Who Is Eligible for Medicare?

The medical insurance system refers to a system in which a country or region raises, allocates, and uses medical insurance funds to solve the problem of residents' prevention and treatment according to the insurance principles.

Medical insurance system

The medical insurance system refers to a system in which a country or region raises, allocates, and uses medical insurance funds to solve the problem of residents' prevention and treatment according to the insurance principles.
The medical insurance system is resident
West
In 1988, the Chinese government began to reform the publicly-funded medical system of institutions and public institutions and the labor insurance medical system of state-owned enterprises. In 1998, the Chinese government issued
our country's
Since August 1921
In a nutshell, our country
Our country
However, we should also see that our country
Reimbursement will be lower or higher, medication will be wider or narrower, and designated hospitals will be more or less. The integration of medical insurance between urban and rural residents will bring tangible benefits to the insured.
Earlier this year, the state officially launched the reform of establishing a unified basic medical insurance system for urban and rural residents, which required the integration of the basic medical insurance system for urban residents and the new rural cooperative medical system. At present, Tianjin, Zhejiang, Shandong, and other 18 provinces across the country have realized the integration of urban and rural residents' medical insurance systems or made specific plans for integration, breaking through the institutional and institutional barriers to the separation of urban and rural health insurance over the years.
More fair system
Seek medical reimbursement, no longer distinguish between urban and rural people
"It is more convenient to see the doctor for reimbursement. It is no longer divided into 'urban people and rural people'." Aunt Li in rural Xingtaiwei County, Hebei has felt the benefits brought by the integration of urban and rural residents' medical insurance. In the past, Aunt Li went to the city hospital to see a doctor and often had to go through the referral procedure. Now she can reimburse her with a diagnosis certificate and social security card.
By the end of last year, China had formed a universal medical insurance system consisting of employee medical insurance, urban resident medical insurance, and new rural cooperative medical system, covering 1.3 billion people. The three medical insurance systems have been established for different groups of people at different times, and have played an important role in ensuring the basic medical care of the people and preventing poverty caused by illness. However, this dual structure of urban and rural divisions, institutional divisions, and decentralized operations also brings inequalities. In particular, the urban residents' medical insurance and the New Rural Cooperative Medical Service have similar funding models and payment standards, but they enjoy very different benefits. For patients with the same disease and the same hospital, the amount of reimbursement for patients participating in the NCMS is much lower than for patients participating in urban residents' medical insurance. For this reason, in early 2016, the State Council issued the "Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents", and urban and rural residents' medical insurance began to integrate.
After the integration, the "six unifications" of urban and rural residents' medical insurance was realized. Unified coverageAll urban and rural residents, except those covered by the basic medical insurance for employees, are included in the urban and rural residents' medical insurance. The improvement of insurance participation methods has promoted full insurance coverage. In areas where system integration has been achieved, the number of participants has doubled. Unified fund-raising policy-Regardless of urban and rural areas, the fund-raising method based on the combination of personal contributions and government subsidies is adopted to rationally determine the unified fund-raising standards for urban and rural areas. Unified protection benefits-Urban and rural residents' medical insurance has gradually unified the coverage and payment standards, and the proportion of hospitalization expenses paid within the scope of the medical insurance fund policy has been maintained at about 75% to provide fair basic medical insurance for participants. Unified medical insurance catalogueThe medical insurance medicine catalogue and the medical service project catalogue for urban and rural residents are no longer different, and the categories are more complete. Unified fixed-point management-the original NCMS primary medical and health institutions were generally included in the fixed-point scope, and medical treatment was given to primary medical institutions, with a higher reimbursement ratio. Unified fund management-Urban and rural residents' medical insurance funds are integrated into the special fiscal account, fund management is more standardized, and the use efficiency is improved. Over the past six months of integration, the fund's support ability and mutual aid ability have been greatly enhanced. Before the integration of Shandong Province, 8 of the 17 cities in the province had experienced overspends in the New Rural Cooperative Medical Service, and all prefectures and cities did not experience overspending.
"After the integration of the urban and rural residents 'medical insurance system, the system is more fair. Residents, regardless of urban and rural areas, participate in the unified urban and rural residents' medical insurance system, participate in the insurance payment and enjoy benefits in accordance with a unified policy, and can enjoy the basic medical security benefits more equitably." The person in charge of the Ministry of Human Resources and Social Security said.
The treatment is improving-
More reimbursement and less out-of-pocket expenses, reducing the burden of seeing a doctor
After the integration of urban and rural residents' medical insurance, "the treatment will be higher or lower," and the level of treatment for insureds, especially rural residents, has improved significantly.
The reimbursement ratio is high.
Ningxia established a unified basic medical insurance system for urban and rural residents earlier in the country. Before the urban and rural co-ordination, the proportion of reimbursement within the policy scope of urban residents was about 57%, and the proportion of reimbursement within the policy scope of rural residents was 53.59%. After co-ordinating in 2014, the proportion of urban and rural residents' reimbursement within the scope of medical insurance policies reached 66%, and the burden on residents was reduced a lot.
Shanghai settled its accounts. In January 2016, Shanghai implemented a unified urban and rural residents' medical insurance system. From the point of view of hospitalization benefits, before the integration, the minimum proportion of urban residents' medical insurance payment was 60% (under 60 years old), the minimum NCMS was only 50%, and the integration after integration was 70%.
The cap line is high.
There is no longer a "limit" for Shanghai rural residents' hospital reimbursement expenses. Xu Hong, deputy director of the Medical Insurance Division of the Shanghai Municipal Human Resources and Social Security Bureau, said that when rural residents who participated in the NCMS were hospitalized, if they exceeded 120,000 yuan, the excess could not be paid by medical insurance. After the integration, the cap of 120,000 yuan was canceled, and even if it exceeded, it could continue to settle according to the prescribed ratio, and farmers benefited a lot. Guangdong has significantly increased the capping limit. The proportion of hospitalization payments within the scope of urban and rural residents' medical insurance policies has increased to 76%, and the capping line has increased from the past 50,000 yuan to the current 440,000 yuan.
"People are most concerned about treatment. After the integration of the system, there are more reimbursement and less self-payment. The burden of seeing a doctor is reduced, and both urban and rural residents benefit from it. This is the biggest significance of the reform." Professor Chu Fuling said so.
More choices-
The scope of drug use for rural residents has significantly expanded, and the number of designated points has doubled
After the integration of urban and rural residents' medical insurance, there are more choices for seeking medical advice, and it is more convenient for people to see a doctor.
"There are a lot more medicines that can be reimbursed than before." "With medical insurance reimbursement, a lot of expensive medicines can be used by rural people," said the participants. It is understood that before the integration, the NCMS's medical treatment and drug catalogs were narrower than the urban residents 'medical insurance catalogs. After the integration, the urban and rural residents' medical insurance catalogs were generally unified with the employee medical insurance catalogs. Statistics show that in the past, only 1,100 medicines of rural residents who participated in the NCMS in Shandong Province could be reimbursed, and the integrated medical insurance catalog reached 2,400 medicines, more than doubled.
Urban-rural co-ordination has brought about an improvement in the level of medical treatment. Residents, especially rural residents, have doubled the number of fixed-point medical equipment available to make medical treatment more convenient. After the integration of urban and rural medical insurance in Chongqing, all 40 districts and counties in the city are networked, 100% of the towns and townships are connected to the hospital, 95% of village clinics can use their cards to seek medical treatment, and more than 32 million urban and rural residents are covered by medical insurance. More than 5,000 designated pharmacies settle payment for medical purchases. The rural residents' choice of medical treatment has expanded, and they have also bid farewell to the trouble of "paid first and reimbursed in the past". With the card, instant settlement can be easily achieved.
The relevant person in charge of the Ministry of Human Resources and Social Affairs stated that the areas where integration has not yet been completed are accelerating, and the reform measures are being implemented earlier, so that the masses can enjoy the benefits brought by the reform as soon as possible. [2]
Aiming at the establishment of the basic medical insurance theoretical system and practical framework in China's current medical insurance system, the sustainable development of regional medical and health services, the establishment of a "medical insurance macroeconomic model" and a "microprocess control model", and further improvement of China's medical insurance quota compensation methods, etc. The issue of institutional innovation was discussed.
China's medical insurance system has been gradually improved in the ten years of reform. Aiming at the establishment of the basic medical security theoretical system and practical framework in China's current medical insurance system, the sustainable development of regional medical and health services, the establishment of a "macroeconomic macroeconomic model" and a "microprocess control model", and further improvement of China's medical insurance quota compensation methods, etc. The issue of innovation was discussed and discussed in order to resonate, promote development and benefit the people.
1 About the basic medical security theory system and regional practice framework
The basic medical security theory system and regional practice framework are the basic projects of China's medical insurance system, and they are also unsolved problems in China's medical reform for more than a decade. The "Three Circles Theory" (see Figure 1) divides medical expenses into three levels of "input, effectiveness, and necessity" from the perspective of economics, and corresponds to "medical behavior, effective behavior, and accurate behavior", which clearly and theoretically The scope of basic medical care and medical insurance is defined in the core area of "necessary expenses" caused by "accurate behavior" of medical treatment; the blue part of the overflow yellow area in the figure is the "effective expenses" caused by "effective behavior" of medical treatment. In the case of insufficient funds, this part of the cost can be included in the payment scope of individual, unit, enterprise or various commercial insurance; the gray part of the overflow blue area in the figure is the "invalid cost" caused by medical "invalid behavior", which is also the focus of medical insurance Manage and do your best to control the reduction. The establishment of the "three-circle theory" made it possible to set up a practical framework for the basic medical security in China. First, the basic "medical path" is scientifically defined and the corresponding costs are divided. Second, various types of medical treatment in the region are divided. The current "three circles" of the institution's medical insurance costs are analyzed statistically; thereafter, a regional practical framework for basic medical insurance is formulated; finally, it is applied, tested, improved, and continuously improved in medical insurance management.
2 About the sustainable development of regional medical and health services
The imbalance of "the number of disease sources × the level of protection> the total amount of medical insurance financing" in China's regional medical insurance economy has been the focus of China's 10-year medical reform and the innovation of the current medical insurance system. In a state where the number of regional disease sources and the total amount of medical insurance financing are relatively constant, the over-control of medical insurance funds will inevitably cause local designated medical institutions to bear the payment of excessive amounts of medical insurance and face greater operational risks. In the long run, it will inevitably seriously affect the survival and development of local medical institutions, thus directly causing irreversible negative effects on the sustainable development of regional medical and health services, and ultimately directly harming the interests of the people in the region and affecting the people in the region. health. The central and local governments and their functional agencies should pay full attention to the long-term negative effects of this phenomenon, go deep into the reality, seek truth and be pragmatic, and live within their means, and really find out the optimization level and actual level of resource allocation in China and the region? What is the gap between the "payment by settlement" guarantee standard and the actual payment? Relevant differences in the CD rate (%) of diseases diagnosed and treated by medical institutions at all levels in China Establish a sustainable scientific development concept, effectively balance the multi-dimensional economic benefits of society, government, enterprises, hospitals, patients, etc., and strive to ensure the relative balance of China's regional health economy from the system of "number of disease sources × level of protection total funding for medical insurance".
3 About the establishment of "health insurance macroeconomic model" and "micro-process control model"
Strengthening the scientific management and control of the use of micro-medical insurance funds is the most fundamental institutional way to balance the gap between health demand and supply. Based on the regional "macroeconomic macroeconomic model", the setting of "micro-process control model" should be included in the important content of regional medical insurance system research. Governments and functional agencies should take the lead in actively investing necessary research funds, using existing framework results, concentrating microeconomic management talents, and organizing research groups to strive to complete the clinical validation of the model framework as soon as possible, and improve it in practical applications. Scientific tools and effective methods to ensure the rational use of limited medical insurance funds and greater effectiveness have been truly established.
4 On Further Improving China's Medical Insurance Quota Compensation System
Fixed compensation is the main form and important component of China's current medical insurance compensation system. Although the 10-year medical reform and medical insurance quota compensation system has been gradually improved in continuous practice and exploration, most regional medical insurance quota economic compensation systems are based on 100% of the budget indicators and some soft assessment results formulated in the past. The disadvantages are obvious: First, the process of formulating budget quota indicators Lack of scientific methods and human factors; the second is the difference between the annual budget and the actual market dynamics, and there are obvious uncertainties in the economic sense; the third is the "CD rate (%) for diagnosis and treatment of diseases" and "patients" Key factors affecting over-standard compensation, such as the proportion of out-of-pocket expenses; and the fourth is negatively leading to non-standard medical behaviors such as the collection of minor illnesses, the promotion of major illnesses, increased out-of-pocket payments, and the risk of passing on. Therefore, it is imperative to further improve the regional medical insurance quota compensation system based on the actual conditions in various places: first, to further improve the scientific nature of the annual budget quota and assessment indicators, increase objective components and operability; second, to gradually establish a "disease score Type "plus" disease x disease classification "three-dimensional cross-integrated management system; the third is to add key factors such as" diagnosis and treatment disease CD rate (%) "and" patient's own expense ratio (%) "in the current compensation basis, and Determine the corresponding weights, see Table 1. As a result, the medical insurance compensation system is more scientific, reasonable, comprehensive, and more positively guided. It more fully reflects the principles of openness, fairness, and justice, promotes the establishment and improvement of regional medical market mechanisms, and ensures the healthy development of China's medical insurance.
China's medical reform has put forward higher requirements for the quality of all members of medical institutions at all levels and the decision-making level, resilience, and knowledge of micro-managers, making them knowledgeable, judgmental, persuasive, actionable, tolerant, and patient Li has been comprehensively tested and sharpened. At the same time, medical institutions at all levels have won opportunities and injected vitality in the face of pressure from risks. Active and effective institutional innovation is the key to China's current medical and health protection cause entering the world platform and continuous scientific development [3]
In a certain period and a certain historical period, medical insurance was adapted to the requirements of the times. When social progress and economic development entered another higher level, the original and traditional medical insurance no longer met the requirements of social and economic development. Shows its own lag, if this lag is not good, it may become a resistance to social and economic development. Therefore, in the final analysis, the reform of the medical insurance system is to study and solve the problem of how the medical insurance system, scale, structure, and implementation form are compatible with modern society. After more than 20 years of reform, China has entered the period of socialist market economy. The reform of the medical insurance system must be based on the specific requirements of the basic socialist politics, economic system, national customs and cultural traditions, and properly handle the socialist market in accordance with the general laws of market economy Under economic conditions, the special and general relationship of medical insurance not only reflects the essential requirements of socialism, but also conforms to the operation mode of the market economy, and reforms the traditional medical insurance system. In December 1998, the "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Workers" proposed overall ideas and specific goals for the reform of China's medical insurance system, and formulated a clear institutional framework for China to promote the reform of the medical insurance system. Gave scientific guidance.
1. Establish a reasonable level of access and protection for basic medical insurance. The traditional dual-track medical insurance has many disadvantages. The biggest flaw is the strict entry standards. There are clear restrictions on the beneficiary's occupation and the nature of unit ownership. Reforming the traditional medical insurance system is to change the dual-track system of urban employee medical insurance to a single-track system, reduce entry standards, establish a unified basic medical insurance system for urban employees, and achieve wide coverage. The system can be expressed as follows: According to the inherent requirements of the socialist market economy, a basic medical insurance security mechanism for urban employees is established, and all urban workers are included in this safety net to prevent urban employees from being affected by unmet basic medical care. The production and reproduction of labor forces have caused great shocks to the operation of the market economy. The standard for defining basic medical insurance should be the affordability of finances, enterprises, and individuals. Where practical and possible, the policy choice for reform must be to address the most basic medical needs of urban employees. This is entirely determined by China's social situation and economic development level, which is in line with the basic characteristics of China's primary stage of socialism. The history of the development of China's medical insurance industry tells us that medical needs are a basic living condition for workers, and the state must provide them with this demand, which is an inevitable trend of social development. And this kind of medical insurance system should be built on the basis of breaking the original ownership and unit barriers, and aim to establish a unified medical insurance system. However, as far as China's actual situation is concerned, the supply of medical insurance is subject to various financial constraints at the current stage. It can only be basic, and the level of medical insurance demand can only be basic, that is, low-level, broad coverage, and guarantee basic medical care. demand.
2. Select a scientific basic medical insurance fund model. Funds are the core of medical insurance, and the determination of the fund model is the key to the success or failure of the medical insurance system reform. The choice of China's medical insurance fund model combines the achievements of reforms in various countries and countries around the world. On the basis of emphasizing the obligations of employers, linking personal responsibility with medical insurance benefits is both an incentive and a constraint. The social pooling fund embodies the "Law of Large Numbers" for mutual assistance and mutual assistance of social medical insurance, which is conducive to the overall adjustment of the medical insurance fund within a certain range of society, balancing the burden of medical expenses, spreading medical risks, and achieving social equity. Personal accounts reflect the responsibilities that individuals should bear, which is conducive to enhancing employees' individual health investment awareness, and motivating employees to accumulate medical insurance funds when they are young, healthy, old and sick, so as to establish a vertical personal accumulation protection mechanism At the same time, personal accounts are owned by individuals, which increases personal responsibility, encourages individual employees to exercise self-restraint in medical consumption, and strengthens the control mechanism for expenses. The basic medical insurance fund implements a combination of social pooling and personal accounts, which realizes the combination of the horizontal social mutual aid function of the medical insurance fund and the vertical accumulation and protection of individuals, taking into account fairness and efficiency, which is conducive to diversifying medical risks. Reform practices in various places in recent years have fully proved this. According to regulations, the basic medical insurance premiums for employees shall be paid jointly by the employer and employees. The employer's contribution rate should be controlled at about 6% of the employee's total salary. The employee's contribution rate is generally 2% of the employee's salary. With the development of the economy, the employer and employee contribution rates can be adjusted accordingly. Basic medical insurance implements a combination of social pooling and personal accounts. All personal contributions are transferred to personal accounts. Unit contributions are transferred to personal accounts at about 30%, and the remaining part is established as a unified fund. The principal and interest of the personal account belong to the individual and can be carried forward and used and inherited. The unified fund and individual accounts should clearly define their respective payment scopes and be managed separately. The purpose is to clarify their respective responsibilities and avoid unified fund overdraft personal accounts. It is necessary to formulate a minimum payment standard and a maximum payment limit for the unified fund. The minimum payment standard is, in principle, controlled at about 10% of the annual average salary of local employees, and the maximum payment limit is, in principle, controlled at about 4 times the annual average salary of local employees. Medical expenses below the minimum payment standard shall be paid from the personal account or paid by the individual. Medical expenses above the minimum payment standard and below the maximum payment limit are mainly paid from the pooled fund, and individuals also have to bear a certain proportion. Medical expenses that exceed the maximum payment limit can be resolved through commercial insurance and other channels.
3. To achieve effective basic medical insurance management. Socialization is the fundamental principle of the reform of the basic medical insurance system. It breaks the pattern of traditional medical insurance's division, decentralized management, and decentralized decision-making, rationalizes the basic medical insurance management system, and enables urban employees to eliminate unfair treatment caused by ownership and occupational differences in a unified basic medical insurance system. Irrational phenomenon. To realize the socialized management of basic medical care, it is necessary to establish a system of separation of government and affairs, separation of implementation and supervision. The main tasks of the government are planning, decision-making, and policy guidance. The social insurance agency is specifically responsible for fund collection, management, and payment of benefits. Supervision agencies composed of the government, mass organizations, and individual workers shall effectively supervise the behavior of social insurance agencies. The socialization of basic medical insurance also includes the socialization of basic medical services, the socialization of payment of benefits, and higher-quality community services.
4. Construct low-cost, high-efficiency medicine, medical and health supporting systems. The distribution of drug production and medical institutions and the efficiency of diagnosis and treatment are directly related to the level of medical costs, and then directly to the reform of the medical insurance system. According to relevant newspaper reports, since 1978, China's pharmaceutical economy has continued to grow at an annual rate of about 18%. Its growth rate ranks first among domestic industries and is also higher than that of major pharmaceutical countries in developed countries. From the perspective of pharmaceutical production, as of 1997, there were 6,391 pharmaceutical manufacturers nationwide, including more than 1,700 foreign-funded enterprises, producing a total of more than 1,350 APIs, more than 4,000 preparations, and more than 8,000 proprietary Chinese medicines. Among the more than 6,000 pharmaceutical manufacturers, there are more than 300 enterprises (workshops) that meet the requirements of the Good Manufacturing Practice (GMP). Among them, only 59 companies, 38 workshops and 13 varieties have obtained the GMP certificate. China's pharmaceutical manufacturing enterprises are small in scale, large in number, many in duplication, low in technical level, and poor in economic efficiency. They have no distinctive features, similar varieties, and few brand-name products. The problem of low-level duplication is very serious. Taking norfloxacin as an example, according to incomplete statistics, there are currently 828 companies producing norfloxacin in the country, and some of them have as many as 75. From the operating situation, by the end of 1998, there had been 16,519 pharmaceutical wholesale enterprises and more than 60,000 retail enterprises in China. There are only 13 pharmaceutical wholesale companies in the United States, of which 5 wholesale companies account for 85% of the country's total business. There are also only 13 pharmaceutical wholesale companies in France, the largest of which accounts for 45% of the country's total business. In terms of usage, in 1998, there were 15,219 hospitals at or above the county level, 51,535 township and street hospitals, and 125,264 individual clinics. In addition, there are sanitariums, specialized prevention and treatment centers, maternal and child health stations (stations), health care stations (stations), medical offices, etc. There are a total of 309,007 medical institutions of various types nationwide, with more than 5.27 million employees. In 1997, there were 4,045 general hospitals in the health sector nationwide, with a total income of 82.178 billion yuan. The revenue from medicines was 42.394 billion yuan, accounting for 51.59% of the total revenue. Among them, 61.36% of the income from medicines outpatient income, and 49.69% of the income from medicines in the hospital. Medical unit sales of medicines from the year-round sales of 16.56 billion yuan, drug operating companies sales allowances and rebates of about 8 billion yuan, a total of 24.56 billion yuan. According to statistics from the health department, in 1997, China's drug consumption was 83.8 billion yuan, and per capita drug consumption was 66.51 yuan, including 175 yuan per capita in cities and 25 yuan per capita in rural areas. In the same period, per capita drug consumption in the middle-developed countries was $ 40 to $ 50, in Western European countries was about $ 160, and in the United States, it was more than $ 300.
China's medical and health system has been in place for decades, and has been unable to meet the needs of the reform of the medical insurance system in many aspects. The structure of the medical and health service system is unbalanced. Medical and health resources are over-concentrated in large cities. In urban areas, they are over-concentrated in large hospitals. Community medical services that are close to the lives of employees, facilitate medical treatment, and have low service costs are underdeveloped. You also need to go to a big hospital. The unreasonable layout of medical and health resources has increased the cost of medical services, which is an important cause of waste of medical insurance funds. The structure of medical services is unreasonable, and the proportion of drug services in medical services is too large. Some medical institutions are pursuing revenue one-sidedly, focusing their services on the provision of pharmaceutical services and high-precision large-scale equipment inspections. Irrational inspections and unreasonable drug use are serious. This is another important reason for increasing medical insurance fund expenditure; The disorder of the drug distribution system, high discounts and high prices have contributed to the unreasonable use of drugs. The internal management mechanism of medical institutions is not complete, and there are a large number of redundant staff, which increases the labor costs of medical services and directly leads to the increase in medical costs. This higher medical cost is eventually converted into medical insurance fund expenditures, which makes the medical insurance financial budget. Constraints continue to soften. Therefore, the reform of the drug production, sales system, and health system must be carried out in conjunction with the reform of the medical system. Focusing on the reform of the medical insurance system, rationalize the drug production, sales, and health management system, and formulate basic medical insurance designated hospitals, designated drug stores, and basic medical care in a timely manner. Catalogs of insured medicines, diagnosis and treatment programs, and standards for service facilities, regulating the drug market and medical behavior. This is an important link in optimizing the allocation of medical resources, reducing medical costs, reducing waste of medical resources, and ensuring the smooth progress of medical insurance system reform.
5. Actively and steadily establish a supplementary medical insurance system. The "State Council's Decision on Establishing a Basic Medical Insurance System for Urban Employees" aims to establish a social medical insurance system that protects the basic medical needs of urban employees. This basic medical need is quantitatively defined with a maximum payment limit. Medical needs beyond this defined amount are not basic needs and can only be resolved through commercial insurance and other channels. Theoretically, basic medical insurance is universal, that is, it is universally implemented in the whole society and aims to protect the basic needs of workers' physical health. The government enforces it through legislation in the whole society. Supplementary medical insurance is in addition to the basic medical insurance to protect the basic medical needs of employees. Employers or individuals should appropriately increase medical items and choose more advanced treatment technologies according to their own characteristics and financial resources. Its insurance level can be high or low, there can be more or less insurance items, and the insurance forms are flexible and diverse. At present, some attempts have been made in some places. Zhenjiang City, Jiangsu stipulates that each insured employee and retiree should pay 30 yuan per person per year as a pooling fund for large medical expenses. If the medical expenses exceed the maximum payment limit of more than 30,000 yuan but less than 100,000 yuan, the individual will no longer pay, and the participating unit will pay 20% and the unified fund will pay 80%. For 100,000 yuan or more, the individual pays 10%, and the insured unit pays 90%. The characteristic of this model is that the supplementary medical insurance is directly managed by the social insurance agency, and the risks are also shared by the social insurance agency, the employer and the individual. Xiamen City stipulates that each person withdraws 18 yuan from his or her personal account and 6 yuan from the social pool fund to insure with insurance companies. For medical expenses that exceed the maximum payment limit of 40,000 yuan or more, 10% will be paid by the individual, the insurance company will pay 90%, and the annual maximum payment limit is 150,000 yuan. The characteristic of this model is that the social insurance agency collects fees and then re-insures the insurance company, and the risk is borne by the insurance company and the individual. The employees' mutual welfare supplementary insurance organized by Nanjing Federation of Trade Unions is actually a supplementary medical insurance. It is characterized by being organized by the masses, with the purpose of mutual aid and mutual aid, not for the purpose of profit. Employees participate voluntarily, and payment standards, insurance items, and treatment levels are independently determined.
The above supplementary medical insurance models all have their advantages and disadvantages, which need to be continuously supplemented and improved during the reform process. Basic medical insurance is the basic content of the medical insurance system and the core of the system. Supplementary medical insurance is also an important content of the medical insurance system. In the process of implementing the basic medical insurance system, multi-level, flexible and diverse supplementary medical insurance should be actively carried out in accordance with the diversified characteristics of medical consumer needs, to enhance the ability of employees to resist the risk of major illnesses, and to meet their higher-level medical consumption needs In order to truly establish a medical insurance system dominated by basic medical insurance and supplemented by commercial insurance and other ways, reflecting the characteristics of China at this stage, at the same time, actively research and explore the specific implementation forms and ways of rural residents' medical insurance.

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