Research found that the basic medical insurance for urban residents and the new rural cooperative medical care (hereinafter referred to as "new rural cooperative medical care"), due to the separation of the system, the separation of the management, and the dispersion of resources, not only enhance the management costs, reduce the efficiency of the management, and bring a lot of inconvenience to the residents of urban and rural areas, but also solidify the urban and rural dual structure, and create serious obstacles and negative impacts on the realization of fairness and justice, and the promotion of social harmony. It has also solidified the dual structure of urban and rural areas, creating serious obstacles and negative impacts on the realization of fairness and justice and the promotion of social harmony, highlighted by the "three disadvantages" and "three duplications".
"Three disadvantages": First, it is not conducive to reflecting social equity. Urban and rural medical insurance system, so that the majority of residents can only be based on the identity of the household registration passively join the corresponding security system, strengthen the concept of urban and rural household registration, solidified the dual social structure, can not well reflect the fairness of social insurance. Second, it is not conducive to the mobility of human resources. As China's rapid urbanization advances, the flow of human resources between urban and rural areas accelerates, and the urban and rural medical insurance systems are not integrated, information is not ****shared, and management is not unified, making it difficult to continue the medical insurance relationship of these mobile workers, and the treatment cannot be converged, and it is particularly difficult for migrant workers to transfer their medical insurance relationship when they move between urban and rural areas. Third, it is not conducive to the sustainable development of the medical insurance system. The urban and rural medical insurance systems are managed and administered by different departments, which makes it impossible to plan the long-term development of the insurance systems in an integrated manner, and to assess the real performance of the systems in a unified and scientific manner, thus increasing the costs of the system and causing a serious waste of social resources.
"Three duplications": first, residents repeat participation. Currently, the employee health insurance, resident health insurance by the human resources and social security sector management, "new rural cooperative" by the health sector management, due to the management and information system is not unified, information can not **** enjoy the actual work and the existence of each other to participate in the insurance resources, resulting in the existence of urban and rural residents around the phenomenon of duplication of insurance. In particular, the problem of duplicate participation by rural migrant workers, township and village enterprise employees, rural students studying in towns and cities, and expropriated land farmers is very prominent. After Tianjin, Chengdu, Xiamen, and Taizhou integrated their medical insurance management resources, they found that 450,000, 270,000, 80,000, and 200,000 people had duplicated their participation in the insurance program through information system comparisons; of the 110,000 urban residents in Qixia District, Nanjing City, 40,000 people participated in the New Farmers' Cooperative Program (NFCP) at the same time. Secondly, financial subsidies are duplicated. According to the typical analysis and rough estimation of the areas that have implemented unified management of urban and rural areas, the proportion of duplicate participation accounts for about 10% of the number of urban and rural residents participating in the insurance. Calculating on the basis of this year's per capita financial subsidy of 120 yuan for urban and rural residents participating in the insurance scheme, the financial authorities will duplicate the subsidy of 12 billion yuan for about 100 million residents participating in the insurance scheme, which will obviously increase the unreasonable burden on the financial authorities at all levels. Third, the duplication of the establishment of management organizations and information systems. After more than a decade of efforts, the information system of urban medical insurance agencies has been basically perfected, and if the NPIC establishes another set of agencies and information systems, it will inevitably increase management costs, reduce management efficiency, and waste a large amount of financial resources. According to estimates by the finance bureaus of cities such as Xiamen, if a new rural cooperative information system were to be constructed with reference to the urban medical insurance information system, it would require a further investment of about 60 to 80 million yuan (not including annual maintenance costs). The country is what a large cost, can be imagined!
How to solve the problems of "three disadvantages" and "three duplications" and realize the comprehensive, coordinated and sustainable development of the basic medical insurance system? The central government pointed out the direction, "on deepening the reform of the medical and health system views" (China Development [2009] No. 6) pointed out that we must "effectively integrate the basic medical insurance management resources, and gradually realize the unity of the basic urban and rural medical insurance administration". In order to implement the requirements of the central medical reform documents and to thoroughly resolve the problems of "three disadvantages" and "three duplications", many places have carried out active exploration. For example, Guangdong Province began exploring urban-rural integration of medical insurance in 2004, and is one of the fastest provinces and cities in the country in terms of speed of advancement. Of the 21 prefecture-level cities in the province, 10 cities, including Shenzhen, Zhuhai and Dongguan, have already begun to explore urban-rural integration of medical insurance, and municipal governments such as Qingyuan, Yangjiang and Meizhou have decided to transfer the New Farmers' Cooperative Program to the social security department for unified management. Fujian Province has clarified the function of the Department of Human Resources and Social Security in coordinating urban and rural medical insurance work, requiring that the New Rural Cooperative Information System rely on the Employee Medical Insurance Information System, and that the provincial government take out 2 million yuan of special funding each year to reward areas that carry out urban and rural coordination of medical insurance. At present, Xiamen City and more than 20 counties, including Shaowu and Shanghang, have realized urban-rural integration of medical insurance. The executive meeting of the Fuzhou municipal government decided to actively create conditions for transferring the new rural cooperative program to the management of the social security department. Jiangsu Province, Wuxi, Zhenjiang, Suzhou, Changzhou, Taizhou and other cities to actively carry out urban and rural integration of the exploration, each city is very much focused on the system convergence, the introduction of the transfer of methods; synchronized to raise the level of medical insurance, improve the fund **** relief capacity. Chengdu, Leshan, Guangyuan Cangxi and other cities in Sichuan Province have actively explored the urban-rural integration of medical insurance. According to the statistics of the relevant departments, the areas where urban-rural co-ordination of medical insurance has been fully carried out include three provincial-level administrative regions, 21 prefecture-level cities and 103 counties (districts and cities) in Tianjin, Chongqing and Ningxia. These areas, in addition to Jiaxing, Zhejiang Province and 33 counties (districts, cities) urban and rural residents of medical insurance by the unified management of the health sector (employee health insurance is still managed by the social security sector), the rest of the region by the unified management of the social security sector.
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