One. Background and process of medical insurance reform in China.
After the founding of the People's Republic of China, government agencies and institutions in China implemented the system of free medical care, and enterprises implemented the system of labor insurance medical care. With the establishment of the socialist market economic system and the deepening of the reform of state-owned enterprises, the disadvantages of this system are becoming more and more obvious. First of all, the growth of medical expenses exceeds the growth rate of gross national product. In other words, the production capacity of a country can't keep up with the consumption level. Moreover, this medical system has also caused a huge burden gap among enterprises: there are few old employees in emerging industries and relatively few medical expenses, while old enterprises always bear a heavy burden. In addition, individuals are accustomed to the free medical system. "One person sees a doctor, the whole family takes medicine", "A minor illness is regarded as a serious illness, and no illness is regarded as a disease." What is the picture? Reimbursement whose money did you earn? Countries and enterprises. What are the consequences? Waste.
Based on the increasingly heavy burden of medical expenses, the State Council made an implementation plan for the reform of the medical insurance system on the basis of the pilot experience of 1994, and at the end of 1998, issued the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Workers. The basic idea of reform is "low level, wide coverage, burden on both sides and combination of unified accounts". "Burden by both parties" means that the basic insurance is shared by both units and employees. "Combination of unified accounts" refers to the combination of social pooling and individual accounts for insurance funds. The medical system of free labor insurance, which has been implemented for more than 40 years, is over. By the end of 2000, China had basically established a basic medical insurance system for urban workers covering 50 million people.
At the social security work conference held in Harbin in April, 2002, all parts of the country were required to speed up the process of medical insurance reform for urban workers, effectively protect the basic medical needs of workers, and ensure the completion of the work goal of starting medical insurance in more than 90% of areas and covering 80 million people this year. The reform of medical insurance system in China has made considerable achievements. By the end of June this year, 307 of the 349 overall planning areas at or above the prefecture level had been implemented, accounting for 88% of the country. The number of people covered reached 50.26 million, accounting for 30% of the number of people who should be insured nationwide.
Two. Practical problems in the new medical insurance system
1. will bring medical risks.
The new system only provides basic medical insurance and does not cover all medical expenses. Therefore, people who have enjoyed free medical care for decades seem to find it difficult to accept the "cruel" reality that they have to pay for medical treatment themselves, which clearly shows their nostalgia for the past medical system. Take personal account as an example. According to the regulations, individuals are required to pay 2% of the average monthly income, and the unit always bears the payment, of which less than 30% is included in the personal account, which is 0.8% of the total amount of 65438+ and less than 38% of the individual's monthly income. Average annual income of Beijing employees 1 10,000 yuan. Therefore, the personal accounts of middle-level employees are less than those of 300 yuan. This is his annual outpatient medical expenses. There is no problem with social co-ordination, but if you get seriously ill, the funds in your personal account will be stretched. Therefore, many people may be reluctant to see a doctor, which will affect their health.
In addition, children are not included in the new system. In the past, the medical expenses of children in labor insurance medical care and public medical care were basically borne by their parents.
The new medical system is not enough to prevent problems. In the past, medical treatment paid attention to prevention, and the unit had formal experience, a fixed infirmary and a children's epidemic prevention station. These all belong to the outpatient category of the new medical insurance. This means spending money from your personal account. This is likely to lead to: the disease that should have been seen was not seen, and it was originally a minor illness but it was delayed into a serious illness. Foreign countries have always regarded "prevention is the most effective way to control serious diseases" as a wise saying.
2. Hospitals may hinder medical reform.
Medical insurance reform is the most complicated of all social security projects, involving social insurance institutions, hospitals, individuals, enterprises and medical industries. The complicated relationship, coupled with the fact that there was no distinction between medicine and medicine in hospitals in the past, is even more complicated. The reform of medical insurance is difficult, not in medical insurance itself, but outside medical insurance. The reform of hospital system and medical system is likely to hold back the reform of medical insurance.
The general idea of medical insurance reform is to "provide better services for the people with less expenses and meet their basic medical needs." Controlling expenses is the fundamental problem of medical insurance. This can't be solved by medical insurance itself, so we can only ask the hospital for help. The main reason for the current high medical expenses is the high drug price. Hospitals are the main channels for selling drugs, and selling drugs to hospitals is the highlight of hospital income. As a non-profit organization, the hospital can only meet 50% of its needs with the national financial allocation to maintain its daily operation. The other 50% mainly depends on selling medicines.
In addition, the unreasonable structure of medical resources is another prominent problem. Despite the huge differences between urban and rural areas (the urban population accounts for less than 30% of the total population, but enjoys 70% of the country's medical and health resources), the structure of urban hospitals is quite unscientific. 90% people suffer from a series of minor illnesses, so it is not necessary to go to a general hospital. There are too many big hospitals and too few small hospitals serving the community. There are many large hospitals, the construction cost is high, and the desire to recover the cost is stronger. Without a well-developed community hospital medical network, the medical expenses for personal diseases will be higher and the medical insurance expenses will be higher.
3. Vulnerabilities in the new system.
According to the new medical insurance system, as long as the parties pay a relatively small part of the expenses, they can use the medical expenses at will within the maximum payment limit of the overall fund (take Shanghai as an example: the new medical insurance accumulated more than four times the average salary of employees in the previous year, and it was 56,000 yuan in 2000). In order to transfer more medical insurance funds to their hospital accounts, some hospitals and doctors do not limit the quantity and amount of drugs prescribed. In this way, it is possible for cardholders to join hands with hospitals or some doctors to cheat national medical insurance funds into private pockets or small group accounts. In another case, one person can enjoy medical insurance for the whole family, because the hospital does not require the cardholder to be present when the medical insurance card is transferred.
Our country is now in the period of social transformation, in the chaotic stage of moral anomie, the coexistence of old and new rules, and it is inevitable that the original social moral norms and moral bottom line will be eroded and destroyed.
Three. In view of the existing problems, the scheme of further deepening the reform is preliminarily discussed.
China's health care reform is indeed difficult. Admitting difficulties is to change them cautiously and actively. China's health care reform will be very difficult, and it will not be achieved in one step. It may take a long time, and it is necessary to constantly propose adaptive programs.
Scheme 1 In the reform of medical insurance, medical and health care and drug circulation system, we should adhere to the "three reforms simultaneously" (first, the reform of basic medical insurance for urban workers; The second is the open accounting and separate management of medicine; Third, the hospital classification management) to further strengthen and improve the management of medical services.
The social security conference held recently pointed out that the basic medical insurance pooling fund can be established first in areas with poor economic conditions, and employees of enterprises with difficulties who are unable to pay fees can also take the method of participating in the basic medical insurance covered by the pooling fund first to solve the problems of hospitalization and serious illness of employees and minimize medical risks.
To implement the medical insurance system, we must solve the current problem of supporting doctors with medicine and cut off the direct economic interest relationship between medical institutions and drug marketing. The outpatient pharmacy of the hospital should be changed into a drug retail enterprise, accounting independently and paying taxes according to regulations. China's Ministry of Health has explicitly required drugs to be purchased by centralized bidding, and will gradually bring the list of essential drugs and drugs with large clinical dosage into the scope of centralized bidding and purchasing.
Hospital reform first requires classified management of hospitals. Non-profit medical institutions are set up to serve the public interests, mainly providing basic medical services, implementing the guiding price of medical services set by the government and enjoying the corresponding preferential tax policies. Liberalize the price of medical services in for-profit medical institutions and independently determine medical service items according to market demand. This is conducive to the competition between hospitals and the establishment of a multi-level medical security system.
The second scheme optimizes the allocation of medical resources and improves the efficiency of use. It is necessary to establish and implement a real competitive access mechanism and a "withdrawal" mechanism for designated medical institutions. According to statistics, the number of brain CT machines in hospitals in China is several times that in the United States and Japan. Every hospital wants to make money by doing CT for patients. It not only increases the medical burden of patients, but also wastes resources. Therefore, the state should uniformly allocate and manage high-grade medical equipment. In view of the relative surplus of community medical services in large hospitals, we should inject real competition mechanism and survive the fittest according to market rules, and the government should not overprotect!
Scheme 3 should ensure the efficiency of the use of the basic medical insurance fund and reduce unnecessary expenses and burdens for patients. Make full use of the achievements of modern information technology and vigorously promote the process of medical insurance: establish a database in central cities, monitor and predict the use of basic medical insurance funds in all co-ordinate areas through network scanning, and evaluate the implementation of policies. At present, large and medium-sized hospitals in Beijing and Shanghai have fully promoted computer inquiry of hospitalization expenses, respecting patients' right to know about examination, treatment, medication and price. Computers will also shoulder the heavy responsibility of standardizing medical behavior and supervising doctors not to abuse drugs. It is gratifying that China is using computer network technology to change the disorderly state of drug procurement and vigorously promote centralized bidding to purchase drugs and health materials. Establish a medical price database, immediately send price information to all networked medical units, and publish national charging standards. This is undoubtedly of great benefit to reducing the cost of medical insurance!
Scheme 4 should also explore the establishment of a multi-level medical security system to properly solve the medical treatment of relevant personnel; Actively explore ways and means of social medical assistance and properly solve the medical problems of poor people. The medical insurance system should be a multi-level medical security system. In addition to the basic medical level guaranteed by the government, there should also be supplementary medical insurance, commercial medical insurance and medical assistance systems. Children, the unemployed and the poor in society should be included in the medical assistance system.
In a word, although the reform of China's medical insurance system has been carried out to a great extent, there are still many specific problems that restrict the perfection of the whole social insurance system. The process of reform always needs to pay a price and the government and all walks of life need to make great efforts.
For reference only, please learn by yourself.
I hope it helps you.