That is, by 2025, the medical security system will be more mature and stereotyped, and the reform tasks in key areas such as treatment guarantee, fund-raising operation, medical insurance payment and fund supervision will be basically completed.
It is reported that this is the first special five-year plan for universal health insurance in China. Relevant measures echo people's livelihood concerns and face the shortcomings in the medical insurance system, which reflects the country's attention to the problem of difficult and expensive medical treatment. Among them, the plan mentions encouraging the development of commercial health insurance, and commercial insurance needs to grasp three opportunities in helping to build a multi-level medical security system.
National Medical Security Plan in the Tenth Five-Year Plan
It is suggested that we should always adhere to the basic concept of insurance and encourage the development of commercial health insurance.
According to the contents of the plan, China has built the world's largest basic medical security network covering the whole people.
During the "Thirteenth Five-Year Plan" period, China's basic medical insurance covered 654.38+36 million people, and the coverage rate was stable at over 95%. In the basic medical insurance policy for employees and urban and rural residents, the proportion of hospitalization expenses paid by the fund is stable at about 80% and 70% respectively. The centralized purchasing price of drugs and high-value medical consumables organized by the state has dropped by more than 50% on average, and the people's sense of medical security has been continuously enhanced.
Although the above data are encouraging, the plan also points out that the development of medical security in China is still unbalanced and inadequate, the multi-level medical security system is still not perfect, the ability to support serious and serious diseases is still insufficient, the coordination of medical insurance, medical care and medicine reform needs to be further strengthened, and there is a gap between medical insurance services and the needs of the masses.
Therefore, the Plan puts forward the basic principle of adhering to basic and more sustainable protection.
-Insist on ensuring basic and more sustainable development. Insist on seeking truth from facts, do what you can, put the basic concept of insurance throughout, scientifically and reasonably determine the scope and standard of insurance, correct the problems of excessive insurance and insufficient insurance, improve the overall economic ability of the fund, and prevent and resolve the operational risks of the fund.
It can be seen that the "14th Five-Year Plan" of medical insurance puts forward that the basic concept of medical insurance should run through, which also means that the water in the "pool" of medical insurance is limited, and it is impossible for all medical expenses to be paid by basic medical insurance in the future. It is particularly important to improve the security system including commercial insurance, charitable assistance and medical assistance.
Among them, the plan mentions encouraging the development of commercial health insurance. The first is to encourage product innovation. Encourage commercial insurance institutions to provide comprehensive health insurance products and services in the fields of medical treatment, disease, rehabilitation, nursing and maternity, and gradually incorporate the application of new medical technologies, new drugs and new devices into the scope of commercial health insurance. Support commercial insurance institutions to cooperate with Chinese medicine institutions to carry out health management services and develop insurance products such as Chinese medicine disease prevention. Pay more attention to the role of commercial medical insurance, guide commercial insurance institutions to innovate and improve the content of protection, and improve the level of protection and service capabilities.
The second is to improve the support policies. Clarify the responsibility boundary of basic medical insurance, support commercial insurance institutions to develop commercial health insurance products that are connected with basic medical insurance, and better cover the expenses that are not paid by basic medical insurance. Explore and promote the medical insurance information platform and commercial health insurance information platform to achieve information sharing according to regulations.
The third is to strengthen supervision and management. Standardize commercial insurance institutions to undertake serious illness insurance business, and establish and improve the performance evaluation mechanism for commercial insurance institutions to participate in basic medical insurance. Implement the responsibilities of industry regulatory authorities, strengthen the supervision of market behavior, and highlight the supervision of key links such as the design, sales and compensation of commercial health insurance products.
The position of commercial insurance in the construction of multi-level medical security system
An important participant in basic medical insurance, a major provider of supplementary medical insurance products, and a leader in commercial health insurance market.
In fact, the National Medical Insurance Bureau publicly solicited opinions on the "14 th Five-Year Plan" medical security plan in September 2020; The executive meeting in the State Council on September, 2002 1 51day also mentioned once again that the multi-level medical insurance system should be improved and the medical insurance assistance policies should be optimized by classification.
In view of the 14th Five-Year Plan, what development space and opportunities will commercial health insurance usher in? In this regard, industry experts have interpreted it to varying degrees. We have sorted out some different opinions as follows:
Zhu Minglai, Director of Health Economy and Medical Security Research Center of Nankai University
The Plan emphasizes that basic medical insurance cannot be fully responsible in the future. Commercial insurance, charitable assistance and mutual medical assistance will all see great development during the Tenth Five-Year Plan period. In particular, we should combine the current three distributions, * * and the rich to build a systematic project to prevent poverty caused by illness, and we can no longer rely solely on basic medical insurance.
Professor Gong Zheng from China Social Security Research Center of Renmin University of China.
During the Tenth Five-Year Plan period, the key task of the reform and development of China's medical security system should be to accelerate the optimization and finalization of the statutory medical security system in an all-round way, and at the same time build a relatively complete legal system of medical security, and promote it to enter the track of rule of law. Among them, the top-level design of multi-level medical security system should be introduced to clarify the functional orientation of different levels; Focus on commercial health insurance; Promoting the development of charitable medical care is listed as a necessary part of the construction of a multi-level medical security system, and support is increased according to the provisions of the charity law.
Ding Shaoqun, Professor and Doctoral Supervisor, School of Insurance, Southwestern University of Finance and Economics
The Tenth Five-Year Plan of National Health Insurance will focus on "four mechanisms" and "two supports". "four mechanisms": first, improve the guarantee mechanism of fair and moderate treatment; The second is to improve the stable and sustainable financing operation mechanism; The third is to establish an efficient medical insurance payment mechanism; The fourth is to improve the strict and powerful fund supervision mechanism.
"two supports": first, coordinate the reform of the supply side of medical services; The second is to optimize the public management service of medical security. In deepening the reform of medical insurance system, commercial insurance will be positioned as an important participant in basic medical insurance, the main provider of supplementary medical insurance products and the leader of commercial health insurance market.
Yang Yansui, Professor of School of Public Administration, Tsinghua University and Director of Research Center for Employment and Social Security.
It should be noted that there are obvious differences between social medical insurance and commercial insurance in terms of coverage, financing methods, claims scope and principles, business models and so on. It is necessary to establish a cooperation mechanism on the basis of clear borders. Introducing commercial insurance to improve the professionalism of supervision, there are two problems that must be handled well: First, it needs the explicit authorization of the government. Commercial insurance is not a government department and has no right to supervise medical insurance funds. When the government authorizes it to supervise, it is necessary to define the boundaries of authority, what can be done and what can't be done, and there must be unified standards.