1. There are few industry premium levels and low insurance premium levels
Currently, according to my country's "National Economic Industry Classification", my country's work-related injury insurance divides industries according to the degree of work-related injury risk in different industries. There are 3 categories: low-risk industries, medium-risk industries and high-risk industries. The contribution proportions for these three types of industries are 0.5%, 1.0% and 2.0% of the employer's total employee wages respectively. It can be seen from the rate setting that the risks of work-related injuries vary greatly between industries, but the differences in rates are not significant.
2. The coverage rate of work-related injury insurance is low
In 2011, 2012, 2013, 2014 and 2015, the number of people participating in work-related injury insurance nationwide accounted for 23.1% of the national employed population. , 24.8%, 25.8%, 26.7% and 27.6%; and the proportion of migrant workers insured to the total number of migrant workers was 27%, 27.3%, 27.0%, 26.9% and 26.9% respectively. Whether analyzed from the total number of people participating in work-related injury insurance and the total number of migrant workers participating in work-related injury insurance, or from the proportion of migrant workers participating in the insurance to the total number of migrant workers and the proportion of the national insured to the national employed people, both are relatively low.
3. Problems in the work-related injury identification system
1. The lack of clear legal provisions for work-related injury identification
The "Work-related Injury Insurance Regulations" do not clearly define work-related injuries. Instead of defining the scope of work-related injuries based on experience, they gave specific examples to illustrate the scope of work-related injuries, and did not use general and basic terms to define the definition of work-related injuries. Under normal circumstances, we can further determine whether it is a work-related injury by judging whether the incident that occurred falls within the listed legal facts. However, because the legal facts listed based on experience are relatively rigid, when some new legal events occur in real life, it is difficult to determine the scope of work-related injury recognition.
2. The work-related injury identification procedure is complex
According to the "Work-related Injury Insurance Regulations", "Work-related Injury Determination Measures" and other relevant laws and regulations, a complete set of relief procedures usually requires an application More than a dozen procedures, including work-related injury identification, review and processing by relevant administrative departments, usually take up to three and a half years. In real life, in order to minimize compensation, many employers abuse their right to litigate and extend the time for relief procedures to wear down the patience of workers and wear them down. Under normal circumstances, employees consider their own physical health and often reluctantly choose to give up the recognition of work-related injuries or accept unfair mediation. This is not only inconsistent with the legislative purpose of the labor law but also violates the legislative purpose of the work-related injury system.
3. Lack of supervision in the work-related injury identification process
The publicity of work-related injury identification results is the most important part of the work-related injury identification supervision process, which requires the social insurance administrative department to collect comprehensive information on the work-related injury identification process. Be familiar with the evidence related to the incident and understand the whole story of the work-related injury, and accurately apply relevant laws; on the other hand, you must actively accept the supervision of the people and judicial authorities. In addition, it must standardize the certification process. However, compared with administrative actions such as administrative licensing and administrative penalties, work-related injury identification directly involves the interests of both parties, labor and management, and is less transparent. As a result, the right to know of the employer and injured employees cannot be fundamentally guaranteed. Therefore, on the one hand, in order to make the evidence collected by the work-related injury identification department and the identification process more transparent and credible, and on the other hand, to make the processing results more fair, it is imperative to design a standardized work-related injury identification system.
4. The subject of the application for work-related injury identification is unclear
The "Regulations on Work-related Injury Insurance" stipulates that when starting the work-related injury identification process, the employer must first submit an application for work-related injury identification. If the employer fails to submit an application within the time limit stipulated by law, the applicant can be the injured employee, a trade union organization or his close relative. However, the law only broadly stipulates that employees themselves, close relatives, and trade union organizations can apply, and does not stipulate which one can apply first. This provision is also inconsistent with the provisions of my country's Civil Law, Criminal Law and other laws, and goes against the generally applicable legal experience.
4. Insufficient construction of work-related injury prevention mechanism
In terms of government management, my country's work-related injury prevention management system is relatively complex, which is mainly reflected in the fact that work-related injury accident prevention is managed by the national work safety supervision and management department, The prevention and treatment of occupational diseases is managed by the occupational health department, and the work-related injury insurance fund is managed by the social security management department.
In terms of work injury prevention, on the one hand, there is a certain degree of overlapping of functions among these departments; on the other hand, there is a lack of corresponding coordination mechanisms between the departments. In addition, a common problem in our country is: on the one hand, after employees participate in work-related injury insurance, work-related injury compensation is guaranteed to a certain extent; on the other hand, because companies with large differences in work-related injury risks have smaller differences in premium rates, some companies do not pay attention to work-related injury prevention. They are no longer so active and no longer pay so much attention to the maintenance of production equipment and the improvement of the working environment.
5. There is a certain degree of moral hazard in work-related injury insurance
1. Work-related injury prevention
my country’s current collection of work-related injury insurance premiums is different. Rates and floating rates. The rates charged to different companies in the same industry will also be implemented at different rates based on the frequency of work-related injuries in the previous year, improvements in safety measures, etc. This has prompted employers to strengthen work-related injury prevention to a certain extent. Reduce their moral hazard. However, the policy does not clearly stipulate the punitive measures to be taken against companies that do not have adequate safety measures, which will increase the existence of moral hazard to a certain extent.
2. Work-related injury compensation and rehabilitation
On the one hand, as the demander of work-related injury insurance, patients know that they do not need to pay medical expenses when they see a doctor, and the work-related injury insurance agency will pay for them. This may lead to over-consumption phenomena such as extensive medical care for minor illnesses, or outpatient services being converted into hospitalization. In addition, there are unreasonable medical expenses incurred by employees injured at work for family members, friends, etc. and unreasonable medical expenses incurred for treatment of previous illnesses.
On the other hand, medical institutions engage in inductive treatment and over-treatment for their own benefit. The income of medical institutions mainly relies on a large amount of medicines and medical service income. At the same time, strong professionalism and information asymmetry make medical services in a monopoly position, and work-related injury insurance institutions and work-injured employees cannot achieve effective supervision. Driven by profit, even when the condition has been determined, doctors will still ask patients to check redundant medical equipment and provide excessive treatment.
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