What problems does China's medical security system face today?

(A) the duality of government medical and health investment and the alienation of public hospital behavior

In recent ten years, the Chinese government has invested in public hospitals mainly in two ways: one is direct financial investment, and the other is policy investment, including tax exemption, price increase of drugs and medical materials, and inspection above cost pricing (the tax exemption part is almost negligible in medical institutions). The two investment methods are soft and hard, and the financial input is relatively insufficient, which is getting softer and softer. However, policy investment is becoming more and more difficult and gradually becomes the main channel of government investment.

2 Alienation of public hospital behavior The reform of public hospitals was designed and promoted by the government, but after the reform, the behavior of public hospitals gradually drifted away from the original intention of government reform. In order to reduce the financial burden and adapt to the situation of national economic system reform, the health system has also been reformed since the 1980 s, from government investment to policy-based hospitals. Hospitals not only "eat" the government (financial input), but also "eat" patients (high interest charges). Policy investment such as drugs and medical materials has gradually become the main channel for government investment and hospital compensation. Facing the duality of compensation mechanism, whether and to what extent hospitals can enjoy the benefits of policy input. Directly depends on the market share occupied by hospitals.

(B) Social medical insurance is unfair and inefficient.

Since 1980s, with the development of rural economic and social system reform, the original cooperative medical system in most rural areas of China has collapsed, and farmers have completely become self-funded medical care. Until 2003, there was basically no medical security in rural areas, and about 90% of farmers relied on self-funded medical care. Medical insurance among different groups of people in cities and towns is equally unfair. 1998' s medical reform plan first excludes a large number of township enterprises, urban self-employed and freelancers and their families.

On the other hand, the medical insurance system for urban workers and the new rural cooperative medical system, which are characterized by "third-party payment", lack effective control over doctors' moral hazard. The information asymmetry, professionalism and strong technology in the medical service market determine the unequal status of the supply and demand sides: doctors are experts and authorities.

(3) "No distinction between management and office", "arrest control" and the integration of government affairs.

The medical insurance market consists of the supplier (doctor), the demander (patient) and the third party, namely the medical insurance institution, and the government is the supervisor above the three. Effective government supervision of medical service providers (hospitals and doctors), users (patients) and medical insurers is a necessary condition for the normal operation of the medical insurance market. However, in China, the regulatory role of the government is chaotic. From the aspect of medical service provision, the government directly organized a large number of medical institutions, forming a typical "father-son" relationship. The hospital is an administrative subsidiary of the government, and the government is equivalent to the president of a general hospital. Because the government's investment mainly depends on policy investment, the compensation of hospitals mainly depends on the market. Therefore, the hospital's power (prescription) to doctors is an incentive, and the government's profit-seeking behavior to hospitals is the default.

(d) Dual health care system and indirect government responsibility.

After the founding of New China, China gradually formed a dual socio-economic structure. Since the 16th National Congress of the Communist Party of China, the dual socio-economic structure is moving towards integration. However, the health care system still adheres to dualism. In terms of medical care, urban medical care and rural medical care are binary. Rural health work has always been the focus of health work, but in practice, the pattern of emphasizing cities over rural areas has never changed. 80% of health resources are concentrated in cities, while the vast rural areas and about 70% of the population only enjoy 20% of health resources, resulting in poor fairness and accessibility of basic medical care.

In this way, residents in different regions and different insurance systems are only fair in a small scope within their own regions and systems, and it is difficult to ensure that everyone enjoys fair medical treatment. This is closely related to the distribution mechanism of government financial input in the development of health care in China.