However, we should also see that there are still many problems in China's medical insurance, some of which are very serious, even to the extent of restricting the smooth progress of economic system reform. These problems can be summarized in the following aspects:
1. "Drugs for doctors" is the most central problem facing China's health care reform
The government has not invested enough money in medical institutions, the supply capacity is weak, and the medical institutions will be pushed into the market so that they can adapt to the market, and be responsible for profits and losses, which has led to the vast majority of hospitals have to choose "medical insurance". The vast majority of hospitals are forced to choose the "medicines for doctors" approach to maintain the normal income and operation of the hospital. Over time, this approach of "supporting doctors with drugs" has become a tool for hospitals to maximize their profits in the market economy, and medical institutions have lost their public welfare nature, and the burden on the public when they go to see a doctor has become heavier and heavier. In fact, the root of the problem lies in the government's insufficient investment in medical institutions. In 2011, China's GDP totaled 47.16 trillion yuan. According to the 2011 Public **** Financial Income and Expenditure released by the Ministry of Finance, the financial revenue was 1,037.4 billion yuan, of which 636.7 billion yuan was spent on healthcare, accounting for only 1.35% of the total GDP, which is lower than the proportion of healthcare investment in many countries. Moreover, this 636.7 billion yuan is not all spent on health care services for each and every one of the people. Removing other items such as the three public expenditures of the health sector and infrastructure, only about 20% is left to be spent on the people and health care organizations of the country. This makes the financial subsidies in most provinces account for less than 5% of the revenue of public hospitals, and even less than 2%, which also forces hospitals to obtain funds from drugs and equipment to maintain normal operation. 2, the fairness and diversity of health insurance policy needs to be improved
Because of many historical reasons and regional differences in the formation of the health insurance system differential treatment still exists, there is a large gap between the different groups of people and different regions of the level of medical care, and there are still some people who do not participate in the health insurance for a variety of reasons. Local health insurance centers have policies specific to their respective regions, resulting in differences in the types of illnesses and reimbursement rates of health insurance in each region, and a lack of coordinated provisions and effective interconnections between the various types of insurance in each region of the country. As a result, the fairness of this nationwide system has yet to be improved. With the development of society and the diversification of forms of employment, the diversity of demands for medical insurance coverage has gradually revealed its inadequacy. Moreover, the transfer of insured persons and the difficulties in the connection of medical insurance in the region and the imperfections in the "one-card" measures have also revealed the need for diversity in medical insurance policies. 3, health insurance policy management system is not sound enough
Because of the different levels of economic development in various regions of China, the medical insurance policy were implemented at the provincial, municipal and county levels of hierarchical management or industry co-ordination-based split management. The medical insurance fund **** poor financial capacity, can not be successfully applied to the whole country. There is a lack of coordination between the basic medical insurance fund, the supplementary medical insurance fund, and the large commercial insurance fund in their application, and the various medical insurance funds are unable to perform their functions in the most effective manner. Medical insurance funds involve the government, medical insurance centers, insured persons and hospitals. Tension between doctors and patients often occurs, as well as insufficient payment of medical insurance funds by insured units, the use of individual medical insurance account funds by insured people, fraudulent use of medical insurance funds, and underhanded operations by medical institutions and pharmaceutical representatives. Therefore, the state needs to formulate strong regulations to coordinate the use of medical insurance funds to ensure the sustainable development of China's universal medical insurance. 4, medical insurance fund risk controllability needs to be strengthened
Medical insurance fund is the main component of the medical insurance system. The safety and controllability of the fund is the premise and key to the success of China's health insurance policy implementation. China has entered an aging society, the unique age structure greatly affects the financing and income of health insurance, and the aging trend directly leads to the burden of health insurance fund expenditures and increases the risk of the fund. The increase in the costs of special types of diseases, chronic diseases of the elderly, and long-term hospitalization and care will jeopardize the controllability of the health insurance fund. At the same time, with the continuous improvement of science and technology, more and more new medicines, technologies and treatments are emerging in the medical field. The emergence of these new technologies and methods will directly lead to an increase in medical costs, which will greatly increase the risk of the health insurance fund's expenditures. The medical insurance center, the insured people and the medical institutions constitute three interrelated interests. The insured people pursue the optimization of medical services, and the medical institutions pursue the maximization of benefits. As a result, the medical insurance fund is subject to ever-increasing expenditure risks. The insured people and hospitals have also been involved in illegal phenomena, such as the use of medical insurance funds, medical staff getting rebates on medicines, and inducing patients to consume excessive medical care.
5. The distribution of medical insurance resources is unreasonable, and the burden of costs is bittersweet. Medical insurance sub-system board structure of the characteristics of the government in the distribution of medical insurance resources are subject to great restrictions, medical and health facilities between sectors, industries, urban and rural differences are huge, Shanghai, Beijing, Guangzhou and other centers of the city, concentrated in the country's best medical personnel, the most advanced diagnostic and therapeutic equipment, economically underdeveloped areas of the medical facilities are far from being able to meet the needs of the region. Institutions, institutions and medical institutions organized by enterprises have an oversupply of medical and health care resources, with low utilization rates and serious wastage. In rural areas, however, there is a serious shortage of medical and health resources, with demand outstripping supply, and the problem of difficulty in seeing a doctor or taking medicine is very common; this lack of medical care in rural areas has led to a steady decline in the ability of some places to prevent diseases and epidemics. Taking hospital beds as an example, the rural population accounts for more than 75 per cent of the country's total population; in 1995, urban hospital beds accounted for 52.3 per cent of the country's hospital beds, while rural areas accounted for 47.7 per cent, and the distribution of urban and rural medical-service facilities is extremely unbalanced. The provision of medical insurance in China is determined by the nature of the economic organization in which the worker lives, and medical expenses are mainly accounted for by the worker's unit. Due to the differences in the contributions of this unit, the age structure of the workers, their physical qualities, and the probability of occupational diseases, etc., the burden of medical expenses between units or enterprises is abnormally light and heavy, and even the phenomenon of overburdened medical expenses has occurred, which affects the production and reproduction of the labor force and deteriorates the environment for the survival and development of the enterprises, and results in a distortion of the rules of access to the market and the mechanism of competition of the enterprises.
6, medical costs have expanded dramatically, "free ride" phenomenon is serious. China's urban workers medical is directly free of charge type of protection, the insured only need to pay a small amount of registration fee, can be directly into the field of consumption, to participate in the distribution of health insurance resources, the amount of its consumption is not restricted, which is prone to small illnesses, no disease is also cured, open a generous, open the human side, a person to see a doctor, the whole family to eat medicine phenomenon. According to the estimation of the relevant departments, the unreasonable medical expenses accounted for about 20.3% of the total medical expenses. 1978, the national employees' medical expenses were 2.7 billion yuan, and increased to 77.4 billion yuan in 1997, an increase of 28 times, with an annual increment of about 19%, whereas the financial growth in the same period was only 6.6 times, with an annual increment of about 11%, which is much higher than the financial growth of the medical expenses of the employees in the same period. Uncontrolled medical consumption has led to collusion between doctors and patients and moral degeneration in a few places. Some people go to hospitals to prescribe drugs and cash in at pharmacies. Some prescriptions can even prescribe TV sets, washing machines and other daily necessities. In some places, there are always small drug stores next to hospitals. The reason for the sharp expansion of medical costs in China, in addition to drugs, health care management system is not smooth and caused by the medicine for medicine and pharmaceutical production costs and drug sales are not standardized factors, the above human factors can not help but cause us to think and vigilance.