System reform medical insurance

The Third Plenary Session of the Eleventh Central Committee established the theme of reform and opening up. During the transition from planned economy to market economy, the institutional background of China's medical security began to change greatly, and the traditional medical security system gradually lost its own foundation. The reform of urban basic medical security system is closely related to the reform of financial system, medical system, the establishment of modern enterprise system and the change of ownership structure. With the reform in various related fields of reform and opening up, the reform of medical security system is a natural thing. The medical system of public expense and labor insurance mainly appeared before the reform and opening up, so I won't explain it too much here. Medical security reform pilot. Since the early 1980s, some enterprises and localities have begun to spontaneously explore the reform of the traditional medical security system for employees, such as reimbursement of fixed medical expenses or overspending in a certain proportion, and linking the payment of medical expenses with personal interests. The continuous development of these reform practices has also laid a certain psychological foundation for employees to bear medical expenses, showing a transition from public medical care system to moderate self-funded system.

In order to further solve the increasingly prominent problems in the field of medical security, on April 28th, 1984, the Ministry of Health and the Ministry of Finance jointly issued the Notice on Further Strengthening the Management of Public Medical Care, proposing to actively and steadily reform the public medical care system, which opened a new stage for the government to explore and reform the traditional public medical care system.

Local governments take the lead in the practice of medical system reform, and the main way is to control costs through social overall planning. For example, since June, Shijiazhuang, Hebei Province has launched a pilot project of social co-ordination of medical expenses for retirees in six counties and cities1985+01; In May, 1987, Beijing Dongcheng District Vegetable Company initiated "serious illness medical co-ordination", which provided an easy-to-operate solution to the thorny problem of huge medical expenses.

1988 On March 25th, with the approval of the State Council, a medical system reform plan led by the Ministry of Health, with the participation of the State Commission for Economic Restructuring, the Ministry of Labor, the Ministry of Health, the Ministry of Finance and the General Administration of Medicine, was established to guide the medical reform pilot. In July of the same year, the Group launched the Assumption of Employee Medical Insurance System (Draft for Comment). 1989, the Ministry of Health and the Ministry of Finance promulgated the Notice on the Measures for the Administration of Public Medical Care, which specified the self-funded items within the scope of public medical care expenditure. In March of the same year, the State Council approved the "Essentials of Economic System Reform" 1989 issued by the State Commission for Economic Restructuring, pointing out that medical insurance system reform should be piloted in Dandong, Siping, Huangshi and Zhuzhou, and comprehensive social security system reform should be piloted in Shenzhen and Hainan.

Under the guidance of relevant policies, Siping City, Jilin Province took the lead in carrying out the medical insurance pilot, and Bishan County, Chongqing City also made some reform attempts according to the pilot scheme. 1April, 1990, Siping public health care reform plan was introduced; 199 1, 1 1 In June, Hainan Province promulgated the Interim Provisions on Medical Insurance for Employees in Hainan Province, which came into effect on June 1992. In September, 199 1, Shenzhen Medical Insurance Bureau was established, and in May, 1992, Interim Provisions on Medical Insurance for Employees in Shenzhen and Detailed Rules for the Implementation of Medical Insurance for Employees were promulgated. From 65438 to 0994, the State Commission for Economic Restructuring, the Ministry of Finance, the Ministry of Labor and the Ministry of Health jointly formulated the "Pilot Opinions on the Reform of Workers' Medical System", which was approved by the State Council to be piloted in Zhenjiang City, Jiangsu Province and Jiujiang City, Jiangxi Province, namely the famous "Two Rivers Pilot".

Medical reform in new countryside

On the basis of the "Two Rivers Pilot Project", in April, 1996 General Office of the State Council forwarded the Opinions of the State Commission for Economic Restructuring, the Ministry of Finance, the Ministry of Labor and the Ministry of Health on Expanding the Pilot Scope of Workers' Medical Security System Reform.

According to the unified deployment, 1997 medical security pilot selected 58 cities. As of the beginning of August, more than 30 cities have launched pilot projects to expand medical reform. By the end of 1998, there were 400170,000 employees and 76,000 retirees who participated in the social pooling of medical insurance and personal account reform, and the income of medical insurance fund reached1950 million yuan in that year. As of 1999, all 58 cities identified as pilot areas have carried out pilot work.

The "Two Rivers Pilot Project" initially established a medical insurance model for urban workers with "unified account" (the combination of social planning and personal account). This model has been well received by the expanded pilot association. At the same time, many cities in China have carried out some reforms and explorations on the payment mechanism in accordance with the principle of "combining unified accounts". In addition to the "three-channel" model of "Two Rivers Pilot Project", the specific models of unified account integration mainly include: Shenzhen mixed model, that is, different levels of insurance models are implemented for different types of people, mainly including comprehensive medical insurance, inpatient medical insurance and special medical insurance; Hainan's "two-track parallel" model adopts the way of separate management of individual accounts and social pooling funds. The latter is used to pay hospitalization expenses and cannot be overdrawn by the former, and is managed and operated by the Social Security Bureau; The basic practice of Qingdao's "three funds" model is to add a unit adjustment fund between the establishment of individual account fund and the overall medical fund, which will be paid by enterprises and individual employees, and the unit adjustment fund and individual account fund will be managed by enterprises. Establish a basic medical insurance system for cities and towns. 19981998 In February, the State Council held a national conference on the reform of the medical insurance system, and issued the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Employees, which clarified the objectives, tasks, basic principles and policy framework of the medical insurance system reform and required the establishment of a basic medical insurance system covering all urban employees nationwide. With the release of this document as a symbol, the establishment of medical insurance system for urban workers in China has entered a stage of all-round development.

The establishment of China's urban basic medical insurance system has played a very important role in ensuring the health of urban workers and promoting social harmony and stability. Since the formal implementation of 1999 system, the coverage of the system has been expanding and good social effects have been achieved. Explore the multi-level medical security system in cities and towns. The first is to expand the basic medical insurance system. Since the establishment of the urban basic medical insurance system, it has been constantly expanding, adding many new coverage. For example, in 1999, the General Office of the State Council and the General Office of the Central Military Commission jointly issued the Interim Measures for the Medical Insurance of Retired Soldiers of the People's Liberation Army of China, stipulating that the state should implement the medical insurance system for retired soldiers, set up a medical insurance fund for retired soldiers, and subsidize the medical expenses of retired soldiers; From 65438 to 0999, the Ministry of Labor and Social Security issued the Notice on Issues Related to Railway System Employees' Participation in Basic Medical Insurance, guiding the railway system employees to change from the original labor insurance medical system to social medical insurance.

As early as 1996, Shanghai took the lead in launching "Shanghai Children's Inpatient Medical Mutual Fund", and on September 1 2004, Beijing Primary and Secondary School Students' Inpatient Medical Mutual Fund was officially launched. Hebei, Guangdong, Jiangsu, Zhejiang, Jiangxi, Jilin, Sichuan and other provinces have issued corresponding policies.

In May 2003, the Ministry of Labor and Social Security issued the Guiding Opinions on Flexible Employment in Cities and Towns and the Opinions on Promoting Employees of Mixed Ownership Enterprises and Non-public Economic Organizations to Participate in Medical Insurance in May the following year, which included flexible employment, employees of mixed ownership enterprises and non-public economic organizations and rural migrant workers in the scope of medical insurance coverage. In 2004, Jiangxi Province issued the "Trial Measures for Urban Flexible Employees to Participate in Basic Medical Insurance in Jiangxi Province", which included urban flexible employees and county towns into the scope of basic medical insurance coverage. On May 24, 2004, Jiujiang City, Jiangxi Province further improved the medical insurance policy for flexible employees, which was implemented on July 1 2004. On June 5438+0 1 day, 2004, Wuhan City, Hubei Province promulgated the Basic Medical Insurance Measures for Flexible Employees in Cities and Towns in Wuhan City, which was implemented on June 5438+February 1 day of the same year. In June+February, 2005, Guangzhou City, Guangdong Province included flexible employees in medical insurance coverage, achieving "full coverage" of the local registered working-age population. Nanjing, Guiyang, Chongqing, Taiyuan, Baoding, Zhangjiakou, Shantou, Mudanjiang, Shenyang and other cities have introduced relevant policies.

Since 2006, the medical insurance system has listed migrant workers as a covered population. On March 27th, 2006, the State Council issued "Several Opinions of the State Council on Solving the Problems of Migrant Workers", proposing to actively and steadily solve the social security problems of migrant workers.

In May 2006, the Ministry of Labor and Social Security issued the Notice on Launching the Special Expansion Action of Migrant Workers' Participation in Medical Insurance, proposing that "the provincial capitals and large and medium-sized cities, the processing and manufacturing industries, the construction industry, the extractive industries and the service industries where migrant workers are concentrated, should make overall planning, classified guidance and step-by-step implementation for migrant workers who have established labor relations with urban employers, and comprehensively promote their participation in medical insurance".

The second is to develop the medical assistance system. Before 2005, there was no nationwide medical assistance system in China. In July 2005, the General Office of the State Council forwarded the Opinions on Launching the Pilot Work of Urban Medical Assistance System issued by the Ministry of Civil Affairs, the Ministry of Health, the Ministry of Labor and Social Security and the Ministry of Finance in April 2005, pointing out that starting from 2005, it will take two years to launch the pilot project in some counties (cities, districts) in various provinces, autonomous regions and municipalities directly under the Central Government, and then it will take two to three years to establish urban medical assistance with institutionalized management and standardized operation nationwide.

The "Opinions" pointed out that it is necessary to carefully select pilot areas and establish urban medical assistance funds. The Opinions also stipulate that the relief targets are mainly those who have not participated in the basic medical insurance for urban workers, those who have participated in the basic medical insurance for urban workers but still have a heavy personal burden, and other people with special difficulties.

The third is to develop supplementary medical insurance. China has been encouraging employers to establish supplementary medical insurance system for employees. Article 75 of the Labor Law stipulates: "The State encourages employers to establish supplementary insurance for workers according to actual conditions". The State Council's "Decision on Establishing the Basic Medical Insurance System for Urban Workers" also proposes that "the medical insurance expenses exceeding the maximum payment limit (basic medical insurance) can be solved by means of commercial medical insurance". From 65438 to 0996, Chengdu, Sichuan launched the pilot project of supplementary medical insurance in China earlier. There are several forms of supplementary medical insurance in China:

The first is the state's medical subsidies for civil servants. According to the "Decision on Establishing the Basic Medical Insurance System for Urban Workers", national civil servants enjoy the Medicaid policy on the basis of participating in the basic medical insurance. This Medicaid policy is actually supplementary medical insurance for civil servants. The purpose of implementing this supplementary medical insurance is to ensure that the medical treatment level of national civil servants will not decline compared with that before the reform.

The second is the supplementary medical insurance carried out by social medical insurance institutions. This form of supplementary medical insurance is provided by social medical insurance institutions on the basis of compulsory "basic medical insurance", and its insurance deductible line is connected with the "top line" of basic medical regulations, giving a higher proportion of compensation to some employees who encounter high medical expenses, which can really spread risks and reduce the burden on employers and sick employees. Because social medical insurance institutions have certain advantages in the collection, management and control of medical expenses of supplementary medical insurance funds, this form is a good way to solve the problem of supplementary medical insurance for employees. It should be noted that the supplementary medical insurance fund and the basic medical insurance fund shall be independent of each other and shall not be overdrawn. At the same time, we should actively expand the scale of supplementary medical insurance and improve the anti-risk ability of supplementary medical insurance funds.

The third is the supplementary medical insurance provided by commercial insurance companies. Supplementary medical insurance provided by commercial insurance companies can be divided into two situations: one is that units and individuals who have participated in the "basic medical insurance" apply to commercial insurance companies for supplementary medical insurance to compensate for high medical expenses, such as the Xiamen model. The "top line" of "basic medical insurance" is the deductible line of commercial supplementary medical insurance, and the high medical expenses above the deductible line are borne by commercial medical insurance, but commercial insurance companies generally still stipulate the upper limit of compensation, such as the annual compensation amount does not exceed 6,543,805 yuan or 200,000 yuan. At present, some domestic commercial insurance companies have actively intervened in the supplementary medical insurance market. However, high-value medical insurance is risky and difficult to manage. At present, only two insurance companies, China Pacific Insurance and China Ping An, have made preliminary explorations in some areas. It is estimated that there is still a process for commercial insurance companies to underwrite such business on a large scale. On the other hand, commercial insurance such as "critical illness insurance" and "cancer prevention insurance" provided by major commercial insurance companies for certain special diseases can also provide a certain degree of compensation for employees' high medical expenses exceeding the "cap line".

In addition, the supplementary medical insurance system also includes employee mutual insurance organized and operated by trade unions, that is, mutual insurance business is mainly carried out by using the original trade union organization system. The exploration of supplementary medical insurance system is conducive to improving the level of the insured, thus resisting the greater risk of medical expenses, thus forming a medical security system for urban workers in China with multi-level security, multi-channel security funds, scientific payment and effective management. Medical insurance system for urban residents. The Third Plenary Session of the 16th CPC Central Committee put forward the resolution of "expanding the coverage of basic medical insurance". In 2006, the Sixth Plenary Session of the 16th CPC Central Committee adopted the Decision of the Central Committee on Several Major Issues Concerning the Construction of a Harmonious Socialist Society, which further clearly stated that "medical insurance for urban residents should be established on the basis of overall planning for serious illness". From the second half of 2004, the establishment of medical security system for urban residents was discussed, and in 2005, the scheme research and design work was carried out for more than one year. At the same time, some local-led pilots are also being launched.

In April, 2007, Premier Wen Jiabao of the State Council presided over the the State Council executive meeting, and decided to carry out the pilot of the basic medical insurance system for urban residents, and made it clear that in 2007, one or two cities in qualified provinces will be selected to carry out the pilot of the basic medical insurance system for urban residents with the focus on overall planning of serious diseases. The pilot of basic medical insurance for urban residents began in the second half of 2007. Summarize the pilot experience in 2008 and continue to promote it. It is expected to be launched nationwide in 2009.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.