Funding for social security

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Medical insurance originated in Western Europe, dating back to the Middle Ages. With the success of the bourgeois revolution, the cottage industry was replaced by large industries and a modern industrial workforce emerged. Due to the harsh working environment, prevalent diseases and industrial accidents made workers demand appropriate medical care. However, their wages were low and it was difficult for them to pay for medical expenses personally. So workers in many places organized themselves to raise a portion of the funds for expenses in case of illness. However, this form was not very stable and was small in scope, with a low ability to withstand risks.In the late 18th and early 19th centuries, private insurance developed in Western Europe and became an important way for the state to raise funds for medical care.In December 1998, the State Council issued the Decision of the State Council on the Establishment of a Basic Medical Insurance System for Urban Workers (Guofa [1998] No. 44), deploying a nationwide The State Council issued the Decision of the State Council on the Establishment of a Basic Medical Insurance System for Urban Workers (Guo Fa [1998] No. 44) in December 1998, deploying nationwide efforts to comprehensively promote the reform of the workers' medical insurance system, and calling for the establishment of a basic medical insurance system for workers throughout the country within 1999

Category I

The medical insurance system can be divided into: ① Indirect medical insurance system. The government's social insurance agency signs a contract with a private medical institution, whereby the patient pays for his or her medical expenses out-of-pocket and then reimburses the social insurance agency for all or part of his or her expenses. This type of system is mostly found in western industrialized countries. ② Direct medical insurance system. The government directly owns and manages medical institutions, and the state bears all or part of the medical expenses of workers. This type of system is mostly found in socialist countries. ③ Basic medical care. Preventive, curative and comprehensive health insurance services. It includes nutritional improvement, sanitary water supply, mother and child care, immunization against major infectious diseases, prevention and control of epidemics, and treatment of common diseases. Such systems are mostly found in developing countries. The conditions for entitlement to health insurance are determined by the duration of employment or the period for which premiums are paid. Usually, the eligibility conditions for medical insurance match those for sickness insurance, and those who receive cash benefits from sickness insurance are entitled to medical services. China's current medical insurance system is divided into a publicly-funded medical care system practiced by State organs and institutions and a labor insurance medical care system practiced by enterprises. Medical expenses are borne by the state or by enterprises, and in the late 1980s a scheme was introduced on a trial basis whereby individuals bear part of the costs.

Category II

I. Commercial medical insurance reimbursement medical insurance and compensation medical insurance. Reimbursement medical insurance (general medical insurance) means that the patient's medical expenses spent in the hospital are reimbursed by the insurance company. It is generally divided into outpatient medical insurance and inpatient medical insurance. Indemnity medical insurance (specialized medical insurance) means that the patient is clearly diagnosed by the hospital as suffering from a disease specified in the contract, and the insurance company pays for the patient's treatment and care according to the amount agreed upon in the contract. It is generally divided into single disease insurance (e.g., cancer insurance) and major disease insurance (major disease insurance for 10, 20, and 30 types of diseases, etc.). Related Books

The above two types of medical insurance have similarities but also differences. The similarity is that you can only be insured if you are sick, and the differences are: general medical insurance is all-encompassing, i.e., you can be insured for all types of illnesses. Specialized medical insurance is a specialized type, i.e., only certain diseases or surgeries specified in the insurance contract are covered. The medical insurance launched by the insurance company will often combine part of the above two categories of insurance to form a combination. Allowance-paying medical insurance In short, allowance-paying medical insurance is a kind of medical insurance in which the insurance company pays benefits to the insured person on a per-occurrence, per-day, or per-item basis in accordance with the subsidy standard stipulated in the contract. Claims are not related to actual medical expenses incurred and no invoice is required. Regardless of the illness and the amount spent on treatment, the standard of payment remains the same. If you are insured with more than one company, you can receive claims from more than one company, and the benefits are paid regardless of the number of policies taken out. This part of the benefit compensates for losses other than medical expenses incurred as a result of hospitalization, such as loss of income due to sick leave, transportation costs, etc. Benefit-paid health insurance is the "icing on the cake". Generally speaking, if you are already covered by social health insurance, it is more suitable to choose a critical illness insurance policy together with a benefit-paid health insurance policy. Benefit medical insurance is not directly related to social insurance, as long as the hospitalization or surgery, the insurance company must pay compensation. Ms. Chen, a housewife, 30 years old. She has taken out 1 hospitalization medical insurance (allowance type, RMB200/day, hospitalization for illness, 3-day deductible) of an insurance company for her husband with each of the three insurance companies. In August this year, Mr. Chen was hospitalized for 60 days due to illness. After being discharged from the hospital, Mr. Chen not only received partial payment of medical expenses from the social insurance institution, but also the three insurance companies*** paid Ms. Yang RMB 36,000 (RMB 200/day*60 days*3) in hospitalization medical allowance. Ans: Ms. Yang chose an allowance-based medical insurance for her husband. The most important feature of allowance-based medical insurance is that it is only related to the number of days of hospitalization, not the medical expenses. The first thing to consider when purchasing medical insurance is the reimbursement of medical expenses, followed by the compensation of damages incurred due to hospitalization. Only when the basic protection is solid and complementary to the basic protection can the icing on the cake be added. For those who have sufficient social insurance coverage, they can give priority to the benefit-paying type of medical insurance. Insurance Principle In insurance science, there is a question about whether the principle of compensation applies to health insurance. This question cannot be generalized. The principle of indemnity means that "the insured cannot be compensated more than his actual loss". This is not the case with benefit-based health insurance, where the benefits are not related to the actual loss. Its design principle is actually to consider the insured's loss of wages due to sick leave during hospitalization, so the contract stipulates that the subsidy will be paid according to the number of days of hospitalization, which does not take into account the costs incurred during actual hospitalization, and has nothing to do with the actual economic loss, which is a kind of "fixed-value insurance". Expense-based medical insurance is based on the actual medical expenses incurred by the customer, and pays the insurance benefit according to the insurance amount agreed in the policy. The purpose is to compensate for the customer's medical expenses, claims need to be issued by the customer outpatient or hospitalization invoices, the scope of claims is basically the same as the "social security". How to buy without medical insurance: Firstly, insure the expense type medical insurance because according to the medical level nowadays, the hospitalization time of the general illness is about 10 days, insure the expense type product, the reasonable hospitalization medical expenses can be reimbursed most of the medical expenses if the ratio of 80% is reimbursed. If you take out an allowance-type medical insurance product, you can only get a claim on the 4th day. If you are hospitalized for 10 days, you can get a claim of RMB 1,500 based on a daily allowance of RMB 250, which is a relatively small amount of claim, and the insured's expenses in the hospitalization of 10 days should be far greater than this figure, so it is recommended that you take out an expense-type insurance policy first, and then consider taking out an allowance-type policy. How to buy with medical insurance: allowance-type medical insurance and expense-type medical insurance complementary to China's current social health insurance policy is divided into two parts, one is the cost of outpatient and emergency treatment, and the other is the cost of hospitalization. Generally speaking, about 80% of outpatient and emergency costs are borne by oneself. An inpatient hospitalization cost of about 10,000 yuan is generally about 30% borne by oneself, while an inpatient hospitalization cost of about 100,000 yuan for a serious illness is 20% borne by oneself. In addition, social health insurance has strict limitations. New, imported and expensive drugs are not covered by social health insurance. For medical expenses caused by traffic accidents, social health insurance is not reimbursed. In addition, the costs that often occur during illness, such as nutritional costs, nursing costs, lost wages and so on, are not reimbursed. Therefore, those who have medical insurance to insure their hospitalization medical insurance can consider purchasing expense-based and allowance-based complementary. Choosing expense-based hospitalization medical insurance is also a useful supplement. Fourth, social health insurance in China in the early 1950s the establishment of public health care and labor insurance medical collectively referred to as social health insurance for employees. It is an important part of the national social security system and one of the important programs of social insurance. Medical insurance has the basic characteristics of social insurance, such as compulsory, mutual aid and social. Therefore, the medical insurance system is usually legislated by the state, mandatorily implemented, and a fund system is established, with costs paid by both employers and individuals***, and medical insurance premiums paid by medical insurance organizations, in order to solve the medical risks brought about by workers' illnesses or injuries. Medical insurance is a kind of material help given by the state or society when people are sick or injured, i.e. a social security system that provides medical services or financial compensation. China's medical insurance has played a positive role in safeguarding the health of workers and maintaining social stability for more than 40 years. However, with the establishment of the socialist market economic system and the deepening of the reform of state-owned enterprises, this system has been difficult to solve the problem of basic medical protection for employees under the conditions of the market economy.