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Currently there are the following main models of medical insurance in the world: (1). Germany's social insurance model, which is characterized by: health insurance fund social co-ordination, mutual **** relief, mainly by employers and employees to pay, the government discretionary subsidies. (2). The national insurance model of the United Kingdom, characterized by: the government directly organizes the medical insurance business, the people pay taxes, the government collects the taxes and allocates them to public hospitals, which provide free services directly to the residents. However, this model tends to impose a heavy burden on the national treasury. (3). The commercial insurance model of the United States, characterized by the freedom to participate in the insurance, flexible and diverse, the money to buy high-grade, no money to buy low-grade, suitable for multi-level demand. However, this system in the United States, which is mainly based on free medical insurance, operated according to the laws of the market and aimed at making profits, tends to refuse to accept those residents with poor conditions and low incomes to take out insurance, so its fairness is poor. (4). In Singapore's savings insurance model, the law requires that a portion of an individual's consumption fund must be converted into a health insurance fund in the form of a savings personal provident fund, and the State establishes a centralized provident fund to share part of the cost. In addition, the Government allocates funds to set up a Health Care Trust Fund to help indigent nationals pay for services. It is based on health care savings and emphasizes individual responsibility while at the same time playing the role of social *** relief and risk sharing.
It can be seen that each of these models has its own strengths and weaknesses. And China's current medical service model is dominated by state-owned hospitals, urban residents of public health care. Competition among hospitals is non-price competition, in order to attract patients and excellent doctors, hospitals usually purchase high-tech equipment to obtain industry reputation and competitive advantage, so that medical costs continue to increase, which not only contributed to the rapid growth of medical costs, but also caused a great waste of medical resources. The current expenditure on publicly-funded medical care has overburdened the state's finances, while patients who are genuinely ill do not receive the necessary and timely medical care, a considerable number of socially disadvantaged groups are not covered, the low-income class pays a higher percentage of their total wages for medical care than the high-income class, and the social security and medical care of peasants is often left unattended for long periods of time on the grounds of the large population and the limited financial resources of the state, so that the health Health inequities persist and tend to increase. Insufficient investment in national health care costs, a poor funding system, and deficiencies in the management of medical prices have seriously impeded the sustained, stable and healthy development of China's socialist market economy. The fundamental interests of the people have been jeopardized. Therefore, how to build a wide-coverage, urban and rural integration of social medical security system, as a way to protect the basic health rights and interests of all citizens, especially the rights and interests of the urban jobless residents and the poor rural population, has become an important topic in the reform of the health care system urgently needs to be explored.
China's health insurance system must not follow a single path of commercialization, although privatized medical institutions can provide more choices for patients' diversified needs; a privatized health care system is more efficient, can provide people with low-cost, high-quality services, and prompts the state-owned hospitals to improve the quality of their services and reduce operating costs. However, the privatization of the healthcare system does not help to reduce the increasing cost of healthcare, and it directly affects the quality of healthcare practices because private healthcare institutions often reduce their operating costs by lowering the wages and benefits of their employees. In addition, in order to pursue efficiency, private healthcare organizations will consciously select patients and confine themselves to certain areas, resulting in excessive and duplicated supply of healthcare services, which not only wastes limited resources, but also undermines the fairness of healthcare services to a certain extent. Since China is a vast country with a low level of socio-economic and cultural development, and since there are great differences in the level of development of different places, we cannot go for a purely savings-based medical insurance model, let alone the path of universal medical insurance. In my personal opinion, China's medical insurance should implement a management-type model combining social insurance and commercial insurance. Commercial medical insurance, as the supplementary medical insurance of the society, should be established on a voluntary basis and operated in accordance with the rules of the market, and the role of the government should be to manage the social medical insurance and to invest in the basic social medical insurance, so as to realize the perfect combination of fairness and efficiency. Improving the social ****ization of the medical system and the socialization of management and services is the basic way out to solve the imbalance of China's medical insurance. Specifically, we should take the following reform measures:
Firstly, do a good job of classifying and managing the medical institutions to adapt to the needs of the reform of the basic medical insurance system. Classify medical institutions into two categories, non-profit and for-profit, and manage them. Based on the nature of medical institutions, their social functions and the tasks they undertake, we should formulate and implement different fiscal, taxation and pricing policies, and actively implement a system of public notification of prices charged for medical services.
Second, accelerate the implementation of regional health planning and strengthen the macro-management of medical resource allocation. The allocation of financial resources should reflect the guiding ideology of regional health planning, with the fundamental basis of improving the efficiency of the comprehensive utilization of regional health resources and meeting the health needs of the people. The object of financial subsidies should gradually shift from subsidizing medical institutions to subsidizing medical patients.
Third, the reform of the "medicine for medicine" system, the implementation of the "technology for medicine" mechanism. For a long time, China's medical institutions to implement the financial subsidies and service charges, drug wholesale and retail spread income, tax breaks combined with economic compensation policy. The shortcomings of "medicine for medicine" have not only led directly to the excessive growth of drug costs, increasing the burden on the people, but also fostered corruption. The government should resolutely implement a system of separate accounting and separate management of medicines, break the monopoly system that does not distinguish between medicines, establish a competitive mechanism for the circulation of medicines, bring down the excessively high prices of medicines, and fundamentally cut off the direct link of economic interests between medical institutions and the marketing of medicines, so as to encourage doctors to administer medicines according to the illness and rationalize the use of medicines, and to curb the wastage caused by indiscriminate prescribing of medicines and overprescribing of medicines. To take into account the actual situation of each region, first of all, the hospital drug income to implement the management of two lines of income and two lines of expenditure, drug income and expenditure balances are all turned over to the regional health administrative departments, into the financial account management. Secondly, we should gradually standardize the financial subsidies and adjust the price of medical services on the basis of the hospital outpatient pharmacy into a drug retail enterprises, independent accounting, taxation.
Fourth, standardize the behavior of medical institutions to purchase drugs, and vigorously implement the centralized bidding and purchasing management of drugs in medical institutions. Centralized bidding and procurement of medicines is the current correction of unhealthy practices in the purchase and sale of medicines, reduce the burden of social costs of medicines, to ensure the smooth implementation of the basic medical insurance system for urban workers. Centralized bidding and purchasing of medicines is conducive to curbing corruption in the process of decentralized purchasing, strengthening the market competition mechanism, reducing the number of circulating links, and lowering the cost of circulating medicines; it is conducive to strengthening the quality control of medicines, and improving the safety and efficacy of medicines used in the clinic; it is conducive to the government's monitoring of the price of medicines, and lowering the inflated price of medicines; it is conducive to promoting the structural adjustment of the production of medicines, and strengthening the monitoring of the quality of medicines, and facilitating the Organize the production of medicines in a planned manner.
Fifth, strengthening quality control and quality management in medical institutions, safeguarding the legitimate rights and interests of patients, and providing the public with medical services of excellent quality and reasonable prices. Adhering to the principle of equal emphasis on legal supervision, administrative management and economic regulation, medical institutions are guided to establish the service ideology and management tenet of "quality first, patient first", and to strengthen the control of practicing qualifications with the licensing and management of medical institutions and their practitioners as the core. In addition, in order to ensure the implementation of quality control and management, medical institutions to establish and improve the system of technical specifications for medical services; to formulate annual quality control program, and regularly check its organization and implementation.