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Accelerate built from three basic medical insurance system covering both urban and rural medical security system

Author: LiYaLin GaoYun From: www.yourpaper.net Posted: 2010-07-01 15:11:23 Read:
Abstract: urban basic medical insurance, basic medical insurance for urban residents, the new rural cooperative medical system covering urban employees, urban non-practitioners, the rural population and the urban and rural needy people. Accelerate three basic medical security system covering both urban and rural medical security system, is a scientific concept of development to adhere to the objective requirements of the people-oriented.
Keywords: medical insurance; covering urban and rural; insurance system

China's basic medical insurance system reform, from the medical insurance for urban workers in 1994, "Two Rivers" pilot, along with 15 years of great economic and social change and development, medical security system after a comprehensive exploration and comprehensively promote, and gradually expand to the rural population and urban non-practitioners, the current implementation of the three basic medical insurance, the basic medical insurance for urban workers, urban residents basic medical insurance and new rural cooperative medical care, as the impact on the livelihood of the major hotspots, take a variety of ways to actively explore the establishment of the integration of urban and rural areas basic medical security management system, in particular, to adhere to the scientific concept of development, in accordance with the requirements of urban and rural development and economic and social development in the current economic and social situation, do a good job in the basic medical insurance system, the goal of health security system covering both urban and rural areas, the significant and far-reaching.

One, the effectiveness of the medical insurance system reform

The original intention of the reform of the medical insurance system, under the conditions of market economy is based on the original publicly-funded labor protection medicare system defects, meet the masses basic medical security needs. The drawbacks of the original public expense labor protection medicare system can be summarized as follows: individuals of coverage, the unit can not afford to dig money, more rural people and institutions outside the resident's medical interests are not protected. After decades of reform and development, China's first basic realization of the system function to re-create the re-positioning of the functions of the government, and gradually built up a broader coverage, independent of the units outside, the implementation of the management of the social medical insurance system. Three basic medical insurance system for multi-level medical security system, improve the demand protection mechanisms and cost constraints sharing mechanism, so as to gradually achieve the protection of rights and interests, safeguarding stability, promoting reform and development goals.

Analysis and the main problems

The basic medical insurance system reform today, a major basic medical insurance for urban workers covering urban employees, the new type of rural cooperative medical care has been a major coverage of basic medical insurance for urban practitioners of urban residents, a major coverage of the rural population in terms of policy basic achieve full coverage on the lives of every citizen, improve their unprecedented degree of social concern, a real hot spot. Analyze the current situation, the three insurance can be summarized as follows: Personnel policies discrete, Attn separate. Five points different:
First, the department in charge. In most cities, the urban basic medical insurance and basic medical insurance for urban residents under the jurisdiction of the labor and social security department management; focal point of the new rural cooperative medical health sector management.
Second, the fund-raising channels. The basic medical insurance for urban workers paid jointly by the employer and the individual workers; basic medical insurance for urban residents and the new rural cooperative medical expenses are paid by the residents (farmers) personal or family, the government will provide appropriate subsidies.
Three different funding criteria. Urban basic medical insurance / person funding amount is generally more than 1200 yuan; urban residents basic medical insurance / person funding amount is generally 220-500 yuan; years of the new rural cooperative medical / people funding level for 100 yuan. .
Fourth, the government subsidies. The basic medical insurance for urban workers, the Government does not grant; year / person of the basic medical insurance for urban residents the government subsidy of not less than 90 yuan; new rural cooperative medical annual government subsidy of 80 yuan / person.
Fifth, the different levels of treatment to enjoy. Urban basic medical insurance reimbursement rate is generally 80% -90%; urban residents basic medical insurance reimbursement rate is generally 65% ??-75%; new type of rural cooperative medical care reimbursement rate is generally 45% -55%.
As can be seen from the analysis of the policies of the basic medical insurance for workers, residents, farmers of different people from a cost Zheng Ji (payment and subsidies) to the treatment generally enjoy (outpatient and inpatient) are too detailed classification artificially increase the difficulty of management, has increased the workload of primary staff. At the same time, around information management system development, the platform is not unified information management system software is not in place, the application is not smoothly, a lot of basic work still rely on manual operation, could easily lead to basic information such insurance insufficiency, regulatory loopholes. Community information platform construction is lagging behind, with the demands of the masses, there is a certain gap.
The medical insurance system reform, both created by the system, but also the process of innovation and exploration; process both continue to play an institutional role, but also continue to find problems, revealing the contradictions and resolve problems. Reform of the medical insurance system, while making positive progress, the deeper contradictions, difficulties and problems have emerged, exposing many problems to be solved, the contradictions and difficulties.
Public finance investment mechanism is not in place, there are economic barriers to basic medical insurance and handling services system.
Management service system is not unified, integrated management and service system of the basic medical insurance system and unified Managers there are institutional barriers.
Third-sharing mechanisms play a role at the same time, different needs protection channels have not formed, there are still personal overburdened.
Fourth, medical insurance and legal system is not perfect, mandatory insurance and normative regulatory legal obstacles, the medical security system system and method of propulsion is the lack of a strong legal support. Third, the development of ideas

Continuous economic and social development, will inevitably require the in-depth development of the various reform, and gradually changing the mindset of the people, the system will promote the evolution and transformation of the contradictions sensitive policy, I think, simply relying on the current efforts and even the current policy has been difficult from the fundamental solution to the problems in the basic medical insurance system run, new ideas, institutional arrangements, policy support and the way change is required, the only way the reform in order to achieve a breakthrough.
First, the government should further increase the public health service reform efforts, the breadth of basic medical services for all citizens; further increasing public financial investment to achieve inclusive of all citizens to participate in the basic medical insurance. Second, the policy should be to achieve the level of treatment levels to set a variety of payment standard insurance, depending on the income situation reflects the system level and can choose, all kinds of groups according to their own economic affordability and healthy consumer demand, choose a different payment standard insurance, and enjoy the the corresponding security benefits, at the same time, the formation of multi-level security system through the implementation of catastrophic health care assistance, commercial supplementary medical insurance. Policy to protect the way through, and between the different levels of security in the form of universal health insurance system covers different payment standards, the establishment of the channel between the various types of insurance, to achieve effective convergence of the various types of insurance within the system, enabling citizens to be able to flow between the various types of insurance. Policy management services to achieve unity, decided to a unified universal health insurance system should be unified, independent management services to institutions outside the executive branch, and the use of the service network of social and medical services resources, improve system operation and management services efficiency.
(A) three unities. First, a unified policy: to formulate a policy apply to different groups of people are free to choose the insured conversion unified, three medical insurance policy to meet all the health care needs of the population. Unified management: the management of existing medical insurance management system, under the jurisdiction of a department. Unified standard: payment standard unified standard for government subsidies and social categories of personnel, and the development of appropriate standards of treatment. Government grants standard regardless of the categories of persons to the introduction of a subsidy standard, simple, convenient work; outpatient, inpatient treatment standards and payment linked to the rights and obligations on equality and mutual assistance.
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