Current situation and perfection of Chinese medical security system
The medical treatment of our country ensures the system to pass the reform and
construction of more than 5 years, set up new-type medical treatment and ensure the system
framework tentatively. To extant social medical insurance coverage narrow, reform form a
complete set, government invest question such as being enough, need passing and setting up
multi-level medical security system, strengthen between government and medical fund input of
service field , accelerate social legislative paces that medical treatment ensure and strengthen
medical insurance reform dynamics action solve.
1． Practice medicine and treat the structure of ensuring the system now
The medical treatment system reform of our country has already made important progress; its
main sign establishes the new-type urban worker's basic medical insurance system mode.
Meanwhile, to the system defect of the basic medical insurance, developed supplementary medical
insurance of various kinds of forms and commercial medical insurance progressively, and has set
up corresponding medical rescue system to the disadvantaged groups. Though the medical
insurance system of China has not covered rural residents yet at present, but some rural areas had
still kept or set up rural cooperative medical treatment system newly. All kinds of medical
treatment ensure the system to form the medical security system of China together.
(1)Urban worker's basic medical insurance system
The State Council issue "about set up urban worker basic medical insurance decision of
system" (is it “determine " to hereafter referred to as ) in 1998. Through practice of more than 5
years, by the end of June of 2003, the national basic medical insurance has covered the number of
people and has already been up to 1 9,400 million. Most areas of the whole country (98%) have
started the system of medical insurance. Having already made the phased achievement in reform,
its sign is: The policy system of the system of basic medical insurance takes shape basically;
Unified medical treatment ensures the administrative system to be set up basically; The system of
medical insurance keeps steady to run basically; The security mechanism of the medical insurance
is given play to basically.
(2) Of different types to supplement the medical insurance
In practice, besides national civil servant's medical insurance of supplementing, all parts
also find out diversified forms of enterprises and supplement the medical insurance mode. Such as
the supplementary medical insurance which the management organization of social insurance
operates by way of social insurance; Supplementary medical insurance held by the commercial
insurance company; Organized by trade union the worker that handles and helped each other
(3) System of medical rescue
The urban worker's basic medical insurance system has two basic characteristics, first, regard
office (Enterprises and institutions or government office) of staff's formal employment as and join
insurance unit. Second, pay the insurance premium to interrelate with enjoying the treatment. It is
it exclude from current regulations in regular department population and worker of unit paid the
fees to have no ability of employment to have, among them have quite a few of persons who are
low income or the disadvantaged groups without income. So, to the institutional defect of medical
insurance, some cities have issued the medical rescue systems of the disadvantaged groups one
after another. Take Beijing as an example, will it be December 2001, Beijing Municipal
Department of Civil Affairs and Bureau of Finance , work , social security office , health bureau
issue " Beijing strand person medical rescue temporary means specially " jointly, have
implemented since January 1 , 2002. The main content is to reduce or remit the hospitalization
costs of the disadvantaged groups.
In sum, through the reform and construction of 5 years, the medical treatment of our country
has ensured the system to realize basically that go through transition and make changing in system
at present. On the system , have finished the transition from in fact the welfare types of socialized
medicine and labor-protection medical care to the insurance type of social medical treatment;
Have already taken shape and relied mainly on basic medical insurance tentatively on the system
aspect, supplemented by the supplementary medical insurance (civil servant supplements the
medical insurance , great volume medical treatment helping each other , insurance that
commercial medical insurance and worker help each other ) in various forms, basic frame of the
multi-level medical security system taking social medical rescue as bottom line.
2. Evaluation in system of medical insurance
Though the reform and construction of the medical insurance system of our country have
already made considerable progress, but on the whole, the progress of the system reform of social
medical insurance is still less than satisfactory . There are still a lot of questions in the operation
course of new system; some problems are still very serious. The subject matter of ensuring the
system of medical treatment of our country is at present:
(1)The social medical insurance coverage is narrow
By the end of June of 2003, the national basic medical insurance effected an insurance the
number of people has already topped 100 million, but look from total amount, the coverage rate of
medical insurance is only equivalent to 42% of the urban employed population (2001 ), have the
lowest rate of joining insurance in three major social insurance.
Looking from structure, what the basic medical insurance is covered mainly is state-owned
enterprise and some workers of government departments and institutions, still include the workers
of some collective-owned enterprises. A large number of other type worker of enterprise,
unofficial to obtain employment personnel, urban disadvantaged groups (low income or laid-off ,
unemployed worker, disabled person and elderly person of no family, the peasant going down
town worker, earlier the pensioner personnel ,etc. " in the system "), and peasants have not been
covered by the system yet.
On the whole, the current medical insurance system coverage of our country is still quite
limited, most social members do not have medical guarantee on system. According to the
statistical data of Ministry of Public Health, the all-inclusive cost of hygiene of our country have
already been up to more than 470 billion Yuan in 2000, among them resident's personal
expenditure of nearly 290 billion Yuan account for its 61%, this proves what can enjoy the system
of national basic medical insurance is still a few people.
(2)The multi-level medical security system has not really taken shape yet
Though the frame of the medical security system of our country has already taken shape
basically at present, but cooperate in being obviously deficient: First, the medical treatment of the
people in the countryside ensures the problem not to be solved at all yet; Second, the operation of
each level has not put on the right track yet in the existing system, the effect is not remarkable.
The worker supplements medical insurance, commercial medical insurance, social medical rescue,
rural cooperative medical treatment system and community medical careless. without getting
effective implementation yet.
(3)The system reform of health care and medical insurance system reform do not form a complete
The reform of the health care system is the key to involving that ensures the system and
moves forward smoothly in basic medical treatment. The health care system includes the
compensation mechanism question and medicines production, circulation system question of the
medical organization (mainly the hospital). Say on the general meaning, the compensation
mechanism of the hospital is to refer to the way that the hospital obtains the income.
Under planned economic system, the ones that do not make profits in nature of the hospital
and welfare , funds its is it come from finance or enterprises (unit ) allocate to come up basically,
other daily cost of the hospital are compensated through the charge of medical care, so, the motive
that the hospital pursues one's own interests is not strong. With the establishment of the market
economic system, the government's compensation policy to state-run hospital changes to some
extent too, the scale compensated is reduced gradually, the hospital relies mainly on managing and
accepting people, pursue the management motive that the economic benefits become the hospital.
For the existence and development of the hospital, the government allows the hospital to obtain
15%-30% of the price differential as compensation in they sell the medicines. In China, 90% of
the medicines are retailed by the hospital. In pursue under profit lead, hospital give patient turn on
great prescription often, turn on abroad importing more or by price high medicines that
overseas-funded enterprise produce.
The serious problem exists in the production of the medicines and field of circulation, the
ubiquitous phenomenon causes the medicines to fix the price empty and high, have influenced
consumers' interests seriously. The hospital is with the compensation mechanism that " the
medicine raises medicine ", medicines production and drawback of the circulation system, have
operated and formed the serious impact to the system of basic medical insurance smoothly. Except
that face the expenses pressure that such natural reasons as the improvement of aging population ,
disease generalization and medical technology ,etc. bring basic Medical Benefits Funds, bear
because the test brought in lagging of the system reform of medical and health. Much to
implement the area of the system of medical insurance , has all presented the situation that fund
people do not apply out the medical pool in various degree, this sustainable development of the
system of medical insurance is very unfavorable.
Medical and health system reform and medical insurance system reform another serious
consequence together whether hospital, medical insurance organization and relation, patient of
three sides have no order, the relation is tense. In order to control the growth of the hospitalization
cost, the government department issues a series of files aiming at standardizing the behavior of the
hospital, choice , use medicine , make a diagnosis project , expenses not to close way and fixed
choice of drugstore make clear regulation in hospital. Especially the medical insurance
organizations of many cities, calculate the method after changing the expenses " paid according to
the project " that implemented " reimbursing the cost " with the hospital in the past, and adopt "
total value budget is made " greater to the engagement of the hospital. This kind of settlement
method has increased the pressure of the fixed hospital, has even presented the conflicts of the
hospital and medical insurance organization.
Hospital and society protect contradiction of organization, is it affect an insurance the
patient's discontent to result in too. They thought they though participated in the medical insurance,
can't get the medical guarantee in fact. This will shake their confidence and trust to the
government to the system of medical insurance
（4）The government puts medical resources into insufficiently
Since the reform, government throw people get fund proportion , hygiene of medical industry
present the downward trend year by year, at the same time the personal expenditure increases
rapidly. The average proportions of taking their expenditures of public health expenditure of the
low income countries in 1997-1998 year (annual income per capita is among 1000-2200 dollars)
are 1. 26%, the middle-income countries (annual income per capita is in 2200 --The average
proportion that between 7000 dollars) is 2. 25%, and there is only 0 in China. 62%. Even
compared with developing country, the public health expenditure of China is still in very low level.
The medical fund input of the national hygiene is insufficient, is a reason why the macroscopic
has the medical insurance fund in short.
The proportion of fund-raising of the basic medical insurance of our country is at present: Last
salaries to workers unit the gross incomes the 6% about, pay individual there is the 2% about the
incomes for salary not one's own (the concrete to pay by proportion, different provinces are
different to some extent). Because there are no accumulation and sediment of the medical fund, to
already " old man " of the pensioner while implementing the new system, their medical insurance
fund forms a sum of " recessive debts ". Under having prerequisite of the fund " stealthy debt " of
medical insurance of solving the old man of other channels , is it is it bear oneself and
hospitalization cost of old man that retire already to come to pay the fees by on-the-job worker
only, will make the pressure of Medical Benefits Funds increase. This is causing many an
important reason why regional Medical Benefits Funds overspend every year.
Meanwhile, aging population causes greater and greater pressure to Medical Benefits
Funds too. With the increase of old population, the demand for Medical Benefits Funds increases
year by year too. Young people in the incidence of disease and suffering from chronic disease rate
and should be all far higher than of old people, the proportion that the laboring population at work
of supplying Medical Benefits Funds with a source accounts for is reducing. Its result is that “the
shortage of Medical Benefits Funds, the medical insurance responsibility that each on-the-job
worker should bear is greater and greater.” Limited and medical demand that the medical
insurance fund raises is relatively limitless, it is a pair of contradictions that the medical insurance
operates. This contradiction, the country throws to the health care industry into the relatively
insufficient background more outstanding today.
The government finance has a very unfavorable impact on system of medical insurance to the
deficiency of medical resource input. Medical Benefits Funds is in the deficient state all the time.
Meanwhile, because of the misfortune of the medical care structure, there is no medical demand
for resolving the patient rationally, makes the heavy expensive hospital of the funds flow, and
make the limited medical insurance fund not get utilizing effectively.
2． Perfect the idea of the medical security system
The basic guidelines of the institutional improvement of future social security of our country
are: Set up the social security system in conformity with development level of economy, regard
pursuing the society the goal fairly as, based on people's livelihood progressively. Because of this
guideline, it should be fairness and universality that the medical treatment of our country ensures
the value of institutional improvement and development to lead; Enable all social members to
enjoy the medical guarantee. And realize the key measure of the fairness is the construction which
perfects the medical security system, cover all social members through ensuring the establishment
of the network in multi-level medical treatment, meet their different medical demands.
(1)Worker's basic medical insurance system is the social insurance system that the country
implemented by force, the purpose is to ensure the basic medical demands of the on-the-job
worker and retired ex employee. The system of basic medical insurance has already run for more
than 5 years steadily, coverage rate is expanding progressively. The critical countermeasure of
perfecting the system of basic medical insurance is to accomplish “should be protected and
protected to the limiting ", enable the outside-the-system worker to enter the range of the system
(2)Should accelerate supplementing the construction of the system of medical insurance , the
expenses solving workers beyond the basic medical insurance coverage properly are born . In
order to affect an insurance worker, especially needy take place large volume at the hospitalization
cost, can be compensated through supplementing the medical insurance way. There can be various
forms to supplement the medical insurance, but it is a wiser choice to make use of advantage
(business insurance) of the market to manage.
(3)Develop the system of medical rescue; solve the worries of the disadvantaged groups. Seek
medical advice to social members (such as the disabled person ) not working or losing labor
capacity in the disadvantaged groups, offer more help , make the disadvantaged groups the same
as other social members, can receive the right of enjoying health ; It is unlikely to give up this
basic demand because of poverty.
(4)The medical treatment setting up and perfecting the countryside of our country as soon as
possible ensures the system, form the new-type cooperative medical service system in the
countryside .According to investigation, " national countryside cause poor returning to poor
peasant household take rural proportion of poor household up to 35% to be about already due to
illness due to illness, 13,050,000 about people in the countryside face the danger that go bankrupt
because of being ill every year ". With the improvement of the economic strength of our country
and deepening of the social security system reform, the medical treatment that the country has
already begun to pay close attention to the countryside ensures the institutional improvement.
Point out in " suggestion of accelerating setting up the new-type rural cooperative medical
treatment system " that the State Council issued on January 16 , 2003, the new-type rural
cooperative medical treatment system is to organize by government , led , stood, peasants
participate in voluntarily, individual , collective and government raise funds in many ways,
peasant relying mainly on comprehensive arrangement for serious disease medical treatment helps
each other and helps the system altogether.
The medical security system of our country should be, by the urban worker's basic medical
insurance, supplement medical insurance , commercial medical insurance , medical rescue and
new-type cooperative medical treatment system of the people in the countryside of the
disadvantaged groups to form . Ensure in the network in this medical treatment, every social
member can enjoy basic medical care and guarantee.