What is the old-age insurance system in Taiwan Province Province?

Taiwan Province province's national health insurance adopts compulsory social security, which is a medical safety guarantee mechanism of payment, mutual assistance, social coordination and fair medical treatment. Its characteristic is that according to the law of large numbers of commercial insurance, it shares the risk of huge medical expenses of a very small number of patients and distributes family wage income for the first time, that is, the horizontal transfer of personal income tax.

Transfer part of the income of high-income people to middle-and low-income people, and transfer part of the income of physically and mentally healthy people to many patients, so as to complete the overall planning of social development, in order to cope with the plight of residents who are sick and have no money to seek medical treatment, or even become poor due to illness. According to a survey in 2004, the satisfaction rate of residents in Taiwan Province Province was 77.6%.

The national health insurance in Taiwan Province Province provides moderate and appropriate medical services, including disease prevention, diagnosis and treatment, health education knowledge, etc. The medical services provided include in-patient medical services and out-patient medical services of western medicine, traditional Chinese medicine and dentists, and the payment scope includes new items such as doctor's examination, inspection, laboratory test, surgical treatment, prescription, medicine, raw materials, diagnosis and treatment, medical treatment, rehabilitation and inpatient ward fees.

Disease prevention and control services include prevention and treatment of diseases in children and adolescents within the scope of planned immunization, general physical examination for prevention and treatment of diseases in adults (once every three years for adults aged 40-64, once a year for the elderly aged 65 and above), pregnancy examination for pregnant women, and cervical smear examination for women. On the level of health education knowledge, health education theme activities are carried out according to the production of various promotional materials and souvenirs, such as physical and mental health guides, staff training courseware, folding pages, audio-visual materials, academic journals, health education knowledge lectures, etc.

We will implement the "Pilot Project of Physician-led Nursing Rules and Regulations of Healthy China Commercial Insurance Company", give full play to the role of family doctors and community doctors in primary outpatient clinics, provide nursing and medical services for patients with various chronic diseases in the community, build a perfect community nursing Internet together with cooperative hospital outpatient clinics, cultivate residents' personal behavior of visiting doctors for health management consultation before getting sick, and promote the improvement of graded diagnosis and treatment and referral system.

The core idea of all-staff health insurance in Taiwan Province Province is to "promote the spiritual essence of self-help and mutual assistance". All-staff health insurance raised 370 billion RMB (40% of which came from beneficiaries, 33% from insured enterprises and 27% from government subsidies), accounting for about 6% of the original GDP of Taiwan Province Province. The contribution rate of the insured is 4.55% of the person's monthly salary. The contribution rates of the six types of commercial insurance objects are different according to the occupational types, and the contribution rates of individuals, enterprises and government departments in the unit are also different.

For the disadvantaged groups with difficulties in economic development, including low-and middle-income families, mentally retarded and physically disabled people, elderly people over 70 years old in low-and middle-income families, unemployed and unemployed people under 20 years old and under the legal age of 55, the government can subsidize part of the expenses by itself. Poor people who do not belong to the above categories but are unable to pay for medical insurance can also apply to the medical insurance management unit for installment payment of insurance fees, interest-free loans for distressed stock funds, and charity teams to pay social security and medical insurance fees.

In addition, in order to alleviate the pressure of medical expenses of patients with serious diseases, the medical insurance management unit listed 3 1 diseases such as tumor, diabetes, mental illness, congenital malformation, immune system disease, burn and occupational hazards as new serious diseases. At this stage, about 5.7 billion people (accounting for 2.4% of the insured employees) have received serious injury cards, which have the preferential treatment of exempting part of their medical expenses. Their medical expenses are about 776,543.8 billion yuan, accounting for 22% of the total medical expenses, which further relieves the pressure of medical expenses for seriously ill patients.

The national health insurance in Taiwan Province Province adopts the method of "effectively utilizing medical resources and gradually implementing the rules and regulations of full payment". In 2002, there were16,958 special medical research institutes for health insurance, accounting for 93.33% of the medical research institutes in Taiwan Province Province, China. In addition, there are 3,348 retail pharmacies, 226 medical examination institutions, 22 midwifery clinics, 53 community rehabilitation organizations for mental illness and 390 community home care organizations. Hospital beds provided by specialized hospitals are 123723.

Because private hospitals in Taiwan Province Province of China account for about 85% of the total, of which 78.4% are beds paid in full by commercial insurance, and 2 1.6% are patients who need to pay for beds. The annual average utilization rate of outpatient service in the hospital is 14.43 times, and the annual average hospitalization times are 13.4 times. Medical expenses account for 67.34% of outpatient medical expenses and hospitalization expenses account for 32.66%. Insured people enjoy medical services, most of which are paid by commercial insurance institutions, and some new projects need to be paid at their own expense.

For example, going to the outpatient department of primary medical institutions needs to pay for 50 yuan at their own expense, and going to the outpatient department of medical technology center needs to pay for 2 10 yuan at their own expense, so as to promote the effective utilization of medical resources, create the concept that insured people are proud of medical expenses, popularize classified services for diagnosis and treatment, and give resources to patients who need care most. For the payment of medical service providers, choose a variety of payment methods, from the previous payment by service, gradually promote the fixed payment by module service project budget, and actively implement the rules and regulations of total medical expenses payment.

Manipulation method of medical expenses in full health insurance

In Taiwan Province Province, the way to raise and repay the full-time health insurance stock fund is "fixed income by expenditure, fixed expenditure by income", and the medical insurance stock fund is paid in cash without accumulation. Therefore, the medical insurance management unit saves expenses, constantly reforms and innovates the medical insurance payment methods, and recently clearly puts forward the "diversified adjustment" plan to actively improve the imperfect parts of private medical insurance enterprises in a more diversified and extensible way to ensure the balance of medical insurance funds.

Setting the relative value makes the payment standard of medical expenses reasonable.

After the establishment of all-staff health insurance in Taiwan Province Province, the charging standard established during the original labor insurance clause was followed, and some modifications were made to fill in, and the charging standard of medical service "Health China Commercial Insurance Medical Expense Payment Standard" was issued as the basis for the invited medical research institute to apply for medical expenses from the health insurance supervision institution after providing medical services for the insured employees. Over the years, although the medical insurance supervision institutions have been revised several times, they are all partially adjusted.

The stock fund has remained basically stable, but due to the aging population, the innovation of diagnosis and treatment technology and the improvement of residents' medical requirements, as of the end of June 2003, the balance of the stock fund account prepared in advance for health insurance protection was/kloc-0.02 billion yuan, which was less than the total payment of commercial insurance for one month. Because health insurance is a social security law with independent accounting and operation,

It is essential to pay the beneficiary's medical expenses with the proceeds of insurance. When the balance of stock funds is difficult, commercial insurance maintains the balance of stock funds by adjusting insurance fees or changing the scope of subtotal payment. Therefore, since September 2002, the first adjustment of health insurance interest rate has been implemented. Taking full account of the sharing of many insured workers and the specific situation of social and economic development in Taiwan Province Province, the interest rate was only slightly adjusted from 4.25% to 4.55%. In addition, since April 2005, the payment base of administrative organs, universities, enterprises and other personnel has been raised to raise funds.