In-depth thinking: "14th Five-Year" period, the reform of the health care system how to innovate ideas? How do I set goals?

The "14th Five-Year Plan" period is the beginning of China's new journey to build a socialist modern country in an all-round way, and it is also the key period when all kinds of contradictions and risks are prone, and the pursuit of high-quality development will be the main tone of the country's economic and social development during the 14th Five-Year Plan period.
(1) Innovative medical security system development concept as an important social security system arrangements, medical security must follow the principle of fairness and justice, to achieve the goal of universal access.
Therefore, the reform and system construction of China's medical security system during the 14th Five-Year Plan period should adhere to the development thought centered on people's health, with the goal of effectively relieving the people's medical worries about disease and constructing a high-quality medical security system with Chinese characteristics, so as to optimize the basic medical insurance system and promote the accelerated development of the multi-level medical security system.
To this end, it is necessary to optimize the current system concept, it includes at least: (1) from universal coverage to universal equity China has initially achieved the goal of universal health insurance, but this goal is still at a low level, in addition to there are still some people unseeded, but also between urban and rural areas, regions, groups, there are differences in financing and treatment.
, the future development must adhere to and implement the universal participation, the system of unified fair medical insurance orientation, in order to system fairness to protect the rights of the whole people fair.
Universal benefits are reflected in the whole people a lot of coverage by the medical security system, the key to the implementation of this principle is to promote all employees to participate in basic medical insurance in accordance with the law, while the urban and rural residents voluntary insurance adjustment to compulsory or automatic insurance;
(2) from the division of the accounts to mutual assistance.
The core content of the medical insurance system is to determine the collective strength to resolve the individual's uncertain disease risk, its reliability can only be based on mutual assistance, so we must follow the law of risk sharing, risk sharing, maximize the release of "one system, one fund" and "everyone participates, everyone shares" mutual assistance function.
We must fully realize that the privatized personal account of medical insurance is not only contrary to the essence of the medical insurance system, but also brings about many undesirable consequences such as greatly reducing the function of medical insurance system protection and deriving self-interest, increasing operating costs and wasting medical insurance resources.
Therefore, it is necessary to comprehensively strengthen the mutual assistance function of the medical insurance system, improve the overall level of the medical insurance fund by eliminating the replacement of individual accounts and corresponding rights and interests, and consolidate the social co-ordination fund guided by "big medical insurance, big health" to truly solve the medical worries of all the people.
(3) From unclear rights and responsibilities to rights and responsibilities before the match has been mentioned, in China's medical security practice, the government and employers continue to increase the responsibility for financing, the personal burden continues to reduce relatively.
of the medical insurance for urban and rural residents, which accounts for about three quarters of the total population, the financing responsibility of local governments has increased significantly faster than that of individuals, while the rights and interests of individuals in medical insurance have developed in a rigid way.
In particular, the use of the same rated contribution system for residents, billionaires and low-income families in accordance with the same amount (absolute value) standard of contributions, which makes the residents' medical insurance system there is a reverse adjustment phenomenon, but also with the ability to pay for high- and middle-income people on the "cheap" ride.
Therefore, in the future, it is necessary to take clear responsibility and responsibility sharing as the basic concept of the health care system to mature, and establish a dynamic adjustment mechanism linking individual contribution standards to residents' income, so as to ensure that the health insurance fund can continue to grow with income growth and responsibility balance.
(4) from the collection of money to the end of the collection.
An important law in the reform of the medical insurance system in the past was to emphasize the collection of funds, the theoretical assumption is how much money to do, how much health insurance funds can be raised to provide the people with how much medical security, the medical security practice under the guidance of this concept is bound to be the people's health insurance rights and interests subject to the scale of financing;
Obviously, the concept of fund-raising is more in line with the people's health as the center and the inherent requirements of the universal health insurance system, and the practice of medical security under the guidance of this concept can also push the financing responsibility towards equilibrium and the boundary of authority and responsibility to clear, so that the construction of multi-level medical security system has the impetus.
(2) The development goals and assessment indicators of the medical security system set out the objectives and tasks of china's medical security system during the 14th Five-Year Plan and the 15th Five-Year Plan period.
It can be determined from this that the 14th Five-Year Plan should be a critical period of steady development and stereotypes and improvement in the direction of system unification, operational norms, steady and sustained direction, and its main development goal is to basically build a chinese characteristic medical security system with clear coverage, clear rights and responsibilities, reasonable architecture, efficient operation mechanism and clear and stable expectations, so as to realize the modernization of basic medical security and medical insurance governance for all, and continuously improve the health and well-being of the people.
(1) to consolidate universal coverage and expand the coverage of the basic medical insurance population, to achieve the "one can not be less" population coverage target.
To this end, basic medical insurance for employees should be paid in strict accordance with labor relations, basic medical insurance for residents should be converted from voluntary insurance to compulsory or automatic insurance, and at the same time, it is necessary to innovate the way in which flexible employment and new employment practitioners are fully integrated into the medical insurance system, fully enable automatic coverage of newborns, improve the policy remedies for the break-off and leakage of insurance, and change to the permanent resident population insurance based on household registration insurance, so as to ensure that the floating population can participate in the life cycle.
(2) contributed to a relatively balanced financing.
improve the policy of medical insurance participation and payment, gradually balance the financing responsibilities of all parties, adhere to the essence of mutual assistance, and steadily move towards a sharing of responsibilities, a relatively balanced and stable and sustainable financing mechanism.
At the same time, it is also necessary to change the phenomenon of excess balance of medical insurance funds, under the premise of annual balance of income and expenditure, a slight balance, appropriate adjustment of unit and individual contribution rate to strengthen individual participation consciousness to appropriately raise the proportion of individual contributions, and gradually implement the "old-age approach, new methods, middle-income methods" of retiree contributions transition policy.
to explore the establishment of insurance coverage suitable for the rural poor, the relative poor as the object of medical assistance, to achieve the relative poor people should be guaranteed, and steadily improve the level of medical insurance financing and medical assistance government subsidies.
(3) to effectively promote fair treatment of statutory health insurance.
establish a unified national list of basic medical security treatment, clarify the policy authority, basis and procedures for determining and adjusting treatment, ensure that the level of treatment, treatment adjustment and treatment are unified, and reasonably improve the level of treatment.
At the same time, the flow of funds within the pool of the medical insurance fund is restructured, and the insured personnel are guaranteed from the aspects of preventive health care, outpatient treatment and inpatient treatment, so as to raise the level of pre-illness prevention and control, outpatient medical security and reimbursement of hospital expenses of the insured population, and give full play to the role of risk protection and health management of medical insurance.
on the basis of unifying the list of basic treatment of national medical insurance, we will explore local additional public health projects, increase the treatment of specific groups of people, and effectively relieve the worries of insured persons as a result of catastrophic medical expenses.
to coordinate outpatient co-ordination, pay-per-head reform, steadily promote the hierarchical diagnosis and treatment system, improve the convergence of the management system of off-site medical treatment, system to accommodate the level of activity, reimbursement and settlement to be simplified.
(4) Strengthen the construction of the rule of law under the conditions of deepening reform and optimizing the institutional arrangements, accelerate the pace of legal construction of medical security in order to promote the special legislation of medical security as the leader, and continuously improve the level of the rule of law of medical security.
During the 14th Five-Year Plan period, we should promote the enactment of the Medical Security Law to provide a legal basis for the entire medical security system, initiate substantive amendments to the Social Insurance Law, introduce administrative regulations such as the Basic Medical Insurance Regulations, the Medical Assistance Regulations, the Commercial Health Insurance Regulations, the Charitable Medical Regulations and the Regulations on the Supervision of the Medical Security Fund, and establish the basic legal framework for the rule of law for medical insurance.
under the premise that there is a law to follow, strengthen the law enforcement of medical insurance, gradually establish professional and mature medical security law enforcement team and management norms, combat fraud and insurance fraud in accordance with the law, and guide the whole society to enhance the awareness of the rule of law and the responsibility of the rule of law.
(5) insist that the health insurance fund budget balance budget balance slightly balance is the basic goal pursued by the national health insurance system.
In Germany, for example, its law provides that the fund balances of individual health insurance institutions may be reserved for a minimum of 25 per cent of monthly expenditures, a ceiling of not more than one month's expenditure, balances exceeding the ceiling can be returned directly to the insured person, and the attractiveness of the insured can be enhanced by increasing the payment items and introducing new types of medical services (family doctors, integrated treatment, etc.).
In South Korea, the law provides that the reserve fund accumulates at least 5 per cent of the cost of insurance contributions for the financial year until the fund reaches 50 per cent of the cost of that fiscal year, in other words, the balance of the Korean health insurance fund is limited to 0.6 months to 6 months.
the balance of the two countries' health insurance funds is not high, but the system is running steadily and can be used as the frame of reference for our country.
China's current medical insurance fund balance is too large, the national basic medical insurance fund (including maternity insurance) accumulated balance reached 2769.7 billion yuan at the end of 2019, of which the basic medical insurance co-ordination fund (including maternity insurance) accumulated balance 19270 100 million yuan, the cumulative balance of individual accounts of workers' health insurance 842.6 billion yuan, while the total expenditure of the National Basic Medical Insurance Fund (including maternity insurance) in the same year was 2085.4 billion yuan, which means that the existing fund balance is sufficient to pay for the medical insurance treatment of the people of the whole country for 16 months.
There are two main reasons for this situation: First, the staff health insurance personal account fund balance can not be shared caused by the lack of effective mutual help between the insured: Second, the low level of health insurance co-ordination led to the fund split in hundreds of co-ordination areas, resulting in different regions of the fund payment capacity is different.
therefore, the "14th Five-Year Plan" period should determine the budget balance, slightly surplus objectives, and enhance the mutual help between the insured and improve the level of integration should become the only way.
(6) Actively promoting the multi-level architecture of different income levels of the population's demand for medical security is bound to be different, the more high-income classes need more comprehensive medical security and health services, its personalized needs require the establishment of a multi-level medical security system.
therefore, the "14th Five-Year" period should clearly define the structure and functional orientation of the multi-level medical security system construction, and take measures to steadily promote, in order to fully mobilize the enthusiasm of market subjects and social forces.
the above objectives, a number of key indicators can be set, as set in table 1: the specific indicators set in table 1 are based on what is necessary and feasible.
first, the rate of participation is a key indicator of basic health care for all and health equity.
under the binary operation structure of the existing system, it should be feasible for statutory medical insurance to realize "guaranteed guarantee".
statistics, the number of people covered by basic medical insurance nationwide in 2018 and 2019 was 134.459 million and 135.407 million, respectively, accounting for 96% and 96.7% of the total population, respectively.
six years from 2020 to 2025, an average annual increase of 0.55 percentage points would enable universal coverage of 100%.
, this is not a goal that cannot be accomplished.
the key is to strictly implement the labor contract law, promote the full coverage of basic medical insurance for workers, urban and rural residents from voluntary insurance to compulsory or automatic insurance, especially for special groups such as newborns need to adopt automatic insurance mechanism as soon as possible, to ensure that "one does not miss insurance."
, the statutory medical insurance reimbursement ratio and the individual out-of-state medical expenses rate are the key indicators to measure people's medical worries about diseases.
To continuously improve the level of treatment of basic medical insurance and effectively solve the people's medical worries about diseases is the fundamental purpose of China's medical insurance system, and focusing on solving the medical expenses of major diseases is the key to reduce the poverty caused by disease and return to poverty.
therefore, the "14th Five-Year Plan" period should further improve the proportion of reimbursement within the scope of the health insurance policy, reduce the rate of individual out-of-payment medical expenses, and then actively explore the basic medical expenses from the fund payment cap to the personal out-of-the-money cap.
Statistics, in 2018, the hospital expenses fund within the scope of the national employee health insurance policy paid 81.6 percent, the actual hospital expenses fund paid 71.8 percent, the individual burden 28.2 percent;
In 2019, the Hospital Expenses Fund within the scope of the National Employees' Health Insurance Policy paid 85.8% of the actual hospital expenses Fund paid 75.6% and the personal burden was 24.4%: the above indicators for residents' medical insurance were 68.8%, 59.7% and 40.3%, respectively.
, the ratio of individual burden financing is an important indicator to evaluate the rationality of the sharing of responsibilities in financing mechanisms.
"14th Five-Year Plan" period, employee health insurance can stabilize the employer's contribution rate at 6%, gradually improve the individual contribution rate, to the final goal of paying half of the steady progress.
It is appropriate to reasonably divide the financing responsibilities of the government and individuals in the residents' medical insurance, while continuing to raise the standard of government subsidies, reform the practice of equally rated contributions for urban and rural residents, explore the equal contribution according to residents' income, appropriately increase the proportion of individual contributions, and increase the share of individual medical insurance financing from the current less than 30 %% gradually raised to about 40% at the end of the 14th Five-Year Plan, which is an important condition for the rational development and sustainable development of the medical security system, and the gap between the per capita medical insurance fund expenditure between the medical insurance for employees and residents' medical insurance and the balance rate of the medical insurance fund are objective criteria for examining the balance of treatment structure and the sustainability of the fund.
On the one hand, the level of medical insurance treatment is a realistic reflection of the effect of the operation of the medical security system, but also a basic measure of the fairness of the system at present, the level of treatment of basic medical insurance between workers and residents is larger, the "14th Five-Year Plan" period should continue to narrow the gap.
this end, it is advisable to further improve the proportion of residents' inpatient expenses reimbursement, the outpatient chronic disease reimbursement model