(This article is taken from the general report of China Social Security Development Report 20 16, which was compiled by China Social Security Society, edited by Zheng Gongcheng, and published by People's Publishing House on February 20 16).
Authors: Member the National People's Congress Standing Committee (NPCSC), President of China Social Security Society and Professor Zheng Gongcheng of China Renmin University.
While fully affirming the great progress made in the field of social security during the Twelfth Five-Year Plan period, we should also see that due to various factors, the construction of China's social security system is still in a backward state and faces many problems and challenges that must be properly dealt with.
(A) there are four major problems in social security reform and system construction.
1. The concept of social security development is vague. At present, there is a worrying phenomenon: in the process of system reform, social fairness, distributive justice and civilized progress that social security system construction should pursue are often lost because of excessive attention to economic indicators, mutual assistance and public welfare that social security system construction should adhere to are forgotten because of excessive attention to personal gains and losses and self-interest, and historical experience and long-term stability expectations that social security system development should pay attention to are ignored because of excessive attention to immediate and short-term responses. Paying too much attention to local and detailed issues and ignoring the complete function and comprehensive effect that the practice of social security system should play, there are also extreme orientations such as "pan-welfare" thought that the government should do everything, and "anti-welfare" that advocates individual responsibility. On the one hand, some people do not face up to the objective fact that the total supply of social security in China is still insufficient, the overall level of security is still low, and the structure of security rights and interests is still unbalanced. Instead, it exaggerates the so-called "welfare disease", "welfare state disease", "welfare trap" and the financial collapse of social insurance, and advocates limiting or even cutting public welfare, adopting a large account system for basic old-age insurance and commercial insurance for social medical insurance, all of which may shake the mutual assistance of social security. On the other hand, the public's expectations for the social security system are getting higher and higher. It is not uncommon for the public to demand not only continuous improvement of social security benefits such as pensions and medical insurance, but also free medical care and universal welfare. In some places, welfare projects are also regarded as short-term performance projects. Under the condition that anti-welfare and pan-welfare thoughts coexist and have their own markets, it will inevitably directly affect people's understanding and evaluation of the social security system, and will also have a complicated impact on the system reform. It will also cover up the structural imbalance and unfair rights and interests in the current institutional arrangements, which will lead to unclear boundaries between the government, the market and individuals, resulting in dysfunction of social insurance and commercial insurance, which is not conducive to the healthy development of social security system construction. Under the background of clear national development concept, China urgently needs to get out of the fog of social security development concept.
China's social security reform faces four major problems and five major challenges.
2. Lack of scientific top-level design. China's social security reform is promoted in a bottom-up and partial way, accompanied by gradual reform in the economic field. Although this strategy has stimulated the enthusiasm of local reform and innovation, the reform without overall consideration and top-level design will inevitably fall into the quagmire of various reform schemes and different reform measures, and form and solidify the pattern of interest division under the immature and unreasonable conditions of the system, thus forming great resistance to institutional integration. At present, many social security projects are facing the reality that it is difficult to deepen reform. First of all, the macro level lacks a complete top-level design of the social security system. At the policy level, the development goal and concept of the whole social security system are still not clearly defined, and the structure and function of the social security system and its main institutional arrangements are not reasonably positioned. Taking the three basic systems of social assistance, social insurance and social welfare as examples, we must have a reasonable functional orientation and division of responsibilities, so we must consider them from a perspective other than the above-mentioned single system. As far as the multi-level security system is concerned, it is necessary to fully consider the reasonable division of labor and coordination between the statutory security system led by the government and the supplementary security led by the market mechanism and social mechanism, and ensure the continuous growth of the material foundation of the social security system through the application of the market mechanism and social mechanism without violating the market rules and the operation of social organizations. China's multi-level system construction has been put forward for many years, and various measures have been taken, but due to the lack of top-level design and coordinated promotion, it is still an empty talk. Secondly, the middle level lacks the top-level design of the basic social security system category. Take the security of the elderly as an example. In reality, there is a lack of overall consideration and top-level design for the economic security, service security and spiritual security of the elderly. The development of old-age care services, old-age care and cultural services related to the dignity of the elderly, social participation, hospice care and funeral undertakings is lagging behind, which is increasingly affecting the quality of life of hundreds of millions of elderly people. Take medical security as an example. Although the linkage of "three doctors" is the greatest understanding of medical reform, in reality, medical reform in various places is still promoted by various departments and piloted in various regions. In this way, it is impossible to find the focus of comprehensively deepening the crisscross of medical reform, and it is also impossible to realize the benign interaction between the "three doctors" and to focus on tackling key problems in the same direction. What's more, it has also caused a hedge between medical care, medical insurance and medicine. Thirdly, the micro-level social security projects still lack top-level design. Old-age insurance, medical insurance, minimum living security and other important security projects have all adopted the strategy of piloting in various places first and gradually advancing, leaving a profound trace of "crossing the river by feeling the stones". There are some defects such as unbalanced responsibilities, unclear hierarchy, unreasonable management system and handling mechanism, and uncoordinated related systems. These defects all involve complex interests. Children's welfare, disabled welfare and other projects have not been systematically considered and designed, and so on. Therefore, the top-level design task of social security during the "Thirteenth Five-Year Plan" period is extremely arduous.
3. Inequality and inefficiency coexist. On the one hand, although social security has begun to benefit the whole people during the Twelfth Five-Year Plan period, fairness is still insufficient. There is still a big gap in pension benefits between government institutions and enterprise retirees. Behind the urban-rural division and group division of medical insurance is essentially the difference in treatment. The social assistance system with the minimum living security as the core is very different between urban and rural areas and between regions. Even simple government disaster relief is different among disasters, affected areas and victims. The result of these differences is the unfairness of the social security system, which not only solves some social problems, but also causes dissatisfaction of some groups. In addition to the unfairness of social security rights, there is also the unfairness of undertaking obligations. For example, old-age insurance payment, low payment in Guangdong and other regions, large fund balance and high insurance benefits; However, the northeast region has high payment, low fund balance and low insurance benefits; This regional difference is entirely due to the regional division of the system. On the other hand, the waste and inefficiency in social security practice are amazing. In medical insurance, more than 45% of the resources of basic medical insurance for employees are in an inefficient state because of the existence of personal accounts, which seriously damages the mutual assistance and economic function of this system and also causes the burden of pooling funds to become increasingly heavy. Due to the profit-seeking of hospitals and the anomie of medical supply, over-diagnosis, over-examination and over-medication in the process of medical service are almost common phenomena. The waste of medical and health resources and medical insurance funds is staggering, and there is still a phenomenon of collusion between doctors and patients eating into medical insurance funds in medical insurance. The People's Daily has disclosed that in some areas of Guizhou, the means of encroaching on the medical insurance fund include farmers' "hospitalization", treating patients if they are ill, inflating the hospitalization days of patients, treating minor illnesses with fake drugs, fake surgery, over-examination, repeated charges, fees for not providing services (empty charges), and listing the surgical treatment expenses that are not within the scope of reimbursement to be shared by both doctors and patients. This phenomenon is not a case. In terms of old-age insurance, due to the regional division of the system, the accumulated fund balance in the country reached more than 3 trillion yuan while the old-age insurance funds in some areas did not pay in the same year. However, due to the inability to centralize operations and investment policies, it is in a state of depreciation every year, and the losses are equally amazing. Because the current system is not strict, the supervision is not in place, and the technical means are not perfect, many loopholes in practice also make it very rare to take the pension and defraud the subsistence allowance. In addition, the social security management system is not completely straightened out, and the handling mechanism is divided, which also causes a waste of administrative resources. Therefore, the unfairness and inefficiency of the system is a major issue that must be highly valued and seriously dealt with.
4. Unclear responsibilities and unbalanced responsibilities. The current social security system hardly defines the responsibilities of all parties, the boundaries of government responsibilities are not clearly defined, and the responsibilities of the central government and local governments are not clearly divided, so the space for market participants and social organizations is uncertain. As a result of this state, the responsibility and pressure of the government will continue to increase, while market players and social forces cannot enter smoothly and play their due roles. The most typical is disaster protection. Commercial insurance, which plays a leading role in many countries, is almost negligible in China's compensation for natural disasters. In the current responsibility sharing system, the contribution rate of pension insurance units is 20%, that of individuals is 8%, that of medical insurance units is 6%, and that of individuals is 2%, which shows that the responsibility of units is large and that of individuals is small. In the medical insurance for urban and rural residents, government subsidies are equivalent to more than three times of individual contributions, which shows that the government has great responsibility and the individual responsibility is small; In social assistance, the central government bears the main responsibility, while local governments bear less responsibility; Wait a minute. This unbalanced responsibility sharing model will inevitably shake the rationality of the development of social security system and easily lead to the extreme orientation of compressing welfare and expanding welfare.
(B) The social security reform and system construction in the new era are facing five major challenges.
The credibility of 1. system is insufficient. For example, the accumulation of national basic old-age insurance fund is increasing day by day, but many people are skeptical about the sustainability of this system, so that more and more people are worried that the phenomenon of not receiving pension, not participating in insurance or stopping insurance or paying less will spread. For another example, in 20 13, the State Council issued an important policy document to develop the aged care service industry, which was simplified by the media and the public as "providing for the aged with housing", which was further interpreted as the government trying to shirk its responsibility. There are also policy ideas that are questioned and opposed by most people, such as gradually delaying retirement age and lifelong payment of medical insurance, and so on. All these reflect that public distrust of the social security system is increasing. If the public loses confidence in the social security system, they will lose their enthusiasm for recognition and participation. Therefore, the crisis of confidence and expected instability are enormous challenges that must be properly addressed.
2. Regional development is unbalanced. Theoretically speaking, social security should be an important institutional arrangement to narrow the regional gap and promote the balanced development of the region, but in reality it is often shown as a vassal of the regional development gap, and some systems have become negative factors to solidify or even enlarge the regional development gap to a certain extent. For example, the Pearl River Delta and the Yangtze River Delta are the regions with the earliest reform and opening up and the most developed economy, attracting a large number of rural young laborers in the central and western regions. Under the condition of regional division of the old-age insurance system, these most developed areas have a large balance of old-age insurance funds because of the younger labor force and low payment; Northeast China lags behind in development, with many retirees and many young laborers going out. As a result, the payment rate is high, and there is a financial crisis that cannot make ends meet. This pattern of light burden and high treatment in developed areas and heavy burden and low treatment in underdeveloped areas is undoubtedly contrary to the goal of coordinated and balanced development among regions. Therefore, how to use the social security system to promote coordinated and balanced development among regions is obviously a question that must be clearly answered during the "Thirteenth Five-Year Plan" period.
The population is aging. China is the country with the fastest and largest population aging in the world, and the aging of fewer children leads to the weakening of family security function. Aging has the most direct impact on social security. Not only do we need to adjust the institutional structure and financial input structure in time, but we also need more types of professionals and more public services with humanistic care. It will also lead to a decline in the number of people paying for old-age insurance, an increase in the number of people receiving it and an increase in the financial pressure of the old-age insurance system. The survey shows that the problem of providing for the aged has become a major livelihood issue with the widest coverage and increasingly strong public response, but in fact, all localities are not fully prepared. Although the pension system has achieved full coverage, the pattern of unbalanced responsibility sharing, weakened mutual economic cooperation and diversified synchronous development has not been formed, and its uncertainty has damaged people's safety expectations. Although the old-age service industry is developing, the total supply is still seriously insufficient, and the phenomenon of disconnection between supply and demand is widespread, and it is facing the problem of "who will provide for the elderly in China". In addition, there is a lack of social mechanisms to meet the demands of the elderly for spiritual security, and humanistic care and spiritual comfort for the elderly have not really been included in the institutional arrangements. Faced with the rising people's livelihood demands of hundreds of millions of elderly people and doubts about where the money comes from and who will serve them, if the social security system and related services cannot be improved as soon as possible, the quality of life of the elderly group will inevitably decline, causing anxiety in the whole society. Therefore, the challenge of aging is severe.
4. The contradiction between the rigid growth of welfare and the slow growth of government financial resources. During the "Twelfth Five-Year Plan" period, the scale of public investment in social security increased substantially, with the average annual growth rate exceeding 15%, and the investment in some projects increased by more than 20%, which directly brought about significant improvement in the benefits of various social security systems. Urban and rural residents still look forward to the continuous improvement of pension, the continuous reduction of personal medical burden and the sustainable development of various social welfare undertakings. However, with the economic development entering a new normal, the growth rate of the national economy has dropped from double digits in the last century to single digits, from over 8% to around 7% in recent years, and the growth rate of fiscal revenue has also dropped from over 20% to single digits. Therefore, the slow growth of national fiscal revenue and the rapid growth of national welfare have become realistic contradictions. In this context, how to optimize the current social security system arrangement, how to mobilize market forces and social forces, and ensure the sustained growth of the material base of the entire social security system is undoubtedly a huge challenge.
5. Large-scale population movement. At present, the floating population in China is between 200 million and 300 million, and hundreds of millions of people are in an unstable state, which poses another big challenge to the social security system. Whether to let the social security system follow the continuous transfer of floating population, or to reduce the mobility of population and promote living and working in peace and contentment to adapt to the social security system is an important issue to be weighed during the 13 th Five-Year Plan period.
To sum up, the task of China's social security reform is far from complete, and various social security systems are still immature. The deep-seated problems and major challenges faced during the "Thirteenth Five-Year Plan" period are more severe than the previous period. Whether the above four problems can be reasonably solved and the five challenges can be properly dealt with will directly determine whether the new social security system can mature and finalize as scheduled.
(This article is taken from the general report of China Social Security Development Report 20 16, which was compiled by China Social Security Society, edited by Zheng Gongcheng, and published by People's Publishing House on February 20 16).
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