What Are the Different Types of Universal Health Care Insurance?

In order to ensure universal medical insurance, the CPC Central Committee and the State Council announced plans for basic medical insurance for the entire population. The basic medical and health system of universal medical insurance alleviates the problem of "expensive medical treatment" for citizens. The country will gradually establish a basic medical insurance system covering the entire population, and for the first time achieve full coverage of medical insurance. The state will also include employees of closed and bankrupt enterprises and enterprises in difficulty, college students, non-public economic organization employees and flexible employees into the coverage of urban employees or residents. In 2009, the basic medical insurance for urban residents was fully launched, and attention was paid to solving the basic medical insurance for the elderly, the disabled and children. In 2010, the entire process from system design to actual operation was completed and entered the 'deep water area'.

Universal health care

In order to ensure universal medical insurance, the CPC Central Committee and the State Council announced plans for basic medical insurance for the entire population. The basic medical and health system of universal medical insurance alleviates the problem of "expensive medical treatment" for citizens. China will gradually establish a nationwide

The meaning of universal medical insurance is that everyone has basic medical security, and the second is that we must have some public health insurance.

On April 6, 2009, the "Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical and Health System" was officially issued. This is for the establishment

Prior to the national brewing of the universal medical insurance system, some provinces have already piloted it. Chengdu, Jilin, Fuyun, Anhui, Hubei, Jiangsu, Guangdong, Zhengzhou, Weifang, Chongqing and other provinces choose different subordinate cities and counties. Many of the pilots still retain "

Due to an omission in the system design, medical insurance appeared in the pilot area.

Increased protection level

According to the "Key Recent Implementation Plan for the Reform of the Medical and Health System (2009-2011)",

The "Plan" pointed out the establishment of a settlement mechanism for medical treatment in different places and explored

Facing adjustments:

The new plan will encourage all kinds of capital to enter the medical market, provide different levels of services for people at different levels, and also encourage Hong Kong and Macao capital to enter the medical market. The purpose is to serve as a complementary part of the entire medical market.

In the future, the greatest efforts of private hospitals will be to try to correct their weak reputation, actively guide them out of their characteristic path, strictly supervise "bad" private hospitals, and even formulate a strict withdrawal system. Private capital with good capital and enthusiastic development of medical care should be strongly supported and given "national treatment" in policy.

It is reported that a specific plan for the expansion of medical insurance, the Pilot Plan for the Basic Medical Insurance System for Urban Residents, has been drafted by the Ministry of Labor and Social Security, the Ministry of Health and other departments. .

In just two years, China's universal medical insurance has been completed.

Universal health care

The whole process from system design to actual operation. By the end of last year, more than 1.2 billion people across the country had received basic medical insurance. However, while achieving fruitful results, the rapid advancement of universal medical insurance also challenges existing management mechanisms and systems. Yesterday, at the 6th China Health Industry Summit Forum hosted by CEIBS, Wang Dongjin, president of the China Medical Insurance Research Association, said: "The medical security system has entered the 'deep water zone', but the three doctors have not yet achieved the necessary linkage , The positive effects of many reforms have been 'eroded' and 'discounted.' "

People have new expectations for improving the level of security

With the rapid entry into the era of universal medical insurance, social psychology has changed. Under the combined effect of psychological changes and welfare effects, people are no longer satisfied with "guarantees", but rather expect a higher level of guarantees that reflect social equity. This change in demand poses serious challenges to the medical security system. China's existing medical security system is commonly known as "three plus one", that is, it is divided into basic medical insurance for urban workers, basic medical insurance for urban residents, and rural new rural cooperative medical care plus urban and rural medical assistance. There is no small difference in the level of protection of the three types of medical insurance in various parts of the country, so the phenomenon of repeated participation in insurance appears.

"According to our survey, the repeated participation rate is about 10%. Based on the 1 billion people insured in urban and rural areas, 10% is 100 million. One person subsidizes 120 yuan, which means that 120 billion yuan of financial funds is equal to water drift Caused great waste. "Wang Dongjin said.

In addition to repeated participation in insurance, information network construction has also been repeated, because each type of medical insurance has its own information network system, and there are three systems for three types of medical insurance, covering both urban and rural areas. It is understood that it takes 60 to 80 million yuan to build a medical insurance information network in a medium-sized city.

In addition, different medical insurances also have their own personnel teams, and the personnel cost is also a significant expense.

Hu Dayang, director of the Jiangsu Province Medical Insurance Fund Management Center, said: "The management of urban medical insurance is managed by one department and the rural area is managed by another department. Social medical assistance is another department, so the system prevents our systems from connecting with each other. , The regional disparity is relatively large. "

Medical insurance is facing an embarrassment: if the three types of medical insurance are not integrated and unified, they will be questioned by fairness, and if integrated and unified, the actual level of economic development will not allow it. "No social security system can exist independently of or beyond the level of economic development." Wang Dongjin said that it is impractical to "hang up appetite" and cause disorder to the construction of the social security system.

Medicare funds become government compensation funds

Hu Dayang, director of the Jiangsu Provincial Medical Insurance Fund Management Center, said: "Universal medical insurance came so fast that we were under-prepared."

The most embarrassing thing now is the implementation of the essential medicines drug list. Earlier, officials from the Ministry of Health have frankly stated that the task of achieving 60% coverage of essential medicines by the end of 2010 is arduous. Wang Dongjin said yesterday that in many places, even half of the coverage rate-30%-has not been reached.

Hu Dayang introduced that it is very difficult for Jiangsu Province to implement the essential medicines list because government compensation is difficult to get in place. According to the essential medicines catalogue system, all essential medicines listed in the catalogue will implement a zero-difference rate sales policy in order to change the status quo of supporting medicine with medicines. Unfortunately, after the implementation of the zero margin, many governments' compensation mechanisms were not in place, and their shortfalls required compensation from the medical insurance fund.

"The medical insurance fund is the" life-saving money "and" life-saving money "of the insured people. It can only be used to purchase basic medical services. If direct subsidies are adopted, it will violate the payment system and operating mechanism.

Based on this, experts believe that to alleviate the problem of "difficult to see a doctor, expensive to see a doctor", it is difficult to cure simply by canceling a prescription for adding medicine. Instead, we should work hard on the system and mechanism of public hospital management, adhere to public welfare, and motivate medical staff.

After the zero-difference rate of medicines is implemented, how the government compensation mechanism is put in place as soon as possible directly determines the success or failure of the basic drug system.

Universal health insurance should abandon the will of the chief

How to solve the embarrassment encountered after the rapid advancement of universal medical insurance? Wang Dongjin said: "We must truly and truly abide by the spirit of the two documents of the central government, strengthen coordination, and truly form a three-medical supporting linkage of medical treatment, health, drug production and distribution, and medical security." Intensify reform and explore institutional innovation. "But system innovation cannot shake the foundation of basic medical security."

Wang Dongjin takes the outpatient planning as an example. Any outpatient planning system should not stimulate the large-scale release of medical needs, let alone flood into tertiary hospitals like a tide. Impacted. "Experts believe that the policies issued by government departments cannot please the people regardless of the local economic foundation. Any decision without feasibility justification is very dangerous.

On the basis of persistence, the government's management of medical institutions must be reformed. "It is necessary to change the government's supervision from the past father-son relationship to the government supervision relationship." Wang Dongjin said, "If the future management still stays in the past to manage people, property and materials, it will likely be worse."

In the era of universal medical insurance, leadership decisions must be changed into institutional decisions in order to establish a stable and long-term medical insurance mechanism.