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At present, there are mainly the following medical insurance modes in the world: (1) The social insurance mode in Germany is characterized by: the medical insurance fund is co-ordinated by the society, mainly paid by employers and employees, and subsidized by the government at its discretion. ⑵. The British national insurance model has the following characteristics: the government directly organizes medical insurance, the people pay taxes, the government allocates funds to public hospitals after collecting taxes, and hospitals directly provide free services to residents. However, this model often brings a heavy burden to the national finance. (3) American commercial insurance model is characterized by free participation, flexibility and diversity, with money to buy high-end products and no money to buy low-end products, which is suitable for multi-level needs. However, the profit-oriented system in the United States, which is based on free medical insurance and operates according to market rules, often refuses to accept insurance from residents with poor conditions and low income, so it is not fair. (4) Singapore's savings insurance model. According to the law, part of personal consumption funds must be converted into medical insurance funds by saving personal provident fund, and the state will set up a central provident fund to share part of the costs. In addition, the government has allocated funds to establish a health trust fund to help poor nationals pay for services. Based on medical savings, it emphasizes personal responsibility and plays the role of sharing social economy and risks.

Therefore, the above models have their own advantages and disadvantages. However, the current medical service mode in China is mainly free medical care for state-owned hospitals and urban residents. The competition between hospitals is non-price competition. In order to attract patients and excellent doctors, hospitals usually gain industry reputation and competitive advantage by purchasing high-tech equipment, which makes the medical cost increase continuously, which not only promotes the rapid growth of medical expenses, but also causes great waste of medical resources. At present, the public medical expenses make the national finance overwhelmed, but the really sick patients can't get the necessary and timely medical care. Quite a few socially disadvantaged groups are not covered. The proportion of medical expenses paid by low-income groups in their total wages is higher than that of high-income groups. Farmers' social security and medical problems are often ignored for a long time on the grounds of large population and limited national financial resources, and health injustice persists and has a tendency to intensify. Problems such as insufficient investment in national medical expenses, poor financing system and defects in medical price management have seriously hindered the sustained, stable and healthy development of China's socialist market economy. It has harmed the fundamental interests of the people. Therefore, how to build a social medical security system with wide coverage and integration of urban and rural areas to protect the basic health rights and interests of all citizens, especially the rights and interests of unemployed urban residents and rural poor people, has become an important topic to be explored urgently in the medical system reform.

China's medical insurance system must not take a single commercial road, although private medical institutions can provide more choices for patients' diverse needs; Privatized medical system is more effective, which can provide people with low-cost and high-quality services, promote state-owned hospitals to improve service quality and reduce operating costs. However, the privatization of the medical system does not help to reduce the increasing medical costs, and because private medical institutions often reduce the operating costs by reducing the wages and benefits of employees, this directly affects the quality of medical behavior. In addition, in order to pursue benefits, private medical institutions will consciously select patients and limit them to certain fields, resulting in excessive and repeated supply of medical services, which not only wastes limited resources, but also damages the fairness of medical services to some extent. Because of China's vast territory, low level of social, economic and cultural development, and huge differences in development levels, we can't take the simple savings-based medical insurance model, let alone the road of universal medical insurance. Personally, I think the medical insurance in China should be managed by combining social insurance with commercial insurance. As a supplementary medical insurance for society, commercial medical insurance should be established on a voluntary basis and operate according to market rules. The role of the government is to manage social medical insurance and invest in social basic medical insurance, so as to achieve the perfect combination of fairness and efficiency. Improving the social economy of the medical system and the socialization of management services is the fundamental way to solve the imbalance of medical security in China. Specifically, we should take the following reform measures:

First, do a good job in classified management of medical institutions to meet the needs of the reform of the basic medical insurance system. Medical institutions are divided into non-profit and for-profit management. According to the nature, social functions and tasks of medical institutions, formulate and implement different fiscal, tax and price policies, and actively promote the publicity system of medical service charges.

The second is to speed up the implementation of regional health planning and strengthen the macro-management of medical resource allocation. The allocation of financial funds should reflect the guiding ideology of regional health planning, and take improving the comprehensive utilization efficiency of regional health resources and meeting the health needs of the people as the fundamental basis. The object of financial subsidies should gradually shift from subsidizing medical institutions to subsidizing medical patients.

Third, reform the system of "supporting doctors with medicine" and implement the mechanism of "supporting doctors with technology". For a long time, China's medical institutions have implemented an economic compensation policy that combines financial subsidies with service charges, drug wholesale and retail price difference income, and tax relief. The malpractice of "supporting doctors with medicine" not only directly leads to the excessive increase of drug expenses, but also increases the burden on the people and breeds corruption. The government should resolutely implement the system of separate accounting and management of medicines, break the monopoly system of supporting doctors with medicines, establish a competitive mechanism for drug circulation, reduce the excessive price of medicines, fundamentally cut off the direct economic interest relationship between medical institutions and drug marketing, urge doctors to treat diseases and use medicines rationally, and curb the waste caused by excessive use and abuse of medicines. According to the actual situation in various places, first of all, the hospital drug income is managed by two lines, and the balance of drug income and expenditure is turned over to the local health administrative department and included in the financial special account management. Secondly, on the basis of gradually standardizing the way of financial subsidies and adjusting the price of medical services, the outpatient pharmacy of the hospital will be changed into a pharmaceutical retail enterprise, accounting independently and paying taxes according to regulations.

The fourth is to standardize the drug procurement behavior of medical institutions and vigorously promote the centralized bidding and procurement management of drugs in medical institutions. Centralized bidding and purchasing of drugs is an effective measure to correct the unhealthy trend in drug purchase and sale, reduce the burden of social medical expenses and ensure the smooth implementation of the basic medical insurance system for urban workers. Centralized bidding and purchasing of drugs is conducive to curbing corruption in decentralized procurement, strengthening market competition mechanism, reducing circulation links and reducing drug circulation costs; It is beneficial to strengthen drug quality control and improve the safety and effectiveness of clinical medication; It is conducive to the government's monitoring of drug prices and reducing the artificially high drug prices; It is conducive to promoting the adjustment of drug production structure and strengthening drug quality monitoring, and promoting enterprises to organize drug production in a planned way.

Fifth, strengthen the quality control and management of medical institutions, protect the legitimate rights and interests of patients, and provide quality and cheap medical services for the masses. Adhere to the principle of paying equal attention to legal supervision, administrative management and economic adjustment, guide medical institutions to establish the service concept and management purpose of "quality first, patients first", and strengthen the practice qualification control centered on the license management of medical institutions and their employees. In addition, in order to ensure the implementation of quality control and management, medical institutions should establish and improve the technical specification system of medical services; Quality control plan must be made every year, and its organization and implementation should be checked regularly.