China establishes a universal public medical security system
The Third Plenary Session of the 18th CPC Central Committee proposed "to establish a fairer and more sustainable social security system." Basic medical security is the top priority of the social security system. China has established a basic medical security system that is said to cover the entire population. However, Gu Yu, a professor at Peking University’s School of Management, believes that this system is still in poor operation, rooted in local differences. Too complicated, the medical insurance is characterized by fragmentation. Professor Gu Yu pointed out that for the current basic medical insurance system, the fine-tuning of the fragmentation has not helped. The most desirable reform direction for Chinese medical insurance is to move toward re-welfare, from social medical insurance to “quasi-public medical careâ€. This reform can be briefly summarized by “workers becoming residentsâ€. In this new system, all nationals are insured as residents, and the fundraising comes from the national quota registration fee and the government quota subsidy. This system is uniform for all insured nationals, and the level of payment and structure are the same. Professor Gu Yu emphasized that this transformation can not only solve many difficult problems caused by the fragmentation of medical insurance, improve the fairness and efficiency of medical insurance, but also boost the social security burden of enterprises in the supply-side reform. The core difficulty in establishing this “quasi-public health care system†seems to be “financial problemsâ€. In this regard, Professor Gu Yu believes that for individuals, "the registration fee of 200 yuan per person per year is completely affordable for the majority of the nationals." For the government, “As the government’s fiscal revenue level continues to increase, as long as it cuts about 9.5% of the future fiscal spending, or adds 6% of the existing fiscal expenditure, It can establish a universal health insurance system for all citizens to reach 75% of the actual medical expenses. The remaining 25% of medical expenses can leave room for the development of private health insurance. The road map has already existed, and fiscal expenditure does not seem to be a problem. It depends on the government’s determination to live up to the promise of “governing for the peopleâ€. China's current medical insurance system is characterized by fragmentation. Data map In China today, a basic medical security system covering the entire population has been established, but this system has a long way to go with well-functioning goals. The basic medical security system consists of the basic medical insurance for urban workers (hereinafter referred to as “medical insurance for urban workersâ€), the basic medical insurance for urban residents (hereinafter referred to as “medical insurance for urban residentsâ€) and the new rural cooperative medical care (hereinafter referred to as “new rural cooperative medical careâ€). Social medical insurance composition. In the past one or two years, under the deployment of the central government, many places have begun to strongly promote urban and rural integration. The latter two insurances have been merged into urban and rural residents' medical insurance. The root cause of poor operation of the basic medical security system lies in the many institutional details of three (or two) medical insurance, such as the level of overall planning, funding model, payment period, payment structure and administrative management, which are highly localized, and the local differences are complex. Sexuality has led to the fragmentation of the entire health care system. Fragmentation of medical insurance not only undermines the fairness of the medical insurance system, but also detracts from efficiency. Facing the fragmentation, the fine-tuning of the various issues and the fragmentary system that have been proposed in the literature and implemented by governments at all levels have not helped. China's medical security system urgently needs systematic reform from fragmentation to integration. It is a desirable and feasible social policy choice to establish a quasi-public medical insurance system with uniform individual payment levels, unified government subsidy levels, and unified payment structure to replace the current social medical insurance system. I. Institutional framework: from fragmentation to integration Rebuilding China's medical insurance on the basis of public health care is not a reinvention of the existing basic medical security system. It is actually another new gradualist reform idea. The main idea of ​​the new idea is to integrate urban workers' medical insurance into urban and rural residents' medical insurance to promote the integration of the basic medical security system. The old idea of ​​fragmentation and fine-tuning is based on the institutional framework for maintaining urban workers' medical insurance. The basic medical security system needs to be consolidated and developed. 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