I. The background and process of China's medical insurance reform
After the founding of the People's Republic of China, China's organs and institutions have implemented the public medical system, and enterprises have implemented the labor insurance medical system. With the establishment of the socialist market economic system and the deepening of the reform of state-owned enterprises, the disadvantages of this system have become more and more obvious. First, the growth of medical expenses exceeded the growth rate of the gross national product. In other words, a country's production capacity cannot keep up with its consumption level. Not only that, this healthcare system has also caused an excessive disparity of burden between enterprises: new industries with fewer old workers have relatively low medical expenses, while old enterprises are burdened with a burden that they can never get rid of. In addition, individuals are also free medical system spoiled. "One person goes to the doctor, the whole family takes medicine," and "a small illness becomes a big illness, and no illness becomes a disease." What's the figure? Reimbursement. Whose money is earned? The state and corporations. What are the consequences? Waste.
Based on the increasingly heavy burden of medical costs, the State Council in 1994, on the basis of the pilot experience, formulated the implementation of the reform of the medical insurance system, and at the end of 1998 issued the State Council on the establishment of the basic medical insurance system for urban workers decision. The basic idea of the reform was "low level, wide coverage, double burden, combined accounts". The "two-party burden" means that the basic insurance is to be borne by both the organization and the employee, and the "combined account" means that the insurance fund is to be a combination of a social coordinator and an individual account. This was the end of the public-funded, labor-insured medical system that had been in place for more than 40 years. By the end of 2000, China had basically established a basic medical insurance system for urban workers, covering a population of 50 million.
At a conference on social security work held in Harbin in April 2002, all parts of the country were asked to speed up the process of reforming the medical insurance system for urban workers, to ensure that workers' basic medical needs were effectively protected, and to complete the work of starting up more than 90 percent of the integrated areas of the medical insurance system this year, covering 80 million people. China's medical insurance system reform has achieved considerable results, by the end of June this year, the country's 349 prefectural-level or above integrated areas, 307 have been launched to implement, accounting for 88% of the country; the number of people covered reached 50.26 million people, accounting for the number of the country's should be insured 30%.
II. Problems with the new medical insurance system
1. Medical risks
The new system only provides basic medical insurance, but does not cover all medical expenses, so the people, who have been enjoying free medical care for decades, seem to find it difficult to accept the "cruel" reality that they have to pay for medical care. Therefore, the people who have been enjoying free medical care for decades seem to find it difficult to accept the "cruel" reality that they have to pay for medical care, and they obviously show their attachment to the past medical system. Take the personal account as an example. The regulations require individuals to pay 2% of their average monthly income, the total unit **** bear the pad, of which 30% or less into the personal account, that is, 1.8% of the total, which translates into 38% of the monthly income of individuals. The average annual income of employees in Beijing is more than 10,000 yuan. So the average employee's personal account is less than 300 yuan. That's his yearly outpatient medical expenses. Social coordination is fine, but if you get a serious illness personal account funds will be stretched to the limit. As a result, many people may not be able to afford to see a doctor and jeopardize their health.
Additionally, the new system does not include children, while in the past, the medical costs of children on labor insurance and public medical care were basically borne by their parents' organizations***.
The new medical system is also ill-prepared for the problem of prevention. Previously, medical care emphasized prevention, with regular experiences in the unit, a regular infirmary, and a children's vaccination station. These fall under the category of outpatient care in the new health insurance. This means that money has to be spent from the personal account. This is likely to lead to: should have seen the disease did not see, originally a small disease is delayed into a serious disease. And foreign countries have always regarded "prevention is the most effective way to control major diseases" as a maxim.
2. Hospitals may be dragging their feet on health care reform
Medicare reform is the most complex of all social security programs, involving social insurance agencies, hospitals, individuals, businesses and the health care industry. The intricate relationship is compounded by the fact that hospitals and medicine were not separated in the past. The difficulty of health insurance reform is not in itself, but outside of health insurance. The reform of the hospital system and the reform of the pharmaceutical system is likely to pull the medical insurance reform.
The general idea of health insurance reform is "to provide people with better quality services at less cost to meet their basic medical needs." Controlling costs is the fundamental problem with Medicare. This is the health insurance itself can not be solved, but only resort to hospitals. The main reason for the current high cost of medical care is the high price of drugs. Hospitals are the main channel for selling drugs, and selling drugs to is the mainstay of hospital revenue. Hospitals, as non-profit-making organizations, have to maintain their daily operation, and the national financial allocation can only meet 50% of their needs. The other 50 percent relies mainly on the sale of drugs.
Additionally, the irrational structure of medical resources is another prominent problem. Putting aside the huge difference between urban and rural areas (less than 30 percent of the urban population enjoys 70 percent of the country's health care resources), the structure of urban hospitals is quite unscientific. 90 percent of people suffer from minor ailments, and there is no need to go to a large general hospital. Now there are too many big hospitals and too few small hospitals serving the community. With more big hospitals, the construction costs are high and the desire to recover costs is even stronger. Without a well-developed network of community hospitals for health care, the cost of medical care for individual illnesses is higher, and the cost of health insurance will be higher as well.
3. Loopholes in the new system's provisions
Based on the new health insurance system, the person concerned only needs to pay a fairly small portion of the cost, and then he or she can spend as much as he or she wants up to the maximum amount of the integrated fund's payment (in Shanghai, for example: the new health insurance is an aggregate of more than four times the average salary of the previous year's employees, which was 56,000 yuan in 2000). Some hospitals and doctors also do not limit the number and amount of medicines they prescribe in order to transfer more health insurance funds into their hospital accounts. In this way, it is possible for cardholders to join forces with hospitals or certain doctors to fraudulently transfer national health insurance funds into their private or small group accounts. Another situation is that one person's health insurance is enjoyed by the whole family, because hospitals do not require cardholders to be present in person when their health insurance cards are transferred.
China is now in a period of social transformation, in a chaotic stage of moral disorders, new rules and old rules coexist, and the erosion and destruction of the original social norms of morality and the bottom line of morality is inevitable.
Three. Preliminary Exploration of Further Deepening Reform Options in Response to Problems
There are indeed difficulties in China's health insurance reform. Recognizing the difficulties is for the sake of prudent and positive reform. China's health insurance reform will be very difficult, will not be achieved in one step, and may go through a relatively long period, requiring continuous proposals for adaptation.
Option 1: Adhere to the "three reforms" of medical insurance, health care and drug distribution system reform (the three directions are, first, the reform of basic medical insurance for urban workers; second, the open accounting of medicines and the separate management of medicines; and, third, the classification and management of hospitals) to further strengthen and improve the management of medical services.
Recently, the social security conference pointed out that poor economic conditions in the region can first establish a basic medical insurance co-ordination fund, the inability to pay for the difficult enterprise workers can also take the first to participate in the co-ordination fund to pay for the scope of the basic medical insurance, to solve the problem of hospitalization of the workers and the major medical problems, so as to minimize the risk of medical care.
The implementation of the medical insurance system must solve the current problem of supporting doctors with medicines, and must cut off the direct link of economic interests between medical institutions and the marketing of medicines. Outpatient pharmacies in hospitals should be converted into drug retailing enterprises, with independent accounting and paying taxes according to the rules. China's Ministry of Health has explicitly called for centralized bidding and purchasing of medicines, and will gradually bring medicines in the basic drug list and those with high clinical usage into the scope of centralized bidding and purchasing.
Hospital reform first requires hospitals to be categorized and managed. Non-profit medical institutions set up to serve the interests of the public, mainly to provide basic medical services, and the implementation of the government's guiding price of medical services, enjoy the corresponding tax incentives. For-profit medical institutions are liberalized in terms of medical service prices and determine their own medical service programs according to market demand. This is conducive to competition among hospitals and the establishment of a multi-level medical security system.
Option 2 Optimize the allocation of medical resources and improve the efficiency of their use. We need to establish and implement a real competitive entry mechanism and "exit" mechanism for designated medical institutions. According to statistics, the number of brain CT machines owned by Chinese hospitals is several times that of the United States and Japan. Every hospital wants to make money by doing CT for patients. This not only increases the medical burden of patients, but also leads to a waste of resources. Therefore, for high-grade medical equipment, the state should be unified configuration and management. And for large hospitals relative surplus community medical services relative shortage of the situation, should be poured into the real competition mechanism, according to the law of the market survival of the fittest, the government should not be overprotected!
Program 3 To ensure the efficiency of the use of the basic medical insurance fund, to reduce unnecessary costs and burden on patients. Should make full use of the achievements of modern information technology, vigorously promote the process of medical insurance: the establishment of databases in central cities, through network scanning and other means of monitoring and forecasting the use of the basic medical insurance fund of the coordinated areas: assessment of the implementation of the policy. At present, large and medium-sized hospitals in Beijing and Shanghai have fully promoted computerized inquiries on hospitalization costs, respecting patients' right to know about examinations, treatment, medication and prices. The computer will also take on the heavy responsibility of regulating medical behavior and supervising doctors not to abuse drugs. It is gratifying to note that our country is using computer network technology to change the unorganized situation of drug purchasing, and is vigorously pursuing centralized bidding for the purchase of drugs and health materials. A database of medicine prices has been established, and price information is instantaneously sent to all computer-networked medical units, and national tariffs are being publicized. This will undoubtedly be of great benefit in reducing the cost of medical insurance!
Option 4 should also explore the establishment of a multi-level medical insurance system to properly solve the medical treatment of the people concerned; actively explore ways and means of social medical assistance to properly solve the medical problems related to special hardship cases. Medical insurance system should be a multi-level medical insurance system. In addition to the basic level of medical care guaranteed by the government, there should be supplementary medical insurance, commercial medical insurance, and a medical assistance system. Children, the unemployed, and the poorer sectors of society should be included in the medical aid system.
In short, although the reform of China's medical insurance system has been a great degree of reform, but there are still many constraints on the overall social insurance system to improve the specific problems that need to be solved, the reform process always need to pay a price, which requires the government and all sectors of society to make great efforts.
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