At present, the new medical insurance system implemented by the country is basically still based on the insurance operation mechanism, that is, paying the insurance premium first, and then enjoying the medical insurance benefits, with equal rights and obligations.

The coverage is basically employees of state-owned enterprises or formal employment departments, which belongs to on-the-job insurance.

Even so, some employees of companies in difficulty are still excluded from the scope of medical insurance. Although they are working, they may not be able to enjoy medical insurance.

Members of other vulnerable groups are even less likely to receive social medical insurance benefits.

The shortcomings of the traditional medical insurance system are fully demonstrated. my country's traditional medical insurance system, the so-called "publicly funded medical care" and "labor insurance medical care", was founded in 1951 and was once the main pillar of our country's medical security system.

This kind of medical system has played an extremely important role in protecting the health of our country's employees and maintaining the stable development of society for a long time in the past.

However, with the reform and opening up, especially the in-depth development of the socialist market economy, this traditional medical insurance system has become outdated and has all its shortcomings. It has three shortcomings: (1) The scope of implementation is not wide. The traditional medical insurance system cannot reflect social insurance.

Generally speaking, there is also the problem of unfair distribution of social insurance resources.

The traditional medical insurance system is mainly applicable to units owned by the whole people, and its coverage, including employees' family members, is only about 20% of the national population; while the rural population, which accounts for about 80% of the country's population, and some employees in non-publicly owned units, basically have no coverage.

Enjoy this kind of medical insurance treatment.

According to the survey, among the reasons why urban and rural residents need to be hospitalized but are not hospitalized, about 58% of rural residents give up hospitalization due to family financial difficulties.

This narrow coverage of the security system has obviously affected social and economic progress and the improvement of people's lives.

(2) Financing channels are not wide. The costs required for the implementation of the traditional medical insurance system are borne by the state and units, and individuals have almost no payment obligations.

In recent years, affected by factors such as the aging of the population, environmental pollution, advances in medical technology, adjustments to drug prices and medical charging standards, as well as some human factors, medical expenses have risen sharply.

According to statistics from the Ministry of Labor, in 1980 my country's employees' medical expenses were only 6 billion yuan, rising to 46.5 billion yuan in 1993, reaching 65.38 billion yuan in 1995, and as high as 77.37 billion yuan in 1997. It averaged 20 per year. % rate increased dramatically.

According to other statistics, Shanghai's medical expenses in 1994 alone were as high as 6 billion yuan, more than double that of New York, the largest city in the United States!

Such huge expenditures and growth rates have overwhelmed the country and units, making it difficult to balance the deficit in medical expenses in a timely manner and making it difficult for medical insurance funds to raise funds smoothly.

Even when some enterprises are in difficulty, employees are not provided with basic protection.

(3) The management system does not conform to the traditional medical insurance system. In the management system, there is a phenomenon of "those who manage money do not care about doctors, and those who manage doctors do not care about money".

There is a lack of effective control mechanisms over finance, diagnostic prescribing and drug management.

The management organization is not sound, and some medical units engage in refined packaging in order to pursue economic income one-sidedly; some medical institutions lack the necessary economic responsibility and awareness of economy, provide excessive "services", and write "favor prescriptions" and "big prescriptions";

However, corporate units lack strict review of the rationality and standardization of medical prescriptions and reimburse them at will.

These phenomena have further aggravated the pressure on the state and enterprises to pay medical expenses, and have caused some loss-making enterprises to carry out internal medical "reforms", reducing or delaying the medical expenses of retired employees, or simply adopting the method of spreading existing medical expenses equally to everyone.

, the "death guarantee" method of not reporting overspending.

This so-called reform, which is not protected by law, has greatly damaged the medical rights of employees.

The new medical insurance system is imperative. The various shortcomings of the traditional medical insurance system make it difficult to continue its normal operation.

Against this background, the State Council took the lead in piloting the social medical insurance system reform in Zhenjiang City, Jiangsu Province and Jiujiang City, Jiangxi Province in 1994, and expanded the pilot in 1996.

The "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees" promulgated at the end of 1998 marked the comprehensive launch of medical reform.

In 1999, 24 provinces across the country had issued overall plans for medical reform, and 36 medical reform coordinating areas at or above the prefecture level had introduced plans and officially put them into operation.

The goal of this year's medical reform is to strive to organize and implement it in 70% of the regions, cover about 50 million people, and basically establish a basic medical insurance system for urban employees. Therefore, a new medical insurance system is imperative.

Compared with the traditional medical insurance system, the new medical insurance system has the following salient features: First, the coverage has been expanded.

Its coverage is all urban employment units and employees.

Including enterprises (state-owned, collective, foreign-funded, private), agencies, institutions, social groups, private non-enterprise units and employees. At the same time, owners of urban individual economic organizations and their employees can also participate in basic medical insurance.

It needs to be emphasized that basic medical insurance is a compulsory social insurance, and employees of any unit within the coverage must participate.

Second, management and services should be socialized and localized.

In principle, the scope of basic medical care coordination is based on administrative regions at or above the prefecture level as the coordination unit, and counties and cities can also be the coordination units (referred to as coordination areas).

In principle, the four municipalities directly under the Central Government implement overall planning within the city.