient and emergency partial medical insurance implemented from 1996 to 1997. By the end of 1997, 21,000 enterprises and institutions were participating in social medical insurance, and the number of insured workers was 4.89 million, including 1.57 million retirees.
4. Development trend
The development trend of medical insurance is to set up a medical security system covering all urban workers, with employees' social medical insurance as the mainstay, supplemented by additional insurance and medical relief. A new pattern of medical insurance is being formed that is compatible with the socialist market economic system, with diversified main bodies of protection (the state, society, organizations and individuals), multiple channels of funding, and multiple levels of protection.
In 1995, the reform of the national medical insurance system took the lead in Zhenjiang and Jiujiang cities to carry out pilot projects. In 1998, the State Council issued the Decision on the Establishment of a Basic Medical Insurance System for Urban Workers (Guo Fa [1998] No. 44), and the reform of the medical insurance system began to be carried out vigorously nationwide.
The main task of the reform was to establish a basic medical insurance system for urban workers, i.e., to adapt to the socialist market economic system, and to set up a social medical insurance system that would safeguard the basic medical needs of workers in accordance with the affordability of finances, enterprises and individuals.
The principles of the reform are: the level of basic medical insurance should be commensurate with the level of development of the productive forces at the primary stage of socialism; all urban employers and their employees should participate in basic medical insurance, which should be managed on a territorial basis; basic medical insurance premiums should be borne by both the employer and the employee***; and the basic medical insurance should be based on a combination of a social coordinator and an individual account.
The scope of coverage of the basic medical insurance system for urban workers is: all urban employers, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.), organs, institutions, social organizations, and privately-run non-enterprises, and their employees.
Adapting to the needs of social and economic development, and in order to include more people in the basic medical insurance system, 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 this year, to include the participation in medical insurance of flexible employment, mixed-ownership enterprises and non-publicly owned economic organizations. The opinions on promoting the participation of flexibly employed persons and employees of mixed ownership enterprises and non-publicly owned economic organizations in medical insurance were issued in May this year, bringing flexibly employed persons, employees of mixed ownership enterprises and non-publicly owned economic organizations, and rural migrant workers into the scope of medical insurance.
From 1994, China's Zhenjiang City, Jiangsu Province, and Jiujiang City, Jiangxi Province, began a pilot reform of the medical insurance system, now more than 10 years; nationwide health care reform has been launched, but also after five years of history, China's health care reform has made important progress, the initial establishment of a new health care system framework, to establish a new type of medical insurance system model. The model of a new medical insurance system has been established. However, not long ago, a research report by the Social Development Research Department of the Development Research Center of the State Council, entitled "Evaluation and Suggestions on China's Healthcare System Reform", put forward the viewpoint that "China's healthcare reform has been basically unsuccessful", which included the reform of the health insurance system. This makes people inside and outside the industry have to re-examine the reform of the medical insurance system that has been carried out for so many years.
The puzzling reform of the health care system
The study makes a good point. Mainstream public opinion has been cautioning that these are "problems in the making" that need to be solved by "further deepening the reform". However, the people's feeling is that the deeper the "reform", the more problems it brings.
So, recently, some people inside and outside the industry to turn their attention back to the planned economic era of China's health care system. Some people issued such a feeling: at that time, China is so poor, there are "three major medical security system", namely, the public medical institutions, enterprises and rural cooperative medical labor insurance medical. Now, the reform and opening up has been 27 years, our country's rapid economic development, comprehensive national strength and planned economy compared to the era, not the same day, but why the majority of workers, farmers, but on the contrary, can not afford to see a doctor? Recently, some experts have summarized the "three basic experiences" of China's medical and health care development in the planned economy era: first, the layout of the medical and health care service system and its service objectives were reasonable; second, the focus of intervention in health work was chosen reasonably; and, third, the formation of a wide-coverage mechanism to protect medical expenses. It also concluded that the decisive factor in the success of health care in the planned economy was the leading role played by the government.
There are also experts who have analyzed and evaluated China's current health care system: since the reform and opening up, China's health care system has undergone great changes, and progress has been made in some areas, but the problems exposed are more serious. The reason is based on two points: the basic direction of the reform of the health care system is commercialization and marketization; the resulting negative consequences are manifested in the decline of the fairness of medical services and the macro-efficiency of health inputs.
Of course, there are people who hold a different opinion, that the planned economy era of medical care is "low level", is "not worth mentioning", simply can not look forward to CT, nuclear magnetic **** vibration as a symbol of modern medical equipment, and Linlin total Imported drugs and other luxuries of today's large hospitals. However, there is one thing that can cause people to *** knowledge: the most people at the bottom of the masses are concerned about, not whether the hospital is luxurious, whether the equipment is advanced, whether the drugs are imported, but whether there is a minimum of health protection.
December 2, 2004, the Ministry of Health announced the "third national health services survey main results", the survey results show that: China's medical services costs growth rate exceeded the growth of per capita income, medicine and health spending has become the third largest consumption after the family food, education spending. This survey found that due to economic difficulties and inconvenience of access to medical care, 48.9% of China's residents who are sick do not go to see a doctor, while the doctor diagnosed that should be hospitalized but not hospitalized also amounted to 29.6%.
What is the problem?
Entering the 1990s, with China's planned economic system to the socialist market economic system of the transition, the original health insurance system, the inherent defects are increasingly exposed: First, the narrow scope of the population to enjoy medical protection. The traditional health insurance system applies only to the staff of organizations and institutions, state-owned enterprises and some collective enterprises. Other workers, especially those in non-public enterprises, such as private workers, foreign workers and self-employed persons, and their employees, are not covered by basic medical insurance. Second, medical expenses are fully covered by the State and enterprises, while medical expenses are constantly increasing, adding to the burden on enterprises and the State. Thirdly, there is a lack of scientific and effective methods for the management of medical insurance expenses, resulting in a serious waste of medical expenses. This is China's medical insurance system reform of the "three major driving forces".
Some experts have commented that China's health insurance reform has basically realized the system transition and mechanism conversion. In the system, completed from the original public medical and labor insurance medical welfare to social health insurance type of transition, the implementation of the combination of social integration and individual accounts, cost sharing, medical services, competition, cost control and socialized management of the new operating mechanism. At the institutional level, a basic framework for a multi-level medical insurance system has been initially formed, with basic medical insurance as the mainstay, supplemented by various forms of supplementary medical insurance, and with social assistance as the bottom line. However, it is unexpected that attempts to remove the original health care system as the cause of the reform of the health care system, after five years (from the two rivers should be counted as 10 years from the pilot), there are more problems:
One of the narrow scope of coverage of social health insurance. This is supposed to be one of the drawbacks of the reform to be eliminated, but in terms of total coverage, the current health insurance coverage is only equivalent to 42 percent of the urban employed population, which is the lowest participation rate among the three major insurances. Structurally, basic medical insurance covers workers in state-owned enterprises and some institutions, as well as workers in some collective enterprises. A large number of other types of workers, the informally employed, the urban disadvantaged groups (low-income or laid-off, unemployed workers, the disabled and widows and orphans, rural migrant workers moving to the city, early retirees within the "system", etc.), as well as the vast majority of the rural population, are not covered by the system.
Secondly, a multi-level medical insurance system has yet to take shape. First, the problem of medical insurance for the rural population has not yet been fundamentally resolved; second, the operation of the various levels of the existing system has not yet been put on the right track, and the results have not been significant. Employee supplementary medical insurance, commercial medical insurance, social assistance medical care, rural cooperative medical system and community medical services have not yet been effectively implemented.
Thirdly, the reform of the medical and health care system is not complementary to the reform of the medical insurance system. Under the planned economic system, hospitals' basic funding comes from financial or enterprise (unit) allocations, and hospitals' other day-to-day costs are compensated through fees for medical services, so hospitals have little incentive to pursue their own interests. With the establishment of the market economy system, the government's compensation policy for state-owned hospitals has changed, and the scale of compensation has been gradually reduced, with hospitals focusing on operating income, and the pursuit of economic efficiency becoming the motivation for hospitals to operate. For the survival and development of hospitals, the government allows hospitals to receive a certain price difference in drugs as compensation. This is the origin of "supporting doctors with medicines" and one of the major reasons for the "high cost of medical care". In addition, inflated pricing of medicines, which is common in the production and circulation of medicines, has also seriously affected the interests of consumers. The compensation mechanism of hospitals "supporting doctors with medicines" and the shortcomings of the drug production and distribution system have had a serious impact on the basic medical insurance system. In addition to the cost pressures brought about by natural causes, such as the ageing of the population, changes in the disease spectrum and improvements in medical technology, the basic medical insurance fund also has to withstand the trials brought about by the mismatch in the reform of the pharmaceutical and health-care system. In many areas, to varying degrees, the situation of the medical coordination fund is unable to make ends meet.
Fourth, the government has not invested enough in medical resources. Since the reform, the proportion of government funds invested in medical and health care has been on a downward trend year by year, while personal expenditures have been growing rapidly. Insufficient investment of national medical and health care funds is one of the reasons for the shortage of medical insurance funds on a macro level. At present, the financing ratio of China's basic medical insurance is generally as follows: units pay about 6% of the total wage income of employees, and individuals pay about 2% of their own wage income (the specific payment ratio varies from province to province). Since there is no accumulation and deposition of medical funds, for the "old people" who had already retired when the new system was introduced, their medical insurance funds constitute an "invisible debt". This debt, which depends on the contributions of active employees to cover their own medical expenses and those of the retired elderly, will certainly increase the pressure on the medical insurance fund. The result is a shortage of medical insurance funds and a growing responsibility for medical insurance on the part of each active employee. The limited nature of the medical insurance fund and the unlimited nature of medical needs are a pair of contradictions in the operation of medical insurance. This contradiction is more prominent in today's context of insufficient national investment in health care.
What is the way forward?
Looking back at history, China's public **** health and medical insurance once had a glorious period. During those years, the state (government)-led system was fully implemented. From the cities to the countryside, a medical system that was more advanced in the world at that time was established. In particular, our rural health care model at that time was widely recognized around the world for solving the practical problems of farmers. From the historical experience, can we think that: in the reform of the health care system, appropriate reference to the reasonable components of our traditional system, combined with the social conditions of the transition period, the creation of a government-led, mobilize all aspects of society's positive factors of the new social health care system, may be the future reform of the health care system to take a practical path.
I. General Idea
The general idea is to establish a multi-level medical insurance system. Although due to the constraints of socio-economic development strategies and productivity levels, China's medical insurance is not yet possible to be a unified system for all, but the establishment of a medical insurance system suitable for the requirements of different groups, or can be realized.
The basic medical insurance system for employees is a social insurance system mandated by the state, and its purpose is to protect the basic medical needs of in-service and retired employees. But at present in our country many enterprises due to operational difficulties, can not afford to pay the medical insurance fees, resulting in these enterprises are difficult to be covered by the basic medical insurance system. Therefore, the important countermeasure to improve the basic medical insurance system is to do "should be insured as much as possible", so that workers outside the system can also enter the scope of the system.
The construction of a supplementary medical insurance system should be accelerated, so that insured workers, especially those in difficulty, can be compensated for large medical expenses through supplementary medical insurance. Supplementary medical insurance can take many forms, and commercial insurance, which takes advantage of the market, should be a better choice.
Flexible employment has emerged in recent years, and this group will expand in the future. The government should take advantage of the situation and set up a special medical billing system for flexible employment, a new form of employment. It is appropriate to adopt flexible and diversified management methods for the flexibly employed, with different arrangements in terms of the mode of enrollment, the method of payment of contributions, the payment of benefits, and the management and service of the fund.
The medical treatment system is also important. More help should be given to members of society who do not have jobs or have lost their ability to work (such as people with disabilities) to seek medical treatment, so that the disadvantaged groups, like other members of society, can be given the right to enjoy health.
This year, the CPC Central Committee and the State Council put forward the guideline of "promoting agriculture with industry and bringing the countryside with the city", and the new government-led rural cooperative medical care is an important way to protect the health of rural residents, and systematically ensures that farmers have access to public **** health products. In order for this system to advance smoothly, the issue of urban-rural integration should be taken into account in the system. It should actively explore the integration and centralized management of the new rural cooperative medical care system and the basic medical insurance system for urban workers, and implement a unified management mechanism, unified funding management, and a unified mode of operation (allowing for differences in funding channels and reimbursement ratios), so as to establish a medical care system that breaks through geographic boundaries, breaks down the identities of rural and urban residents, and covers the entire population.
In short, China's medical security system should be: the basic medical insurance for urban workers, supplemental medical insurance, commercial medical insurance, special medical insurance for flexibly employed persons, medical assistance for disadvantaged groups, and a new cooperative medical system in rural areas should be a medical security network that meets China's national conditions and has Chinese characteristics. In this medical security network, every member of society can enjoy basic medical services and protection in a fair manner.
II. Policy Recommendations
(1) Increase the government's financial investment in the medical service sector, laying the foundation for the effective operation of the medical insurance system
The government's financial investment is mainly reflected in two aspects, one is the investment in the supply side of the medical service (the hospitals), and the second is the investment in the other medical insurance systems, such as the medical insurance for the flexibly employed, the medical care assistance for the disadvantaged groups and the new cooperative medical care system for the farmers. assistance and the new cooperative medical care system for farmers.
For hospitals, the government should consider increasing the proportion of financial subsidies, and completely change the situation of "supporting doctors with medicines" in terms of the compensation mechanism. Both the central and local governments should take responsibility for investing in health care. For medical insurance systems other than the basic employee medical insurance system, governments at all levels have the responsibility to invest funds. The direction for the development of China's social security system is the establishment of a social security safety net compiled jointly by the Government and a variety of other social forces, such as nongovernmental organizations, charitable organizations, enterprises and individuals***. For the cooperative medical care system for farmers, governments at all levels should also increase their financial input. The Opinions on Accelerating the Establishment of a New Rural Cooperative Medical Care System have already clarified the criteria for government funding, and the key issue is that responsibilities should be effectively fulfilled.
(2) "Four reforms linkage" to create a favorable environment for the medical security system
In recent years, the Hangzhou government has vigorously pursued the "four reforms linkage" of medical care, medical insurance, medicine and assistance, which should be regarded as the four components of the social medical security system. The four components of the system. Only through the "four reforms" can the entire medical system be guaranteed to provide basic medical services and safeguard the health of the people.
First, the government should correctly position public hospitals or other non-profit medical institutions, and transform the hospitals' business model of "supporting doctors with medicine" through the compensation mechanism. Second, the government should resolve to completely solve the problems in the production and distribution of pharmaceuticals, and reverse the situation of inflated pricing of medicines. Thirdly, the interests of all parties involved in the supply, demand and coverage of medical insurance should be adjusted. Fourthly, medical assistance should be provided to the disadvantaged groups. Only in this way can we achieve the goal of reforming the health care system to "provide relatively high-quality medical services at relatively low cost and strive to meet the needs of the general public for basic medical services".
(C) speed up the pace of legislation on medical insurance system, to provide legal protection for the implementation of the system
Medical insurance is a tripartite payment system, so it is very important to regulate the responsibilities and behavior of the three parties: the demand side, the supply side, and the insurer. Therefore, it is necessary to legislate on medical insurance as soon as possible. The financing of medical insurance for urban workers should be guaranteed by legal means, and the fund collection of enterprises and units should be strengthened to ensure that the fund is in full.
Suggests special legislation on the new rural cooperative medical care. Although the state has written into the cooperative medical "Agricultural Law", the Ministry of Health, Ministry of Finance, Ministry of Agriculture industry jointly issued "on the establishment of a new rural cooperative medical system," but the actual operation of the difficulty. Therefore, it is necessary to speed up the legislative work of the new rural cooperative medical system, the government-run new rural cooperative medical care into the legal system, so that participation in cooperative medical care as a citizen to fulfill their legal obligations, firmly establish a new rural cooperative medical care of the legal system, mobilize all aspects of the community to support and pay attention to the new rural cooperative medical care, and to promote the improvement and consolidation of the new rural cooperative medical care.
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