What is the difference between Chinese mainland's medical insurance and Taiwan Province's medical insurance system?

After years of economic development, western developed countries and some developing countries have established their own social security systems and different social security models. According to the characteristics and main influencing factors of different social security modes and social security systems in western countries, combined with the problems existing in their development, a comparative analysis is made, which is of reference significance for perfecting China's social security system. I. Types, characteristics and influencing factors of social security model (I) Social security model emphasizing efficiency Some newly industrialized countries and developing countries implement the social security system of savings fund, which is a typical social security model with liberalism as the guiding ideology and emphasizing efficiency. Take Singapore as an example, its central provident fund system requires employers and employees to pay the same amount of insurance premiums (central provident fund) for special purposes. It is characterized by emphasizing self-protection and unified personal savings rather than scattered personal savings; The financing method is mainly compulsory savings; The management organization is concentrated in the Singapore Central Provident Fund Bureau. (2) Social security model that pays attention to fairness The social security model with interventionism as the guiding ideology pays attention to fairness, mainly including the welfare state model and self-protection and public assistance model in developed countries. The former is characterized by income redistribution and progressive tax system, so that social wealth is not concentrated in the hands of a few people; The latter is characterized by the fact that the government's legislation on social security is the basis for implementing social security. (III) Factors influencing the choice of social security system mode The choice of social security system mode is restricted by many factors, among which the main factors are composed of three aspects: first, the social conditions and economic development level of each country; second, the theoretical and ideological background when each country chooses the social security system; and third, the different cultural factors of each country. Second, the comparison of social security systems in western countries We select several typical types of social security systems in western countries, and analyze and compare them with Britain, the United States and Chile as representatives. (1) Analysis of the British social security system After World War II, the western economy continued to grow at a high speed, but the British economy developed relatively slowly, and the industrial manufacturing industry retreated from the original world number one to the third. The difficulties facing the British economy are becoming more and more obvious, and the social problems in Britain, especially poverty and unemployment, are becoming more and more serious. This promoted the British government's reform of the social security system. Britain's social security system includes five aspects: national insurance, national medical care, personal social welfare, housing and education. Its own characteristics are as follows: first, the integrity of social security projects; Secondly, it goes deep into the family and replaces the traditional family support function to some extent. Therefore, national insurance bears the responsibility of supporting the family for the insured to a certain extent. Third, the principle of universality is the basic criterion for the construction of British social security system after the war. Finally, the government plays a major role in the social security system. The social security system in Britain is completely managed by government agencies and public officials. Although the social security system in many western countries also involves government agencies and public officials, it emphasizes the role of social organizations, such as some fund management agencies, trade unions and various associations, and plays a greater role in social security management. In the institutionalized security system, British social organizations have little effect. British national insurance is directly managed by the government and has become a huge department of the government. (II) Analysis of American Social Security System Keynesianism played a decisive role in the establishment of American social security system. 1929- 1933 The world economic crisis has dealt a severe blow to the United States, changing the traditional view that Americans think poverty comes from laziness for a long time. 1935 social security act has a far-reaching impact on the establishment of American social security system. After World War II, the continuous development of American economy laid a good material foundation for the perfection and development of social security system, and the rapid development of social economy provided a reliable source of funds for the American government to increase the types of social insurance, expand the scope of protection and improve the payment standard. The generalized security system in the United States consists of social insurance and social welfare. The social insurance system mainly includes narrow social security items (old-age insurance, widow insurance and disability insurance), medical insurance system and unemployment insurance system. Like western European countries, employers and employees in the United States must pay social insurance tax to enjoy social insurance benefits. Social welfare depends entirely on public expenditure, and recipients do not have to pay taxes for it, but applicants must pass the government's "livelihood review" to receive welfare, which is equivalent to "social relief" in Western Europe. The main characteristics of American social security system are: first, the inherent trend of marketization and socialization. While continuing to implement the traditional social security policy, great changes have taken place in the original way of providing social security. It not only restricts the historical tendency of the federal government to assume more social security responsibilities, but also opens the way for the social security system to transform into marketization and socialization, thus forming a unique "marketization and socialization social security model". Second, a diversified social security management and operation system. Public and private considerations, federal, state and local governments, non-profit organizations and profit organizations. Third, the multi-level nature of American social security plan. This multi-level nature is mainly manifested in the structure, form and type of the project. Finally, the multi-channel nature of social security fund raising. This is manifested in the following aspects: the funds provided by the federal government play the role of the main channel; The taxes collected by the government from employers and the welfare funds provided by business owners for employees have become important sources of funds for social security projects; Various communities and social welfare organizations also provide some social security funds for different interest groups; Private individuals provide social insurance funds by paying insurance taxes and providing specific insurance items. In addition, some people's charitable donations have also played a great role. (III) Analysis of Chile's Social Security System The privatization reform of Chile's social security system in the 1970s was deeply influenced by the neo-liberal theory. In terms of social policy, it advocates that social welfare undertakings that can be put on the market should be transferred to private operation, and the practice that social welfare is entirely held by the state should be changed. In addition, Chile's reform is also greatly influenced by American conservatism. 1at the end of 973, Pinochet's military government came to power and began to implement liberalized economic reforms. Pinochet's military government basically represents the interests of the middle class politically and advocates privatization economically. From the end of 1970s, Pinochet's military government began to implement a comprehensive economic reform policy of liberalization, and the privatization management of the social security system was one of the main contents of this radical reform. During 197 1- 1973, Allende's government carried out nationalization measures, which seriously damaged the political and economic interests of the Chilean middle class, triggered a series of political contradictions, and also led to a sharp decline in economic efficiency:1971-1 The average annual economic growth rate dropped to 1.2%, the ratio of fiscal deficit to GDP rose to 1 1.5%, and the economic situation deteriorated seriously. Chile's social security system consists of three parts: social welfare plan, medical insurance system and pension system, among which the pension system (including social insurance for the disabled and survivors) and medical insurance system were established after major reforms to the original old system. Taking the pension system as an example, its characteristics are as follows: First, individual pension savings are capitalized. During the period of employment, an individual deposits a certain percentage of his salary as capital into his personal account every month, and the pension fund management institution makes investment, so that the fund will continue to increase in value. The amount of personal pension depends on personal savings during employment. Secondly, pension funds are managed by private institutions. Third, introduce a competitive mechanism in the field of social insurance. Pension fund management companies attract more policyholders by improving investment profit rate and service level. At present, these eight management companies are formed by reorganization and merger on the basis of more than 20 previous companies, and nearly 70% of the insured have chosen three of them. Based on the above analysis, we summarize the analysis as table 1 (see table 1). Table 1 Applicable conditions and characteristics of comparative theoretical system model of social security systems in various countries. The defects are that newly industrialized countries and developing countries with national free savings funds emphasize self-protection, the financing method is mainly compulsory savings, the government's financial burden is heavy, the management is standardized and institutionalized, and the competitiveness is reduced. Singapore and Chile are interventionists. Welfare countries have developed economies and improved social and material living standards. It is not conducive to the sustainable development of the economy. Britain and northern European countries, self-insurance and public assistance industrialized countries or countries with strong economic foundation, provide basic economic security for members of society. The high cost of enterprises is not conducive to competition. The social security systems in Germany, Western Europe, the United States and Japan have both advantages and disadvantages for China. According to the current economic and social environment, China should choose a social security model suitable for China's national conditions, so as to meet people's basic needs, ensure social stability and promote long-term sustainable economic development. Throughout the development of social security system in the world, the legalization of social security system was attached great importance in the early stage of development. Under the strict legal system, the smooth implementation of social security measures can be guaranteed, which not only improves the stability of the system, but also helps to restrain the behavior of all parties. Although China has issued a series of measures, regulations and decisions in the process of social security system reform, there is still no complete legislation on social security, which makes it impossible to find legal basis for solving many problems in actual operation, which is a weakness of China's social security system reform. For this problem, we can gradually establish specific laws and regulations, and establish a basic social security law when conditions are ripe. At the same time, we must also ensure that relevant laws and regulations can be effectively implemented. First of all, the social security system is based on the potential conflict between efficiency and fairness and market failure. The establishment of social security system is to meet the needs of the public for social and economic development in many aspects, not just to protect the needs of marginal groups; The scope of welfare tolerance is far from being satisfied by economic growth and material interests, but the integration of various human interests including material interests; Due to various market failures, the market system without intervention can hardly achieve the efficiency goal, let alone the goal of social equity and other human concerns. Therefore, government intervention is essential for social functions and goals that the market cannot achieve through intervention. Fairness and efficiency are two different and related goals in the design of social security system. The fairness here is not only the fairness of income distribution, but also the fairness of sharing the fruits of social progress, the fairness between the sexes, the fairness between the strong and the weak, and the fairness between generations. Efficiency not only refers to stimulating people's enthusiasm for hard work and innovation, but also refers to the enthusiasm of enterprises to continuously improve operating efficiency, and also refers to the effective allocation of social resources and the effective operation of the whole economy. The degree of fairness and efficiency will be different in different countries or different development periods of the same country. When inefficiency becomes the main factor restricting economic development, the main goal should be to pursue efficiency growth; When the imbalance of fairness forms a restrictive force that hinders economic growth, the main goal of promoting growth should be to adjust the fair relationship. Through the development of social security thought, we can find that people who attach importance to economic efficiency emphasize liberalism and rely on market forces; People who attach importance to social fairness advocate expanding government intervention and correcting the deviation from the goal of fairness through redistribution. Secondly, the choice of social security mode is restricted by values and the level of economic development. Values mainly depend on the government's judgment on the importance of different development goals and the analysis of social welfare content, and are also influenced by a country's social and cultural factors. The level of economic development determines the level and scope of a country's public welfare goals. Third, the design of social security system should clearly define the responsibility sharing relationship of social security objectives at all levels. Due to the different nature of social security objectives (social security services) at all levels, the responsibilities of different types of social security project undertakers are also different. Some can introduce market mechanisms (such as medical security and old-age security), while others can only be provided by the government (such as social relief and security services); For example, the old-age security to maintain a normal standard of living and the old-age security to pursue a higher quality of life. The government's social security responsibility is very important, but if we don't pay attention to letting enterprises and individuals bear the corresponding obligations or responsibilities in the system design, even the social security plans in economically developed countries will collapse. Since 1970s, the rise of multi-pillar model is a correction to the mistakes of previous system design. An effective social security system is not only a system that meets the goals of fairness and efficiency, but also a system with vitality. Fourthly, in the aspect of old-age security, the change from pay-as-you-go system to partial accumulation system conforms to the principle of efficiency, but it has obvious transition costs and will bring different benefits to different groups. At present, China is changing from pay-as-you-go system to multi-pillar model, but there are still many problems to be solved urgently. These problems include: the empty account operation of personal account, the standardization and institutionalization of social security system, etc. The government will play an important role in solving these hidden problems.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.