How to strengthen the connection between various systems?
(1) Increase the government's investment in medical services to lay the foundation for the effective operation of the medical security system.
The government's capital investment is mainly manifested in two aspects, one is the investment in medical service providers (hospitals), and the other is the investment in other medical security systems, such as medical insurance for flexible employment groups, medical assistance for vulnerable groups, and new cooperative medical system for farmers. For hospitals, the government should consider increasing the proportion of financial subsidies appropriately and completely change the business model of "taking medicine to support doctors" from the compensation mechanism. It should be emphasized that both the central government and local governments will bear corresponding responsibilities in the input of medical security, and the two levels of government should carry out a reasonable division of labor, not just relying on the central financial allocation. Of course, there should also be necessary supervision over the use of government funds to ensure that the funds are really used for the services of medical insurance participants. Governments at all levels have the responsibility to invest in other medical security systems other than the basic medical insurance system for employees. At the same time, the medical assistance system advocates charitable donations and various financing methods. The development direction of China's social security system is to establish a social security safety net jointly compiled by the government and other social forces, such as non-governmental organizations, charities, enterprises and individuals. For the farmer cooperative medical system, governments at all levels should also increase capital investment. The Opinions on Accelerating the Establishment of a New Rural Cooperative Medical System defines the government payment standard, that is, the local finance subsidizes each farmer every year 10 yuan. The crux of the problem is that the government should earnestly perform its duties. At the same time, the central government should increase capital investment in poor areas to ensure that farmers get medical security.
(2) linkage of medical insurance, medical care and medicine. Create a good environment for the implementation of the medical security system
Medical care, medical insurance and drugs are three components of the social medical security system. Only when the three aspects work together can the whole medical system provide basic medical services normally and protect people's health. The positioning of medical care, medical insurance and medicine in the medical system and the close relationship among them determine that the three reforms must be linked and go hand in hand. First of all, the government correctly locates public hospitals or other non-profit medical institutions, and changes the hospital's business model of "taking medicine to support doctors" through appropriate compensation mechanisms. Secondly, the government should make up its mind to completely solve the problems in drug production and circulation and reverse the situation of inflated drug prices. Finally, adjust the supply, demand and guaranteed benefits of medical insurance. Only in this way can we achieve the goal of "providing high-quality medical services at a relatively low cost and striving to meet the needs of the broad masses of people for basic medical services".
(3) Developing community health services. Straighten out the medical and health service system
Community health care service has the functions of "prevention, health care, medical treatment, rehabilitation, health education and family planning". In the process of improving the medical security system, it is very important to speed up the construction of community health service system. A reasonable medical and health service system should be a two-tier or three-tier mechanism, that is, minor diseases and common diseases should be treated in community hospitals with general practitioners as the main body, and serious diseases should be treated in larger hospitals. The medical cost of community hospitals is relatively low, and patients can get timely and affordable services. In order to promote the development of community health service, we should first vigorously train the general practitioner team to become the main force of community medical service; Second, encourage doctors or doctor groups to set up clinics in the community, which can be newly established or transformed by district-level (first-and second-class) hospitals; Third, support private capital to enter the field of community medical services and encourage society to donate community medical services; Fourthly, community medical services should be included in the basic medical security system, and community hospitals or clinics should be designated hospitals.
(four) to speed up the pace of social medical security legislation. Provide legal protection for the implementation of the medical security system.
It is very important to implement the tripartite payment system in medical insurance, standardize the responsibilities and behaviors of demanders, suppliers and insured parties, especially strengthen the supervision of medical behavior and strictly control the occurrence of unreasonable medical expenses. Therefore, it is necessary to legislate on medical security as soon as possible. For medical service providers, strict implementation of medical insurance designated hospitals, retail pharmacies access qualifications, medical insurance agencies through the signing of contracts with designated hospitals, designated pharmacies for standardized management. For demanders, it is also necessary to use laws to restrain their medical treatment behavior. Increase personal expenditure awareness through classified payment. Those who lend or fraudulently use medical insurance cards will be punished by certain financial compensation or suspension of issuance. For enterprises and units, it is necessary to strengthen the collection of funds through legal means. The fund should be paid in full and on time to ensure that the medical insurance fund has a long-term stable source. For social medical insurance management institutions, there should also be corresponding codes of conduct and exercise their functions and powers in strict accordance with the law. At the same time, it has the obligation to announce its management performance to the public and accept public inquiries and social supervision.
(5) Support the development of commercial medical insurance and truly form a multi-level medical insurance system.
In order to further promote the development of commercial medical insurance, at least two aspects can be considered: one is to divide the scope of social medical insurance and commercial medical insurance, and supplementary medical insurance should be handed over to commercial medical insurance. Therefore, the business scope of social insurance should be defined by law, and commercial insurance should not be involved in the jurisdiction of social insurance; And it belongs to the basic field beyond the coverage of medical insurance, and social insurance management institutions should not interfere. The second is to further improve and implement policies to support the development of commercial medical insurance. The current preferential policies are not strong enough, so we can consider learning from foreign experience to further improve and implement the preferential tax policies. For example, supplementary medical insurance premiums are paid before tax within a certain amount (4% of total wages); For companies operating supplementary medical insurance, the premium income is reduced or exempted from business tax; Personal income tax is not levied on medical insurance premiums paid by individuals.