Related contents of establishing China's medical insurance system

The basic medical insurance system is an important part of the social security system, which is formulated by the government with the participation of employers and employees. The following is the full text of China's basic medical insurance system carefully compiled by Bian Xiao for reference only.

Basic meaning of basic medical insurance system

The basic medical insurance system is an important part of the social security system, which is formulated by the government with the participation of employers and employees. It determines the basic medical security level of employees according to the affordability of finance, employers and employees, and has the characteristics of universality, mutual assistance and compulsion.

The basic medical insurance system for urban workers is an important part of the social security system. The social security system is an important pillar of the socialist market economy. Accelerating the establishment and improvement of a social security system independent of enterprises and institutions is a concrete manifestation of the implementation of General Secretary Jiang Zemin Theory of Three Represents, which is related to the overall situation of reform, development and stability. The public medical care and labor insurance medical care systems established under the planned economy system have played an active role. However, under the condition of market economy, its disadvantages are increasingly prominent, which are mainly manifested in the following aspects: first, the state and enterprises bear too many responsibilities and lack a reasonable mechanism for raising medical expenses; Second, there is a lack of restraint mechanism between doctors and patients, and medical expenses increase too fast and are seriously wasted; Third, the coverage is relatively narrow, which makes it difficult to guarantee the basic medical care of social workers and is not conducive to the rational flow of labor. Therefore, in order to establish and improve the social security system, create a fair competitive social environment, promote the rational flow of labor force, guarantee the basic medical care for employees and safeguard the rights and interests of employees, it is necessary to establish the basic medical insurance system for urban employees.

With the improvement of China's economic development level and the attention of the government and related research fields, in order to achieve the goal of basically establishing a medical security system covering all urban and rural residents, the State Council decided to start the pilot work of basic medical insurance for urban residents in 2007, explore and improve the policy system of basic medical insurance for urban residents, and gradually establish a basic medical insurance system for urban residents with a focus on overall planning of serious diseases.

Since 2007 (20 10), the basic medical insurance for urban residents has achieved remarkable results. The coverage of the system has gradually expanded, and the number of participants has also increased steadily. According to the statistical yearbook of the Ministry of Health in 20 10 and the summary of health statistics in China in 20 10/0, the basic medical insurance system for urban residents has covered 3/kloc-0 provinces, municipalities and autonomous regions, and the number of participants has increased from 429 10 in 2007 to 20/kloc-.

2. Relevant documents of the basic medical insurance system

The State Council's Decision on Establishing the Basic Medical Insurance System for Urban Workers

Accelerating the reform of the medical insurance system and ensuring the basic medical care for employees are the objective requirements and important guarantees for establishing the socialist market economic system. On the basis of summarizing the pilot experience of medical insurance system reform in various places, the State Council decided to reform the medical insurance system for urban workers nationwide.

Tasks and principles of reform

The main task of medical insurance system reform is to establish the basic medical insurance system for urban workers, that is, to adapt to the socialist market economic system and to establish a social medical insurance system to ensure the basic medical needs of employees according to the affordability of finance, enterprises and individuals.

The principles of establishing the basic medical insurance system for urban workers are: the level of basic medical insurance should be adapted to the development level of productive forces in the primary stage of socialism; All employers and their employees in cities and towns should participate in basic medical insurance and implement territorial management; The basic medical insurance premium is shared by both the employer and the employee; The basic medical insurance fund combines social pooling with individual accounts.

Coverage and payment method

All employers in cities and towns, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises and private enterprises, etc.). ), organs, institutions, social organizations, private non-enterprise units and their employees should participate in the basic medical insurance. Whether township enterprises and their employees, owners of urban individual economic organizations and their employees participate in basic medical insurance shall be decided by the people's governments of all provinces, autonomous regions and municipalities directly under the Central Government.

In principle, the basic medical insurance shall be based on the administrative regions (including prefectures, cities and leagues) or counties (cities) above the prefecture level. In principle, the three municipalities directly under the Central Government, namely Beijing, Tianjin and Shanghai, shall implement overall planning within the city (hereinafter referred to as the overall planning area). All employers and their employees shall participate in the basic medical insurance in the overall planning area in accordance with the principle of territorial management, implement unified policies, and implement unified collection, use and management of basic medical insurance funds. Railway, electric power, ocean transportation and other enterprises. Production mobility is large and its employees can participate in basic medical insurance in different places in a relatively centralized way.

The basic medical insurance premium is paid jointly by the employer and the employees. The employer's contribution rate should be controlled at about 6% of the total wages of employees, and the employee's contribution rate is generally 2% of his salary income. With the development of economy, the contribution rates of employers and employees can be adjusted accordingly.

Establish basic medical insurance funds and personal accounts.

It is necessary to establish the basic medical insurance pooling fund and individual account. The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts. The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish the overall fund, and the other part is included in the personal account. The proportion of individual accounts is generally about 30% of the employer's contribution, and the specific proportion is determined by the overall planning area according to the payment scope of individual accounts and the age of employees.

The overall fund and individual account shall delimit their respective payment ranges, and shall be accounted for separately, and shall not occupy each other. Determine the qifubiaozhun and the maximum payment limit of the overall fund. In principle, the qifubiaozhun is controlled at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled at about 4 times of the average annual salary of local employees. Medical expenses below Qifubiaozhun shall be paid by personal account or borne by individuals. Medical expenses above Qifubiaozhun and below the maximum payment limit are mainly paid from the overall fund, and individuals also have to bear a certain proportion. Medical expenses exceeding the maximum payment limit can be solved by means of commercial medical insurance. The specific qifubiaozhun, maximum payment limit and personal burden ratio of medical expenses above the qifubiaozhun and below the maximum payment limit of the overall planning fund shall be determined by the overall planning area according to the principle of balance of payments.

Improve the management and supervision mechanism of the basic medical insurance fund

The basic medical insurance fund shall be included in the financial account management, and shall be used for special purposes and shall not be misappropriated.

Social insurance agencies shall be responsible for the collection, management and payment of basic medical insurance funds, and shall establish and improve the budget and final accounts system, financial accounting system and internal audit system. The business expenses of social insurance agencies shall not be drawn from the fund, and shall be solved by the financial budgets at all levels.

Bank interest calculation method of basic medical insurance fund: the part raised in the current year will bear interest according to the deposit interest rate; The fund principal and interest carried forward from the previous year shall bear interest at the bank deposit rate of lump-sum deposit for 3 months; The deposited funds deposited in the social security financial special account shall bear interest at the three-year zero deposit and lump-sum savings deposit rate not lower than the interest rate of this grade. The principal and interest of an individual account are owned by the individual and can be carried forward and inherited.

Labor and social security and financial departments at all levels should strengthen the supervision and management of the basic medical insurance fund. Audit departments should regularly audit the fund revenue and expenditure and management of social insurance agencies. In the overall planning area, a medical insurance fund supervision organization with the participation of relevant government departments, employers, medical institutions, trade union representatives and relevant experts should be established to strengthen social supervision of the basic medical insurance fund.

Strengthen the management of medical services

It is necessary to determine the service scope and standard of basic medical insurance. The Ministry of Labor and Social Security shall, jointly with the Ministry of Health, the Ministry of Finance and other relevant departments, formulate the scope, standards and settlement methods of basic medical services, and formulate the national basic medical insurance drug list, diagnosis and treatment items, standards of medical service facilities and corresponding management measures. The administrative departments of labor security of all provinces, autonomous regions and municipalities directly under the Central Government shall, in accordance with the provisions of the state, jointly with relevant departments, formulate corresponding implementation standards and measures in their respective regions.

The basic medical insurance is managed by designated medical institutions (including Chinese medicine hospitals) and designated pharmacies. The Ministry of Labor and Social Security shall, jointly with the Ministry of Health, the Ministry of Finance and other relevant departments, formulate measures for the examination and approval of the qualifications of designated medical institutions and designated pharmacies. Social insurance agencies should, in accordance with the principle of integrating traditional Chinese and western medicine, take into account grass-roots units, specialized departments and comprehensive medical institutions, be responsible for determining designated medical institutions and pharmacies, and sign contracts with designated medical institutions and pharmacies to clarify their respective responsibilities, rights and obligations. When determining the designated medical institutions and pharmacies, we should introduce the competition mechanism. Workers can choose a number of designated medical institutions to seek medical treatment and purchase medicines, or they can buy medicines at a number of designated pharmacies with prescriptions. The State Administration of Pharmaceutical Products shall, jointly with relevant departments, formulate measures for handling drug purchase accidents in designated pharmacies.

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