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On the status quo and reform of the rural medical security system
The rural medical security system is a comprehensive medical security system that guarantees rural residents' access to basic medical care and preventive health care services through the government's system design and maintenance, fund-raising and management, and health maintenance regulation and supervision. With the rapid development of China's economy after the reform and opening-up, China's construction in all aspects has been gradually improved, but the development of China's social security program has been relatively slow, especially the rural medical insurance problem is prominent. There are nearly 900 million peasants in China, and the problem of medical care for such a large population has not been completely solved, which will seriously affect the stability of the rural society and the healthy development of the economy, and become a bottleneck in the comprehensive construction of a moderately prosperous society and the construction of a harmonious socialist society. This paper will discuss the reform measures of the rural medical insurance system from the current situation.
I. The development of rural medical insurance system
After the founding of New China, the Party and the government have attached great importance to the health of the people, and have strongly supported the development of rural health care. Although most areas were economically backward, through direct administrative intervention by governments at all levels, and along with the rise of cooperative agriculture and people's communes, cooperative medical care was rapidly established in a wide range of rural areas from 1955 onward, and "by the end of the 1970s, medical insurance covered almost all of the urban population and 85% of the rural population. This was an achievement unparalleled in low-income developing countries." By 1980, 90 percent of the country's production brigades had cooperative medical care. However, after the 1980s, with the abolition of the "people's commune," the unification of government and society, the implementation of the household contract responsibility system, and the reduction of the collective economic component, the cooperative medical care experienced a serious decline; by 1985, the implementation of the cooperative medical care of the rural grass-roots units from 90% (production brigades) plummeted to 5% (administrative villages).
In January 1997, the State Council put forward the idea of "actively and steadily developing and perfecting the cooperative medical system in rural areas," and in March of the same year, the Ministry of Health submitted to the State Council a number of opinions on the development and perfection of cooperative medical care in rural areas. The development of rural cooperative medical care reached a modest climax in 1998, when "12.56 per cent of the country's rural residents were provided with some degree of medical protection, and 6.5 per cent were provided with cooperative medical care". However, "the proportion of urban residents paying out-of-pocket for medical care still accounted for 44.13%, and the proportion of rural residents paying out-of-pocket was as high as 87.44%." After 1998, cooperative medical care was once again in the doldrums.
Since 2003, with the proposal of ruling for the people, putting people first and building a harmonious society, the government and all walks of life have fully recognized the great significance of carrying out the pilot work of the new rural cooperative medical care, and under the impetus of the relevant policies of the Central Government of the People's Republic of China*** and the State Council, the pilot work of the new rural cooperative medical care has been pushed forward in a solid and positive and steady manner and has achieved remarkable results, and in 2006, the State Council In 2006, the State Council forwarded the Notice on Accelerating the Pilot Work of New Rural Cooperative Medical Care issued jointly by the Ministry of Health and seven other ministries and commissions, in which it was proposed that "by 2006, the number of pilot counties (municipalities and districts) nationwide should reach about 40% of the total number of counties (municipalities and districts) in the country; in 2007, the number should be expanded to 60%; in 2008, it should be basically implemented nationwide; and in 2010, it should be realized". The new rural cooperative medical care system basically covers rural residents".
The year 2007 was a critical year for the new rural cooperative medical care to move from the pilot stage to the stage of comprehensive promotion. The State Council's inter-ministerial joint conference on new rural cooperative medical care decided that, starting in 2007, the country's new rural cooperative medical care would move from the pilot stage to the full-scale promotion stage, covering more than 80% of the country's counties (cities and districts).
Two, China's current stage of the current situation of rural medical security system
Currently, although the per capita income of rural residents has risen, but can not solve the expensive medical costs, rural medical conditions are still very serious. It is mainly manifested in the following aspects:
First, the problem of rural medical conditions. Most of our countryside (township) health center houses are dilapidated, lack of basic medical equipment, a considerable part of the practitioners of health technology is not high quality, lack of necessary professional medical knowledge, resulting in unnecessary medical accidents. 2002, the country reported more than 580,000 cases of new tuberculosis patients, 80% in the rural areas. The prevention and treatment of endemic diseases, such as schistosomiasis, endemic fluorosis (arsenic), macrosomia, iodine deficiency and keshan disease, which are prevalent in rural areas, are facing new challenges. Due to the economic backwardness of these endemic areas, poor medical conditions, sick people can not get timely and effective treatment, production, life has been seriously affected, hindering the local socio-economic development.
Second, the cost of rural medical care. As a result of increased pollution of the rural environment, the impact of poor lifestyles, the urban-rural income gap, the rapid rise in medical costs and changes in the disease spectrum, farmers to cope with the risk of disease with the family has become overwhelmed. According to the 1998 National Health Services Survey, 87.4 per cent of farmers in China pay entirely for their own medical care. Due to financial difficulties and inability to pay for medicine, 37% of the sick farmers had an average hospitalization cost of 1,532 yuan. According to a sample survey conducted by the National Bureau of Statistics in 1998, 33.5 per cent of the farmers in China had a per capita net income of less than 1,500 yuan, and in six of the country's 31 provinces (autonomous regions and municipalities directly under the Central Government), the net income of farmers was less than 1,500 yuan; once a farmer was sick and hospitalized, all of his income for the year was not enough. The proportion of poor rural households in localized areas that are impoverished or return to poverty because of illness is as high as 50 per cent, which has become one of the constraints affecting the development of the rural economy and the elimination of poverty and prosperity among farmers. Nowadays, the cost of rural medical insurance is paid by the government, and relying on government finance alone is indeed a bit reluctant, but now the cost of medical care is constantly rising. The shortage of funds for rural medical insurance is a big bottleneck.
Third, the management of the medical insurance system. It is difficult for the government to clarify the medical situation of the residents, so that some people need medical insurance but did not get the corresponding health care, while some do not need but get too much health care services, which inevitably have the phenomenon of profit for private interests. Therefore, it is necessary for government administrators to carry out supervision, which requires the establishment of an independent supervisory body that can not only identify the problems of medical insurance, but also recognize whether there are irregularities. And how to set up this monitoring body is another problem. The Government has to raise funds and then spend them. How much has been raised, how much has been spent and where has it been used? Even if the funds are used to the point, if the results are not satisfactory, public opinion will suspect that the funds have been misappropriated. It is because of these problems that the government needs to supervise the use of only the funds raised for the medical insurance business. In short, there are management flaws in rural medical insurance, can not rely on the government alone.
Three, China's rural medical insurance system reform model
Based on the above problems of China's rural medical insurance system defects, the author believes that the current stage of rural cooperative medical care for the people's office to help the most basic model, at the same time, it should be appropriate to carry out reforms. The current stage of rural medical cooperation is mainly characterized by two features: private and public assistance: private. Farmers participating in rural cooperative medical care to pay a certain amount of health care fees; rural cooperative medical care fund mainly from the collective economy, originating from the collective economy of the public welfare funds;
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