4. What are the contents of the current medical insurance system in China? What are the problems in reality and what are the insights

After the overall goal of social security is set, there is a lack of specific goals and long-term planning

The Third Plenary Session of the 14th Central Committee of the People's Political Consultative Conference of the People's Republic of China (CPPCC) set the overall goal of reforming China's social security system to be "basically to establish a comprehensive social security system with multiple sources of funding, multiple levels of protection, rights and obligations that are compatible, and socialization of management and services. " The Third Plenary Session of the Fourteenth Central Committee also proposed that "the level of social security should be commensurate with the level of development of China's social productive forces and the affordability of all parties." But so far, the specific goals are still unclear.

●●Lack of target setting for different levels of protection

Currently China's social security system mixes protection and insurance. It is basically confusing as to what exactly are the rights of citizens and what exactly are the rights of people guaranteed by social security. There is no clear concept of what should be guaranteed by the government and what should be guaranteed by individuals. This leads to the fact that some of the rights that should be safeguarded are not safeguarded, while those that should not be safeguarded by social security are safeguarded at great financial and material expense.

●Lack of goal-setting at different stages

China's economy and society are in a period of transition and rapid development, and there is no clear understanding of what level of social security is compatible with what stage of development of economic life and how it should be adapted, not to mention the lack of long-term planning and overall deployment. In this way, what problems arise in the economy and society, hasten to introduce the relevant policies, it is inevitable that the formation of the "headache, headache, foot" situation, more temporary policies, long-term policy less, the system design is becoming more and more complex, the implementation of the cost of more and more high, while the policy effect is often unsatisfactory, and even lead to dissatisfaction.

■ The rights and responsibilities of the government, enterprises and individuals are not clear boundaries

China's social security reform is to reduce the responsibility of the government and state-owned enterprises as a starting point. But as the reform continues, the responsibilities of the government, enterprises and individuals remain vaguely defined. The proportion of national financial expenditures on social security in total expenditures grew from 5.5 percent in 1998 to 11.2 percent in 2005, an average annual increase of 29.8 percent. The central government's investment in the "two guarantees" and "low security" alone rose from 9.6 billion yuan in 1998 to 80.4 billion yuan in 2005, an average annual increase of 35.5 percent.

Local governments at all levels are also increasing their investment in social security year by year. However, at the same time, both enterprises and individuals generally feel that the burden of paying social security contributions is getting heavier. The proportion of individual contributions to the basic pension has increased year by year from 3% at the beginning to 8%, and the contribution base is also increasing year by year. People's dissatisfaction with the social security system is also increasing.

One of the major reasons for this dissatisfaction of all parties is the unclear definition of responsibilities of all parties. The people do not have a clear idea of where the government spends its money, nor do they have a clear expectation of the rate of return on the contributions made by enterprises and individuals. Therefore, the government's responsibility in what areas, should bear how much; business and personal responsibility in what areas, tend to what level, should be further clarified, so that we can really establish the responsibility **** bear the mechanism.

■The evasion of the historical legacy of the formation of systemic deficiencies

China's social security system is facing two basic realities: one is the problem of population aging; one is the problem of historical debt.

Population aging refers to the trend of increasing proportion of the elderly population in the total population. 21st century, China has entered the aging society, and the degree of aging is intensifying, the burden coefficient of the pension fund is gradually increasing, the pension insurance payment will enter the peak period. While ensuring that retirees' pensions are paid in full and on time, the phenomenon of the pension insurance fund not being able to meet its expenses and being short of funds is becoming increasingly prominent, and the pension insurance fund has entered a state of tight operation, with some regions even running a fund deficit. Coupled with the restructuring of enterprises to implement early retirement, making this problem even more serious, directly affecting the operation of China's pension insurance system and play a role.

Historical hidden debt is an important problem in the design of China's current pension insurance system. China's social security system reform began in the mid-1980s. Previously retired people have not paid pensions, there is no personal account, before joining the work of the personal account from the start of pension payments, personal accounts are incomplete. Therefore the retirement costs of these people will have to be borne by those who are working. Under the pressure of historical debt, the partial fund accumulation model of China's pension insurance system, combining social coordination and individual accounts, exists in name only in most areas because of the operation of empty individual accounts. Once China's economy enters a period of steady development and enters an aging society, it is impossible for the pensions collected in the current period to cover the retirement costs of retirees. If a variety of measures cannot be taken to resolve the historical debts to middle-aged and elderly workers formed as a result of the transition between the old and new pension systems, the future will eventually have a major impact on China's social security system. At present, there is a huge gap in the basic pension insurance fund, the pressure to pay is increasing year by year, the risk of payment is becoming more and more prominent.

■The problem of the low level of coordination has been slow to be solved

●The social security system is not unified among the localities

For many years, social security reforms have been made by the regional decision-making, and each region has formulated its own policies, standards, and measures that are only applicable to its own region, resulting in the phenomenon that the level of payment and management are not the same among the regions.

●Difficulties in inter-regional transfers

The lack of uniformity in protection systems across the country has made it difficult to transfer social security between regions, not only between provinces, but also between intra-provincial regions. This is completely contrary to the requirements of the market economy for the free movement of labor. In the reality of the increasing mobility of human resources in China, the difficulty of inter-regional transfer has a great negative impact on the collection and disbursement of social security funds.

●Lack of uniform standards for various social security policies

Social security policies include basic pension insurance, unemployment insurance, industrial injury insurance, maternity insurance, minimum social security and many other types of insurance, and different types of insurance are often formulated by different departments. However, social security covers both targeted and cross-cutting objects, and the introduction of various policies is often to solve the outstanding problems arising in reality, it is not possible to go through a long period of gestation, so there are contradictions and conflicts between the various systems. According to different policies can be implemented different standards of assistance or protection, the newly introduced policy will affect the implementation of previous policies.

●Difficulties in fund management

According to China's current policy, social security funds at the provincial and sub-provincial levels can only be deposited in banks or purchased as treasury bonds. And for a period of time, the interest rates of both banks and treasury bonds have been low in China, with the current bank interest rate already below the inflation rate. With negative real interest rates, social security funds are in fact depreciating in value. This has made the already dire situation of social security funds in China even more severe. On the other hand, it is difficult to guarantee the safety of social security funds if provincial and sub-provincial social security fund management organizations make investments. Therefore, in order to realize the preservation and appreciation of the value of the fund, it is necessary to raise the level of coordination of social security funds, the central level of integrated management.

■Inequitable treatment of different social groups

●Inequitable treatment of social security between regions

The underdeveloped regions in the central and western parts of the country are the labor force's exporters, and the exported labor force works and pays social security contributions in the developed regions. But in the reality that it is difficult to raise the level of social security coordination and implement inter-regional transfers, the funds they pay can only stay in the developed regions and cannot be brought back. This is also one of the important reasons why the developed regions in the east have abundant social security funds and the underdeveloped regions in the central and western parts of the country are short of funds, thus forming the strange phenomenon of "feeding the rich with the poor" and making the already unbalanced regional development even more unbalanced.

●Equitable social security treatment between enterprises, institutions and government agencies

The dual-track operation of social security between enterprises, institutions and government agencies, and the different adjustment mechanisms have not only resulted in different social security burdens between enterprises and institutions and government agencies, but also widened the gap in the treatment of retired employees of enterprises and institutions and government agencies, resulting in unfairness. Treatment gap, resulting in unfairness, has triggered social discontent.

●Inequity in social security treatment between enterprises of different ownership systems and people with different forms of employment

At present, there is still a considerable gap between the goal of basic pension insurance coverage and the goal of a considerable number of employees of non-publicly owned enterprises, flexibly employed people, rural migrant workers who have moved to cities, and expropriated farmers who have been left out of the pension insurance system, and those who have already enrolled in the insurance system do not have a high rate of actual contributions, and the contribution period is intermittent. The number of years of contributions is sporadic. With regard to unemployment insurance, workers in joint-stock enterprises, three-funded enterprises, private enterprises, and township and village enterprises, where work is most precarious, have virtually no unemployment protection. With regard to occupational injury insurance, China is currently facing the reality of a high accident rate in high-risk industries, the incidence of occupational diseases is increasing, and the problem of occupational injuries to migrant workers is very prominent. Most of the migrant workers who enter the city to work in high-risk industries, the risk of occupational hazards is much higher than that of other industries, and they often do not participate in work injury insurance.

In fact, under the current system, the more vulnerable people need social security, the more they are unable to enjoy it because they can't afford it. Taking the flexible employment and the unemployed as an example, no one pays the part of the enterprise for them, and the contribution base is based on the local average social wage, so a large part of the low-income group can't afford to pay all kinds of social security contributions, and they become the long-term unpaid group of social security, and thus can't enjoy the social security.

●Inequity between urban and rural areas

The rural population accounts for the majority of China's population, but the rural social security system has not yet been formed. Although the Sixth Plenary Session of the 16th Central Committee explicitly proposed the establishment of a "social security system covering both urban and rural residents", the new rural social security system is still in the exploratory stage, with rural pension insurance basically at a standstill in most places. No effective system model has been formed, and the development of localities is extremely uneven.

■Technical problems of system design and management

With the deepening of the reform of the social security system, China's social security system has been designed to be more and more complex, and the cost of management has become higher and higher. The construction of the entire social security system is characterized by a clear contingency, the degree of importance attached to a particular security system changes with the size of the political voice of different social groups, the size of the sectoral forces or the size of personal influence. Non-institutionalization is very obvious; the level of legalization is not high, and even where regulations exist there is a serious lack of law enforcement; there is a lack of communication and coordination between departments, between systems, and between upper and lower levels, and the phenomenon of overstepping and missing positions occurs from time to time. Social security financing is not standardized, the level of management of funds is limited, and supervision of social security funds needs to be improved. The level of electronic management also needs to be improved.

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