Under the new situation, how can medical assistance "support the bottom"?

The Opinions on Deepening the Reform of the Medical Security System put forward the acceleration of the construction of a multi-level medical security system with basic medical insurance as the main body, medical assistance as the base and other forms of security for common development.
according to the requirements of the Opinions, medical assistance should be integrated into the multi-level medical security system, especially the basic medical security, which is the responsibility of the government.
under the new situation of deepening reform, it is very necessary to rethink and position the responsibility and function of medical assistance under the overall framework and development goals of medical care, and to clarify the basic connotation of the "bottom" of medical assistance.
, the particularity of medical assistance has long been established and developed under the framework of comprehensive social assistance, and the establishment and development of medical insurance, the main system of medical security, is separate from each other.
Medical assistance not only lacks coordination and convergence with medical insurance in policy design and management, but more importantly, similar to other social assistance programs, medical assistance also limits the scope of assistance to the general poor groups (low-insured people, five insured households, three no personnel, etc.), but also the treatment policy often does not reflect the characteristics of medical expenses protection (to resolve the risk of medical expenses payment), not fully consider the complexity and differences of medical assistance.
medical assistance is not only an integral part of the social assistance system, but also an integral part of the medical security system.
, although medical assistance and other social assistance programs have in common to eliminate and alleviate poverty, but medical assistance has a more distinct personality.
is the particularity of reaching the population.
It is not only low-income poor people who need medical assistance, but also sick-related poor people who suffer from high medical costs, defined not only as income-based, but also as disease and medical expenses.
is the auxiliary nature of the function.
In our country, medical assistance is not a system that plays the function of protection alone, but an integral part of the multi-level medical security system with basic medical insurance as the main body, and it is an auxiliary system that plays the role of supplementary protection for the needy groups on top of basic medical insurance, which needs to be closely coordinated with basic medical insurance.
is the uncertainty of spending.
Other social assistance programs usually provide relief protection based on income compensation, aid expenditure to the income subsidy of the object of assistance to the extent that can maintain a basic life as the upper limit, relief expenditure is relatively certain, controllable and predictable;
uncertainty presents great challenges to medical assistance in determining the level of financing, designing treatment policies, and strengthening management supervision.
, under the premise of realizing the unified management of medical security, we should give full consideration to the above-mentioned particularity of medical assistance and redefine the responsibility and function of medical assistance in the medical security system.
Ii, the boundary of responsibility for medical assistance in the medical security system what responsibility medical assistance should bear, medical assistance should help who, and what scope and extent of relief treatment should be provided, clear the boundary of responsibility for medical assistance needs to answer these questions.
In terms of the sharing of responsibilities for multi-level health care, the definition of the boundary of responsibility for medical assistance depends both on the size of the responsibilities of basic medical insurance (which currently includes major illness insurance, which is closely linked to basic health insurance) and on the boundary of responsibility for the entire basic medical security (the basic, major illness and relief triple guarantee for which the government is committed to basic health care).
the former decides that basic medical insurance leaves room for medical assistance, the former and the latter can really clarify the specific scope of responsibility for medical assistance.
, in practice, the responsibility for medical assistance is the responsibility for the protection of treatment left after basic medical insurance - basic medical insurance (plus major illness insurance).
, the level of protection of basic medical insurance, the government commitment to basic medical security (triple security) objectives are different, the size of the responsibility for medical assistance is different.
the goal of basic health care, the lower the existing level of coverage for basic health insurance, which means that the greater the responsibility for medical assistance, the reverse.
future, we need to clearly define and gradually unify the level of treatment of basic medical insurance and the development goals of basic medical security, in order to finally define the unified scope of responsibility for medical assistance.
the definition of the object of protection, the responsibility of medical assistance is reflected in providing assistance to two groups of people.
Is the traditional low-income poor (the scope can be slightly higher than the low-insurance line of the marginal poor people appropriate extension), not only to provide them with insurance contributions, but also to provide medical expenses relief;
to provide medical assistance to the second group of people is an important aspect of the special nature of medical assistance, indispensable.
From the definition of the scope and level of protection treatment, taking into account the characteristics of the above two groups of people, the level of relief treatment should also be different, relief treatment should be tilted forward, in order to ensure that the general poor people can enjoy the protection of relatively high treatment protection of basic medical services, not because of the weak ability to pay and self-inhibit the necessary and reasonable medical needs.
specifically, the former group of people set a lower starting line, a higher proportion of relief payments, the latter set a higher starting line, a relatively low proportion of payment.
In addition, based on the principle of "basic insurance" of basic government medical care, the scope of medical services assisted by medical assistance should in principle be consistent with basic medical insurance, that is, the main responsibility for the payment of medical expenses paid by individuals within the scope of the policy, and the burden of medical expenses outside the scope of the policy should be borne by commercial health insurance, charitable donations, social medical assistance, etc.
However, medical assistance should also retain some flexibility on the basis of adherence to principles, with some relief funds, and provide a degree of medical assistance support through an open and transparent professional assessment process for certain special services (e.g. children), special diseases (e.g. rare diseases) that are particularly expensive and not covered by the policy, especially where commercial health insurance, charitable contributions and social assistance are not available from the market and society.
3, the appropriate support of medical assistance "on deepening the reform of the medical security system" clearly requires that the development goal of basic medical security is to provide fair and "moderate" treatment protection.
With the implementation of the treatment list system, the scope of responsibility for basic medical security and basic medical insurance will gradually conse generally conse generally, and the boundaries of medical assistance will gradually conse generally, that is, the scope of medical assistance responsibility - moderate basic medical security - moderate basic medical insurance.
Refore, although the Opinion makes it clear that medical assistance must assume the function of support, but the basic medical security, basic medical insurance development goals are moderate protection, which determines that the bottom protection of medical assistance is a moderate bottom.
The so-called modest support is to further improve the level of basic health care through medicare on the basis of medical assistance, to reduce the personal burden to a lower level, so that the target can afford (or with the help of social forces can afford), but not exempt from the full responsibility of the individual.
The reason why the basic medical security should be moderately guaranteed, medical assistance should also be moderately supported, both for a considerable period of time China's economic development level, the constraints of the government's financial capacity (the primary stage of socialism), but also to maintain a certain amount of individual out-of-the-way to restrain unnecessary abuse of medical services, control the rapid growth of medical costs of the real need.
s out-of-the-nation benefits, which are based on basic health insurance and medical assistance, can also be helped through commercial health insurance, charitable contributions, and social medical assistance, i.e. through a diverse mix of government, markets and society to achieve fuller health care.
As to the level of individual out-of-pays after the medical assistance support is specifically reduced to what level is appropriate, how to define what kind of individual out-of-payment is still within the scope of individual affordability, we need to learn from international experience and fully consider China's national conditions, carefully study to clarify.
From the international experience, from the post-World War II to today, in order to cope with the payment crisis brought about by over-welfare, the social medical insurance system in the western developed countries (equivalent to China's basic medical insurance and medical assistance) has undergone a huge change in the personal burden from nothing to nothing, increasing.
, however, under political pressure, welfare-cutting reforms are often difficult, so the level of personal out-of-pays for health care in developed countries remains very low.
Even so, there is a general stop-loss mechanism for individual burdens, i.e., individual out-of-home catastrophic health expenditure thresholds (beyond which individual burdens will affect their basic lives), and individuals no longer pay, fully covered by government health insurance (often referred to as the personal burden cap).
although the world health organization recommends a threshold of 40 per cent of individual out-of-home health expenditures, the actual threshold for countries is often well below this level.
such as Germany, where the threshold is 2 per cent of household income, and chronically ill people, which fell further to 1 per cent (2009), Sweden has only 366 euros per year (2009).
western developed countries from the excessive protection of free medical care to low-level personal out-of-the-way development process, it is worth our in-depth thinking.
In the process of promoting the medical security system to mature and stereotyped, we should avoid reverting to the old way of over-guaranteed, high welfare and difficult to reduce in developed countries (even if the scale of the decline through difficult reform is very small, personal responsibility is too small).
For a long time, our country should maintain the basic medical security treatment at a moderate level, the government is in the snow to send carbon rather than icing on the cake, for individuals to leave a certain affordable, affordable out-of-the-way responsibility, on the basis of shared responsibility to achieve the goal of medical treatment for all.
For a long time, it is not appropriate for our country to establish a cap-and-limit mechanism for individual burdens, to eliminate the abuse of medical services and the waste of limited relief resources, and the lessons of excessive protection in the process of poverty alleviation should be seriously learned.
In particular, on the one hand, basic health insurance maintains the current average level of treatment of about 80 per cent (employees) and 70 per cent (residents) (areas with excessive coverage need to be reduced and under-guaranteed areas need to be improved), and the vast majority of the insured can afford the remaining 20-30 per cent of individual out-of-the-way costs, while a few Those who can't afford it (the poor and the sick-related poor who are in spending poverty) move further into the scope of medical assistance, raising the coverage of the poor to 90 per cent through basic health care (triple guarantees) and keeping the personal burden at around 10 per cent.
90% of the basic medical security treatment level should be the current stage of China's medical assistance to assume the support function of the moderate level.
, of course, the level of modest support is not static.
With the improvement of the level of economic development, the support capacity and efficiency of the medical security fund can further improve the level of treatment of basic medical insurance and medical assistance, and provide a higher level of medical security and medical assistance for the general public and the needy.
of course, the realization of the function of medical assistance needs the corresponding financial support.
basic medical insurance, medical assistance belongs to the direct responsibility of the government, and medical assistance at a moderate level needs special financial input support.
In order to fulfill the pre-set responsibility of medical aid support, it is necessary to establish a corresponding special budget for medical aid finance independent of basic medical insurance, so that the rescue budget and the relief responsibility match, in order to ensure that the medical aid support really can afford and hold.
Of course, even with matching budget input, medical security needs to be strengthened management and supervision, through agreement management, payment mechanism and regulatory mechanism to restrain and guide the behavior of medical services, reduce waste, improve the efficiency of the use of health care funds, including the rescue budget, so that health care, medical aid system operation is stable and sustainable.
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