Disadvantages of traditional medical insurance system

At present, the new medical insurance system implemented by the state is basically based on the insurance operation mechanism, that is, pay the insurance premium first, then enjoy the medical insurance treatment, and the rights and obligations are equal. The scope of protection is basically employees of state-owned enterprises or formal employment departments, which belongs to on-the-job insurance. Even so, some employees in difficult enterprises are excluded from the scope of medical insurance. Although they are employed, they may not be able to enjoy medical insurance. And members of other vulnerable groups are even less likely to receive social medical insurance benefits.

The disadvantages of the traditional medical insurance system show the traditional medical insurance system in China, that is, the so-called "free medical care" and "labor insurance medical care", which was founded in 195 1 and used to be the main pillar of China's medical security system. This medical system has played an extremely important role in safeguarding the health of Chinese workers and maintaining the stable development of society for a long time. However, with the reform and opening up, especially the in-depth development of the socialist market economy, this traditional medical insurance system has fallen behind the times, and its disadvantages are also obvious. There are three disadvantages:

(1) is not widely implemented. The traditional medical insurance system can't reflect the universal principles of social insurance, and there is still the problem of unfair distribution of social insurance resources. The traditional medical insurance system is mainly applicable to units owned by the whole people, including employees' families, covering only about 20% of the national population; The rural population, which accounts for about 80% of the national population, and some employees of units not owned by the whole people basically do not enjoy this kind of medical insurance treatment. The survey shows that among the reasons why urban and rural residents need to be hospitalized but are not hospitalized, about 58% of rural residents give up hospitalization because of family financial difficulties. This narrow coverage guarantee system obviously affects the social and economic progress and the improvement of people's lives.

(2) Financing channels are not wide. The expenses required for the implementation of the traditional medical insurance system are borne by the state and units, and individuals hardly bear the obligation to pay. In recent years, due to the aging population, environmental pollution, the progress of medical technology, the adjustment of drug prices and medical charges, and some human factors, medical expenses have risen sharply. According to the statistics of the Ministry of Labor, the medical expenses of employees in China were only 6 billion yuan in 1980, rising to 46.5 billion yuan in 1993, 65.38 billion yuan in 1995 and 77.37 billion yuan in 1997, with an average annual increase of 20%. According to statistics, the medical expenditure in Shanghai alone is as high as 6 billion yuan, which is twice that of new york, the largest city in the United States! Such a huge expenditure and growth rate make the country and units overwhelmed, and it is difficult to balance the deficit of medical expenses in time and raise medical insurance funds. Even when some enterprises run into difficulties, the basic protection of employees is not available.

(3) The management system is not in line with the traditional medical insurance system, and there is a phenomenon in the management system that "those who manage money don't care about doctors, and those who manage doctors don't care about money". There is no effective control mechanism in finance, diagnosis prescription and drug management. The management organization is not perfect, and some pharmaceutical units engage in fine packaging in order to pursue economic income unilaterally; Some medical institutions lack the necessary economic responsibility and awareness of saving, provide excessive "services" and prescribe "human feelings" and "big prescriptions"; However, enterprises lack strict examination on the rationality and standardization of medical prescriptions and submit them for reimbursement at will. These phenomena further aggravate the pressure on the state and enterprises to pay medical expenses, and lead some loss-making enterprises to engage in medical "reform", reduce or delay the medical expenses of retired workers, or simply adopt the "dead responsibility" method of sharing the existing medical expenses equally with people and not reporting the overspending. This so-called reform, which is not protected by law, has greatly damaged the medical rights and interests of employees. A new medical insurance system is imperative.

The disadvantages of the traditional medical insurance system make its normal operation unsustainable. In this context, the State Council took the lead in carrying out the pilot reform of social medical insurance system in Zhenjiang City, Jiangsu Province and Jiujiang City, Jiangxi Province in 1994, and expanded the pilot in 1996.

At the end of 1998, "the State Council's decision on establishing the basic medical insurance system for urban workers" marked the all-round development of medical reform. From 65438 to 0999, 24 provinces in China have issued overall plans for medical reform, and 36 prefecture-level areas have issued plans and put them into practice. The goal of this year's medical reform is to organize and implement it in 70% areas, covering about 50 million people, and basically establish a basic medical insurance system for urban workers. Therefore, a new medical insurance system is imperative.

Compared with the traditional medical insurance system, the new medical insurance system has the following remarkable characteristics:

First, the coverage has expanded. Its coverage includes all employers and employees in the town. Including enterprises (state-owned, collective, foreign-funded and private), organs, institutions, social organizations, private non-enterprise units and employees. At the same time, the owners of urban individual economic organizations and their employees can also participate in the basic medical insurance. It should be emphasized that the basic medical insurance is compulsory social insurance, and employees of any unit within the coverage must participate.

Second, management and service should be socialized and localized. In principle, the scope of basic medical co-ordination is based on the administrative regions at or above the prefecture level, and counties and cities can also be used as co-ordination units (referred to as co-ordination areas). The four municipalities directly under the central government shall, in principle, implement overall planning within the city. Unified policies are implemented in the overall planning areas, and funds are raised, used and managed in a unified way, which solves the problem of great differences in medical treatment between different ownership, different industries and different units under the traditional system.

Third, the medical insurance system has been unified. After the medical reform, the mode of combining social pooling with individual accounts will be unified; And eliminate the boundaries of employees' participation in medical insurance due to the nature of urban employee units and employee status, and the medical insurance costs are shared by employers and individuals. The employer's contribution rate is about 6% of the total wages of employees, and the employee's contribution rate is 2% of my salary.

Fourth, reform medical institutions and strengthen the management of medical services. Through the policy of "one point, two sets and three catalogues", that is, separate accounting and management of medicines are implemented; Implement the management of designated medical institutions and pharmacies, and formulate scientific and reasonable cost settlement methods; Clearly formulate the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and corresponding management measures, limit excessive service and excessive consumption, and reduce the waste of medical expenses.

Fifth, give some people proper care. The medical treatment of retired personnel, the old Red Army and disabled revolutionary servicemen above Grade B remains unchanged; Retirees do not pay insurance premiums and give appropriate care to the expenses borne by individuals; On the basis of participating in basic medical insurance, national civil servants can enjoy Medicaid policy; The insurance premium of laid-off workers from state-owned enterprises shall be paid by the re-employment service center based on 60% of the average salary of local workers, and they shall enjoy the corresponding medical insurance benefits.

Characteristics of the new medical insurance system:

1. Low energy level

The newly established basic medical insurance system for urban workers can only meet the basic medical needs of urban workers and cannot expect too much. China's current national strength and national income level determine that we can only implement the basic medical insurance system.

2. Wide coverage

The number of beneficiaries has expanded unprecedentedly. Including state-owned enterprises, collective enterprises, private enterprises (excluding township enterprises) and other urban employers, as well as organs, institutions, social organizations, private non-enterprise units and their employees. The medical insurance system for urban workers treats state-owned and non-state-owned workers equally.

3. Burden by both parties

In the past, the expenses for personal medical treatment were basically paid by the unit at public expense and labor insurance. In recent years, although individuals also bear part of medical expenses, the proportion is very small. The newly established basic medical insurance system for urban workers has a personal payment mechanism, which is very conducive to preventing waste.

4. The combination of social pooling and individual accounts. How to combine the medical insurance social pooling fund and individual account needs further exploration, but the combination of the two can avoid the unfair use of social medical expenses to the greatest extent and break the same pot and egalitarianism.

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