The former director of the Ministry of Civil Affairs talks about supplementing health care - how to build "tens of billions" and "trillions".

The construction of multi-level medical security system in China's medical insurance dream is the key task of deepening the reform of medical security system in China.
The Opinions on Deepening the Reform of the Health Care System, issued in March 2020, set out clear reform objectives: by 2030, a medical security system with basic medical insurance as the main body and medical assistance as the sole support, supplementing medical insurance, commercial health insurance, charitable donations, and mutual medical assistance will be fully established.
According to the plan of the Opinion, multi-level medical security can include four levels: the first level is the basic medical security organized by the state, the second level is the enterprise supplementary medical insurance organized by the employer, the third level is the commercial health insurance mainly purchased by individuals, and the fourth level is from the social and market-oriented charitable public welfare and medical mutual assistance.
Zhenyao, director of the China Institute of Public Welfare at Beijing Normal University, has long been committed to the construction of a fourth-tier medical security system.
From 2001 as the Director of the Disaster Relief Department of the Ministry of Civil Affairs, to promote the full establishment of the minimum living security system for urban residents and the realization of "guaranteed", to 2008 responsible for the formation of the Ministry of Civil Affairs Social Welfare and Philanthropy Promotion Division and served as Director, and now is currently the Director of the China Public Interest Research Institute of Beijing Normal University, Shenzhen International Public Interest Institute founding president.
more than 20 years, President Wang Zhenyao not only began to promote the development of China's charitable relief work, but also witnessed the historical development of this cause from state-led to the participation of the whole people.
for him, charity is no longer a simple job, but a career he will fight for all his life.
China Health Insurance (ID:zgylbxzzs) recently conducted an interview with President Wang Zhenyao, the former director of the Ministry of Civil Affairs from the perspective of charitable assistance, talked about his understanding of multi-level complementary health care.
: What role should you play in the construction of China's multi-level medical security system, public welfare charity and social mutual assistance? Wang Zhenyao: Public welfare charity and social mutual assistance and commercial health insurance are part of the supplementary medical security system, before we may know less, but recently because of the emergence of water droplets, easy preparation, as well as this response to the outbreak, we found that social forces could have played such a large use.
The so-called "supplement" is to ensure that the national basic health insurance can not take care of the part, but not because it is "supplement" can be available, in the field of basic health insurance coverage, its role is very important, even indispensable, if the mechanism is built, it can and basic health insurance policy to form a very benign interaction.
its advantages I think can be reflected in two aspects: first, the potential is great.
In a large country of 1.4 billion people, what small dedication multiplied by 1.4 billion is huge, which is not easy for other small countries to form, so once the mobilization of the whole people will be very large resources, even if one person a dollar has a full 1.4 billion yuan.
second, flexibility is good.
basic health insurance is a national policy that cannot be easily changed and may require some processes and review cycles when it comes to entitlement.
but charity and social assistance are flexible, faster than policy adjustment, it is more the need for everyone's moral and self-discipline.
: You have been engaged in more than 20 years of related work, during which time China's charitable relief business has changed? Wang Zhenyao: Since I started working in the Disaster Relief Department of the Ministry of Civil Affairs in 1997, I have been concerned about the development of charitable and medical assistance-related undertakings.
personally, our charitable relief business is always accompanied by major disasters or public health events and breakthrough development.
such as SARS in 2003, although at that time in the allocation of funds, personnel deployment and other aspects of the response mechanism is not yet mature, but the national materials, funds quickly mobilized more than 40 billion, can be quickly put into SARS treatment.
And the 2008 Wenchuan earthquake is to make charitable relief to a very big step, the donation activities in the earthquake objectively and comprehensively innovated the development pattern of China's philanthropy, so we also called this year China's philanthropy "the first year of public welfare", from this year, China's public welfare began to move from the edge to the mainstream.
then came the Charity Act of 2016, and the understanding and participation of charitable aid has been increasing, and the amount of money available to various funds and charitable organizations has been increasing.
Not only that, these two years with the rapid development of the Internet, and then there have been water drops, easy preparation, mutual treasure such relying on the network platform of the new model of mutual assistance, it can be said that now charity relief has gradually infiltrated into our daily life.
: What is the "network mutual assistance" that has become popular in recent years? What is the biggest difference between it and charitable aid? Wang Zhenyao: The more well-known "mutual treasure" and "water drop chip" are in fact a typical form of network mutual assistance that has emerged in recent years, in fact, its essence is a kind of traditional social mutual assistance in China for many years.
For example, someone may have had a serious illness before, the same village, the same community people will make voluntary donations to help him, but now the network developed, in the form of an online platform.
the simplest summary of social mutual assistance is that "one side has difficulties and eight parties support".
this idea is basically not understood in foreign countries, they mentioned that charity is the act of organization, which is also the biggest difference between social mutual assistance and charitable aid.
so in a certain sense, the concept of charity is passed from the West, which is a way they groped out, and social mutual assistance is characteristic of China.
Because our traditional culture has acquaintance culture, so there will be "eat a hundred meals, wear a hundred clothes" such a story, in this concept of social assistance is sometimes non-cost, can not be measured.
: Do you think there are any problems that must be solved in the process of participating in the construction of China's multi-level medical security system? Wang Zhenyao: I think the most important issue now can be summed up in two sentences: the mechanism is not very smooth, the procedure needs to be sound.
mechanism is mainly docking mechanism, that is, how the existing social forces can interface with the government's basic health care system, whether it can form a mechanism of financial and information connectivity.
when a person has a serious illness to go to the hospital, basic medical insurance can be reimbursed how much? If basic health insurance can't be covered, how to find social assistance channels? Without the establishment of this docking mechanism, it is easy to find two-way obstacles such as charity can not find donors, need to donate can not find a way.
The original medical assistance and medical insurance is in the civil affairs, people's social two departments in charge, in the establishment of connectivity mechanism there are difficulties, but the formation of the National Health Insurance Bureau after the formation of these two parts of the work put together, I think the mechanism of construction can be put on the agenda.
, there is now a lack of a set of working procedures that enable social assistance groups and platforms to interface with health and hospitals.
, for example, now on the Internet mutual aid platform, they sometimes go to the hospital to set up a stall, hoping to help those who can't get treatment.
But now there is a lack of procedures to connect this social platform with hospitals, which are not well understood and adapted, and there is no way for patients in need to get help in this way, and there is no way for hospitals and doctors to do so.
: For social forces to participate in medical security, what are the more practical experiences in the world to learn from? Wang Zhenyao: I won't say that China's health care system has its own characteristics, and it's not good to copy foreign experience directly in this regard.
I would like to say a more learned experience, that is, many developed countries in the world have developed medical social work system, they are also a very important part of the medical system, can effectively reduce the contradiction between doctors and patients.
how do medical social workers play a role in the participation of social forces in health care? In a hospital, for example, when a patient is seriously ill with surgery, he or she is told that the medical social worker will first tell the patient about the medical expenses and how to reimburse them, and that if the patient cannot afford it himself, the medical social worker can help them contact the social organization for donation assistance.
in short, a medical social worker is a group that helps hospitals, patients and society connect, and he has access to social assistance organizations and platforms across the country.
with such a group of "middlemen", doctors do not have to spend a lot of energy and patients to tangle with the cost of the problem, can concentrate on the treatment work, patients also have access to help.
of course, medical social workers are part of the public service, so a mature medical social workers system must be led by the Government.
although our national health department has also sent a message to promote the relevant work, but in fact, the construction of hospitals later a large gap, medical social workers in our country also presents a fragmented state.
( Note : Medical social workers are short for medical social workers , who are professional social workers who provide psychological care and social services to patients in hospitals and health institutions .
November 2018, the Medical Social Work System was listed as a separate level indicator in the Assessment Indicators of the Action Plan for Further Improvement of Medical Services (2018-2020) issued by the National Health and Health Commission.
Health Insurance: What are your possible suggestions for giving full play to the role of charitable assistance in supplementing health care? Wang Zhenyao: First of all, I think we should strengthen the communication and linkage within the social charity force.
can be led by several intermediary agencies, through the form of alliances scattered in different places of charities, foundations, mutual aid agencies for major diseases, such as the Red Cross once led the establishment of a platform for children's major disease relief.
, the formation of a network of social charity pattern, for the next step and health care sector, health sector and health care system to establish docking mechanism to do a good job.
, we should strengthen data sharing and information communication.
mechanism level, the lead unit can determine an interactive mechanism, such as monthly and quarterly meetings for some common issues, typical cases of communication.
technically, we want to be able to connect information systems for medicare and medicare, or that health care and health systems can provide this data, break down barriers created by information asymmetry, and help social charities find more people in need.
: Finally, what do you expect from China's charitable assistance and social assistance? Wang Zhenyao: Now everyone's sense of charity is getting stronger and stronger, each year through various channels to raise charitable funds also have tens to hundreds of billions.
is small compared with trillions of dollars in spending, but it is flexible.
and the creativity of the people is also very strong, especially now after the 80's, 90's, 00's, their imagination is far more than we, can combine the current Internet technology to greatly expand public participation in philanthropy.
I think the Government should advocate and encourage more for such "innovation".
At the same time, as soon as possible to build charitable assistance, social assistance industry regulatory norms and working mechanisms, in the hundreds, hundreds of billions of charitable relief funds and trillions of basic health insurance funds between the formation of a bridge, with this part of flexible funds to help basic health insurance, hospitals and doctors to solve urgent, difficult, dangerous, heavy medical security problems, so that it is truly qualified "complementary health care."
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