The basic role of medical insurance in medical reform is reflected in three aspects: first, the nature of medical insurance determines the nature of medical reform, and the insurance attribute of medical insurance determines that medical reform must introduce market mechanisms; second, medical insurance is the basis for the formation of the medical service price mechanism.

We must insist on giving full play to the negotiation function of medical insurance; third, medical insurance provides the material basis for medical reform, and the sustainability of medical insurance funds must be maintained.

Medical insurance lays the material foundation for medical reform. The first thing to emphasize is the rationality of the material foundation, and we must resolutely oppose unreasonable demands for the material foundation of medical insurance. The second thing to emphasize is that the material basic role of medical insurance must be sustainable, and we cannot unilaterally propose ways to strengthen medical insurance.

Material basis.

It is worth noting that the basic role of medical insurance does not mean that it takes full responsibility.

Since the "Plan and Implementation Plan for Deepening the Reform of the Medical and Health System During the Twelfth Five-Year Plan" clearly stated for the first time that "giving full play to the basic role of universal basic medical insurance" and "the basic role of medical insurance" have appeared many times in policy documents, such as "Deepening the Reform of the Medical and Health System"

Summary of the work of medical and health system reform in 2014 and key tasks in 2015" "Notice of the Ministry of Human Resources and Social Security and the Ministry of Finance on the implementation of basic medical insurance for urban residents in 2016" (Ministry of Human Resources and Social Security [2016] No. 43), "

Guiding Opinions on Actively Promoting the Joint Reform of Medical Care, Medical Insurance, and Pharmaceuticals" (Ministry of Human Resources and Social Security [2016] No. 56), "Several Opinions of the Leading Group of the State Council on Deepening the Reform of the Medical and Health System on Further Promoting and Deepening the Experience of Deepening the Reform of the Medical and Health System", etc.

It is proposed that medical insurance should play a fundamental role in medical reform.

As an important institutional arrangement for the country's economic and social development, universal medical insurance is not only an important part of the social security system, but also an important part of the medical and health system. Therefore, it is important whether in building a moderately prosperous society in an all-round way or in promoting the "Healthy China" strategy.

It has important institutional functions and basic role (Wang Dongjin, 2015).

However, there are different opinions in theory and practice on how to play its basic role, and there are many misunderstandings among them.

This article aims to correct relevant misconceptions and put forward three major insights into the fundamental role of medical insurance in medical reform.

The nature of medical insurance determines the nature of medical reform. Since its establishment, my country's modern medical insurance system has been social insurance, not social welfare.

The "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees" (Guofa [1998] No. 44) clearly stated that "the main task of the reform of the medical insurance system is to establish a basic medical insurance system for urban employees", that is, to "establish a basic medical insurance system for urban employees".

Social health insurance system for medical needs”.

"Notice of the General Office of the State Council forwarding the opinions of the Ministry of Health and other departments on the establishment of a new rural cooperative medical system" (Guobanfa [2003] No. 3) states that the new rural cooperative medical system is "mutual medical assistance for farmers with a focus on serious illness coordination**

"Economic system", and mutual aid and economic dispersion are the inherent requirements of the insurance system.

Therefore, conceptually, the new rural cooperative medical system should also be an insurance system rather than a welfare system.

The "Guiding Opinions of the State Council on Launching the Pilot Program of Basic Medical Insurance for Urban Residents" (Guofa [2007] No. 20) also proposes to "establish a basic medical insurance system for urban residents that focuses on coordinating serious illnesses."

The nature of medical insurance determines the nature of medical reform, and the direction of medical insurance determines the direction of medical reform.

The insurance attribute of medical insurance determines that medical reform must introduce market mechanisms, give full play to the basic role of the market in the allocation of medical resources, and cannot go back to the planned economy.

We emphasize that we encourage and allow all localities to actively explore medical reform, but all explorations cannot shake the basic premise of the insurance nature of medical insurance, and cannot violate the basic laws of the market economy.

In the practice of medical reform, there have been debates between third-party payment and "one hand entrusting two companies". The essence is to choose the market mechanism or the planned economic model.

To give full play to the basic role of medical insurance in medical reform is to give full play to the role of the third-party payment mechanism, rather than "entrusting two companies with one hand."

Some people may raise questions about this, thinking that the new medical reform plan puts forward the requirement of "strengthening government responsibility and investment". Does strengthening the third-party payment mechanism conflict with the requirement of "strengthening government responsibility and investment"?

Third-party payment does not deny the government's responsibility, but emphasizes that the demand side of medical insurance should be subsidized through the introduction of market mechanisms through third-party payment, while supporting two companies with one hand, through direct subsidies to medical institutions, so that medical institutions can provide corresponding medical care.

In terms of services, we follow the old path of planned economy.

Medical insurance is the basis for forming the price mechanism for medical services and drugs. In the medical field, the price mechanism for medical services and drugs should be formed through mutual negotiations between buyers and sellers, rather than being decided by the government.

To give full play to the basic role of medical insurance in medical reform is to give full play to the negotiation function of medical insurance as a representative of the demand side, and lay the foundation for a reasonable medical service and drug price formation mechanism through negotiations with medical institutions and drug suppliers.

The negotiation function is one of the basic functions of medical insurance.

Theoretically speaking, as a major demander, medical insurance should have strong negotiation power and deterrence, and can effectively regulate and restrict the behavior of medical institutions and drug suppliers.

However, in practice, the negotiation function of medical insurance fails to work.