Social policy is the basic policy and code of action on social work formulated by governments at all levels. Its function is to solve and prevent social problems, safeguard and improve people's lives, alleviate social contradictions and promote economic development and social stability through social work. 2/kloc-0 In the first half of the century, China will face the trend of rapid population aging. How to do well the endowment insurance and medical insurance for hundreds of millions of elderly people in China in the future and ensure their basic needs is of great strategic significance for improving the quality of life of the elderly, promoting social stability and realizing sustainable development. Based on the present and facing the future, this paper tries to explore some social policies to further improve China's urban endowment insurance and old-age medical insurance for government departments' reference.

First, the reform of urban endowment insurance and medical insurance and its challenges

(a)1Major reforms since the mid-1980s

Since the mid-1980s, China has carried out a series of major reforms on the endowment insurance system and medical insurance system of urban enterprises, and mainly adopted the following reform measures:

1. In the insurance system, the original single old-age insurance and medical insurance will be changed into a multi-level old-age insurance and medical insurance system: basic insurance, enterprise supplementary insurance, personal savings insurance or commercial insurance.

2. In the coverage of basic insurance, the original state-owned enterprises and urban collective enterprises and employees have been changed to all enterprises in cities and towns (including state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). ) and employees, even individual industrial and commercial households in cities and towns and their helpers.

3 in the basic insurance costs, from the original burden of all enterprises to personal burden.

4. On the composition of basic insurance fund, the original labor insurance fund (deposited in the bank account of enterprise trade union), labor insurance transfer fund (deposited in the bank account of provincial trade union or national committee of industrial trade union) and general labor insurance fund (deposited in the bank account of All-China Federation of Trade Unions) are merged into social pooling and personal account.

These reforms in China's urban endowment insurance and medical insurance system are conducive to relatively reducing the burden on enterprises and the government, dispersing the risks of individuals and enterprises in pension and medical care, slowing down the intergenerational contradiction between retirees and on-the-job workers, better ensuring the basic living and medical needs of urban retirees, and promoting economic development and social stability.

(2) Challenges

By the end of 1999, the number of elderly people aged 60 and above in China has reached1260,000, accounting for more than 10% of the total population, and has entered an aging society. According to the forecast of the United Nations, in 2050, the number of elderly people aged 60 and above in China will increase to 397 million, accounting for 26.2% of the total population (Note: United Nations Department of Economic Information and Policy Analysis: Revision of World Population Forecast (1996)). )。 Facing the rapid development of population aging in China in the first half of the 20th century, this challenge is still very severe, and the economic pressure of enterprises, individuals and governments will be very heavy.

First of all, for enterprises, there are many kinds of payments, which are unbearable. According to the regulations of the State Council, the sum of the basic old-age insurance premiums and basic medical insurance premiums paid by enterprises for employees is equivalent to about 26% of the total wages of employees. If the unemployment insurance premium, work injury insurance premium, maternity insurance premium and housing accumulation fund paid by the enterprise are added, it is estimated to be at least equivalent to 1/3 of the total wages of the employees of the enterprise. In addition, in terms of the burden of basic medical insurance, the State Council also stipulates that with the development of economy, the contribution rate of enterprises can be adjusted accordingly. In some cities, in addition to pooling funds, personal accounts or paying by individuals, enterprises have to bear a considerable part of medical expenses. For example, according to the current regulations in Shanghai, the one-time hospitalization medical expenses of retirees are below the deductible line (first-class hospital10.5 million yuan, second-class hospital 2,000 yuan, third-class hospital 2,000 yuan, 500 yuan), and at least 96% of them are borne by enterprises before retirement; For the part above the deductible, the enterprise shall bear at least11.25% before retirement; The medical expenses of retirees in family beds and outpatient clinics (tumor chemotherapy, radiotherapy and dialysis treatment of severe uremia) shall be borne by enterprises before retirement; The general outpatient and emergency medical expenses of retirees shall be borne by enterprises 35% ~ 45% before retirement.

Secondly, for individuals, the payment is increasing and the burden is heavy. According to the regulations of the State Council, employees pay basic old-age insurance and basic medical insurance, which add up to 10% of salary. If the unemployment insurance premium paid by individuals is added, it is estimated that the employees need to spend at least 1 1% of their salary. Although retirees do not have to pay the basic old-age insurance premium, basic medical insurance premium and unemployment insurance premium, they are also given proper care in the amount of personal accounts and the proportion of personal burden of medical expenses. However, due to old age and illness, high medical expenses, expensive drugs can not be reimbursed, the medical pooling fund has stipulated the maximum payment limit, and the supplementary medical insurance and commercial medical insurance of enterprises have not yet developed, so that their personal medical expenses are still very heavy.

Third, it is difficult for the government to bear the responsibility of subsidies. In addition to providing social security for employees and retirees of state organs and fully funded institutions in accordance with relevant regulations, government finance should also support the basic old-age insurance fund for urban employees when it is in difficulties. At present, the basic old-age insurance funds for urban workers in most provinces and regions in China cannot make ends meet, and even personal accounts are completely in an "empty account" operation state. In order to ensure that the basic pension for retirees is paid in full and on time, the pressure from the central and local governments has been considerable; When the peak of population aging comes, this pressure will be even greater. It is predicted that by 2033, the proportion of urban population aged 60 and above in China will reach the highest value of 22.06% of the total population, and the cost of providing for the aged is equivalent to 39.27% of the total wages [1]. If the proportion of basic old-age insurance premiums paid by urban enterprises and individual employees still accounts for 28% of employees' wage income at that time, and the basic old-age insurance fund has not been accumulated over the years, the government will have to spend an amount equivalent to 1 1.27% of the total wages of urban employees, so as to make up for the "deficit" of the basic old-age insurance fund in that year.

Second, suggestions on improving China's old-age insurance and medical insurance policies.

(a) to expand the coverage of basic old-age insurance and basic medical insurance in cities and towns, it should include foreign permanent working-age personnel who are employed in this city or receive business licenses of private and individual industrial and commercial households.

According to the the State Council document, the basic old-age insurance system for urban enterprise employees is applicable to all kinds of urban enterprise employees and individual workers; The basic medical insurance system for urban workers is applicable to all employers and their employees in cities and towns, including state-owned enterprises, collective enterprises, foreign-invested enterprises and private enterprises. As for township enterprises and their employees, owners of urban individual economic organizations and their employees, the people's governments of provinces, autonomous regions and municipalities directly under the Central Government shall decide whether to participate in the basic medical insurance. However, there is no clear regulation on whether the employees of urban enterprises include migrant workers' contract workers and temporary workers, and whether the owners of urban individual economic organizations and their employees include migrant workers. At present, in the reform plans issued by provinces, autonomous regions and municipalities directly under the Central Government, only a few areas have extended the application scope of urban basic old-age insurance and basic medical insurance to migrant workers' contract workers, temporary workers employed by urban enterprises and migrant workers who have obtained individual industrial and commercial licenses in their own towns, but most areas have not included these objects. We feel that, in accordance with the requirements of establishing and perfecting the socialist market economic system, creating conditions for all kinds of workers to compete for employment and enterprises to compete for business on an equal footing, and safeguarding the vital interests of migrant workers, the basic old-age insurance and basic medical insurance system for urban workers should cover the vast number of contract workers and temporary workers who have lived in this town for more than half a year, as well as the migrant rural population who have lived in this town and engaged in individual economic activities and obtained legal business licenses. Moreover, expanding the coverage to this group of people will also help increase the number of people paying fees and expand the sources of funds. Because even according to the regulations of the State Council, when employees are transferred, the storage amount of individual accounts of basic old-age insurance can be transferred. When these peasant contract workers and temporary workers leave the town, most of the basic old-age insurance premiums paid by employers for them that are not included in their personal accounts will settle down and continue to be used for social overall planning; When the rural migrant workers leave the town as the owners of private enterprises and individual economic organizations, a considerable part of the basic old-age insurance premiums that are not included in their personal accounts will also be settled and continue to be used for social planning. By the same token, extending the coverage of basic medical insurance to this group of people is also conducive to increasing the number of payers and expanding the sources of funds, and relatively enhancing the ability of the medical insurance pooling fund to pay the medical expenses of the elderly registered in this town.

(two) when the accumulated amount of the basic old-age insurance fund in this town is in deficit, local governments at all levels should not start subsidies.

For the basic old-age insurance in cities and towns, when the reform plan promises that the fund has difficulties, it will be supported by the finance at the same level. However, there is no clear stipulation on how to calculate the need for financial support when the fund is in trouble. In our opinion, we can't wait until the accumulated basic old-age insurance premiums paid by units and individuals in a co-ordination area and their value-added amount are used to pay the deficit of the basic old-age insurance in that year, that is, the average empty account rate of the accumulated savings of the basic old-age insurance fund (that is, the accumulated savings in all individual accounts in a region minus the actual accumulated savings divided by the accumulated savings) rises to a certain proportion, and then we can start to inject special funds from local finance. Take Shanghai as an example. If other financing channels are not broadened, starting from 1999, the basic old-age insurance premiums paid by units and individuals in the current year will have a persistent deficit, and the deficit will become more and more serious after the income and expenditure break even. However, due to the implementation of the new urban old-age insurance reform plan from 1993 to 1997, the basic old-age insurance fund has accumulated a lot. Therefore, it is expected that there will be a deficit in the accumulated funds in a few years. If Shanghai does not consider injecting some local financial support during the Tenth Five-Year Plan period, it will greatly increase the local financial burden during the Tenth Five-Year Plan period and seriously affect the sustainable development of the economy. At the same time, in the use of the basic old-age insurance fund, the State Council has not clearly stipulated that "the scope of payment shall be defined and accounted for separately, and shall not be mutually occupied", but used together. When the social pooling fund is insufficient to pay the basic old-age pension, it is first made up from the amount stored in the personal account. Therefore, we can study the difficulty of a regional basic old-age insurance fund from the average empty account rate of accumulated personal accounts that should be credited to the storage amount. According to the actual situation in China at this stage, we suggest that when the average empty account rate of accumulated personal accounts in a social pooling area of urban basic endowment insurance fund is higher than 50%, a "yellow card" should be shown to give a warning; When the average empty account rate of personal account accumulation should reach 70%, the local finance at the same level should start to support it so that it is at least not higher than 70%.

(3) All provinces, autonomous regions and municipalities directly under the Central Government should seize the opportunity that the working-age population of urban household registration will be greatly reduced in the next century and postpone the age of receiving basic pensions in an all-round way.

In 1950s, China stipulated that the retirement age for urban workers was 60 for male workers, 55 for female workers and 50 for female workers. When the urban old-age insurance system was reformed in the 1990s, although the average life expectancy of urban population was much higher than that in the 1950s, and the retirement age could be completely postponed according to the health status of workers, considering the serious problems of urban unemployment and laid-off workers' unemployment at this stage, the reform plans in the State Council and other parts of the country did not make new provisions on the retirement age of urban workers to receive basic pensions. We believe that although the working-age population of China 15-59 will increase a lot in the first half of the 20th century, according to the United Nations' forecast, it will be 83 10/00000 in 2000, 927 million in 2065, 438+000934 million in 2020 and 888 million in 2030. ), but according to estimates by Fudan University, East China Normal University and Institute of Population Studies of Shanghai Academy of Social Sciences, the registered population of Shanghai1male aged 6 to 59 and female aged 54 will decrease by131~1600,000 male in the same period. When scholars in Beijing predicted the development trend of Beijing's permanent population from 1996 to 2025, they also showed that the population aged 0-5-59 in Beijing would decrease by 940,000 by 20 10, and the population aged 60 and over would increase 12 100 (. For this reason, we feel that megacities such as Shanghai and Beijing have the opportunity to postpone the retirement age of urban workers from 20 10. If the retirement age of urban workers is gradually postponed within five years, the retirement age of male workers is postponed to 65 years, and the retirement age of female workers is postponed to 60 years, then these cities can postpone the retirement peak of urban workers, extend the period for employees and their units to pay basic old-age insurance premiums, and shorten the period for retirees to receive basic old-age insurance, thus greatly reducing the deficit after the basic old-age insurance funds in these cities break even. Of course, in the first half of 2 1 century, the changes in the age structure of urban population in the social pooling areas of provincial basic old-age insurance funds were not exactly the same, so it is necessary to seize the best opportunity to postpone the retirement age of urban areas according to the actual situation. By then, there will still be a considerable number of floating population in cities and towns in China. The key is to deal with the relationship between properly absorbing foreign labor and delaying the retirement age of urban registered workers. Don't simply follow the routine when there is a gap between supply and demand of urban labor force, and let the inflow of foreign labor force make up for it.

(four) change the basic medical insurance fund can only pay for medical expenses, leaving a small part for disease prevention.

According to the provisions of the the State Council document, the urban workers' basic medical insurance pooling fund can only pay the medical expenses above the Qifubiaozhun and below the maximum payment limit of the employees of the payment unit, and cannot be used for preventive expenses including health examination. We feel that at present and in the first half of the 20th century, the disease spectrum of the elderly population has changed greatly compared with the 1950s and 1960s, showing a high incidence of chronic non-communicable diseases, mainly hypertension, coronary heart disease, chronic bronchitis and arthritis. Many of these chronic diseases are related to smoking, alcoholism, high salt, high sugar, unreasonable nutrition and lifestyle. Therefore, in order to effectively promote healthy aging, make the hidden dangers of common diseases and frequently-occurring diseases "early detection, early prevention and early treatment", enhance the awareness of self-care, improve the health level, and save medical resources including the urban workers' basic medical insurance pooling fund, it is suggested that in addition to strengthening lifelong health education and lifelong medical care, urban workers should have a health examination every year from the age of 45 until their death (including retirees), mainly to check some items closely related to the onset of senile diseases. Funds are jointly raised by local governments at all levels, medical insurance funds and units and individuals. Conditional units can also raise funds by themselves, and add a number of inspection items besides the above-mentioned basic inspection items, such as ECG examination and B& D; nbs p； Super inspection, etc. Although this will increase part of the expenditure of the urban workers' basic medical insurance co-ordination fund, in the long run, it can reduce the incidence or degree of chronic diseases and greatly save the expenditure of the urban workers' basic medical insurance co-ordination fund for medical expenses. At the same time, it is also conducive to greatly improving the quality of life of urban workers, especially retirees, reducing the burden of medical expenses for individuals and their families and the pressure of caring for relatives.

(five) to change the provisions that a considerable part of the basic medical insurance expenses for retirees shall be borne by the unit before retirement, and to establish a unit subsidy medical expenses adjustment fund as soon as possible.

At present, in order to reduce the burden of personal medical expenses of urban workers and retirees, some cities stipulate in the reform plan of basic medical insurance for urban workers that most medical expenses shall be borne by the unit and a small part by individuals, except for the part paid by the medical pooling fund. For retirees, this regulation undoubtedly refers to the unit where they worked before retirement, which has increased the burden of medical expenses for enterprises (mainly old large and medium-sized state-owned enterprises and street collective enterprises) with a large number of retirees or even more than the number of employees. At the same time, it also makes the existing urban units unwilling to recruit older laid-off workers and unemployed people for fear of bearing too much burden of medical expenses, which is not conducive to properly solving the re-employment problem of these people. We believe that if we want to continue to implement the basic medical insurance in cities and towns, and if our unit has to pay part of the medical expenses of employees and retirees in addition to the basic medical insurance premium, it is suggested to set up a unit-subsidized medical expenses adjustment fund in the area where the basic medical insurance fund is co-ordinated, and all units should pay a certain proportion of the total wages of employees in the previous year (such as 0.5% ~ 1.0%). In order to help disperse the risk of subsidized medical insurance borne by units and change the situation that the cost of subsidized medical insurance for each unit is extremely heavy, the medical subsidy for employees and retirees will be changed from "all-inclusive" by each unit or unit before retirement to reasonable sharing by each unit.

(six) in the urban basic medical insurance, the use of individual accounts and pooling funds is capped, and at the same time, we should actively support and encourage the development of supplementary insurance.

According to the provisions of the the State Council document, the medical insurance pooling fund determines the Qifubiaozhun and the maximum payment limit, and the medical expenses below the Qifubiaozhun are paid from personal accounts or borne by individuals; Individuals should also bear a certain proportion of medical expenses above Qifubiaozhun and below the maximum payment limit; Medical expenses exceeding the maximum payment limit can be solved by means of commercial medical insurance. According to the oriental cultural tradition, when many old people in China leave this world, they want to leave some legacy to their descendants, instead of letting them bear the debts for themselves. Therefore, before and after retirement, I often scrimp and save a sum of money to pay for medical expenses and nursing expenses when I am terminally ill or bedridden for a long time in my old age. In view of the high prevalence rate of the elderly over 60 years old and the high medical expenses, especially drugs and examination fees, general commercial medical insurance institutions are often unwilling to undertake supplementary medical insurance for the elderly over 60 years old or charge high insurance premiums for the elderly over 60 years old. At present, many employees and retirees in China are most worried about what to do when they are seriously ill and their medical expenses exceed the maximum payment limit stipulated by the medical insurance pooling fund. Although some cities have implemented or will soon implement the reasonable sharing method of medical expenses in the basic medical insurance scheme, it seems impossible not to "cap" the payment limit of the medical insurance pooling fund, but to appropriately raise the "cap" standard for the "elderly" at most. In this case, it is urgent to study practical methods to spread the risks beyond the payment limit of the basic medical insurance pooling fund. Shanghai Workers' Security Mutual Aid Association is a social organization established with the approval of the Municipal Federation of Trade Unions and the Civil Affairs Bureau. From the establishment of1February 1994 to1April 1999, the grass-roots member units of the mutual aid association involved more than 6 trade union organizations in all districts, counties and bureaus in the city, and individual members 1 100 participated. The supplementary guarantee for mutual assistance paid by members is 65.438+0 billion yuan, with total assets reaching 65.438+065.438+0.4 billion yuan, and the capital has increased for more than four years. Since July 1998, with the support of the municipal government's medical insurance bureau, the mutual medical security plan for special seriously ill groups has been launched. Participating individual members only need to pay 20 yuan (or 60 yuan) once a year for three consecutive years. When uremia, malignant tumor, severe hepatitis, heart valve or coronary artery bypass surgery occur, they can get 8000 ~ 65438+. This mutual aid association is characterized by the collective participation of grass-roots trade unions, less individual contributions and more mutual assistance from medical insurance funds, which makes the compensation risk of particularly serious diseases spread to all employees and retirees who join the association, reflecting the spirit of modern mutual assistance and mutual assistance, so it is welcomed by the broad masses. We believe that as long as the application procedures are legal and the fund management is strengthened, this mutual aid association is worth popularizing in other cities. At the same time, it is suggested that the government should also give tax relief to units and individuals who participate in commercial supplementary medical insurance, give tax relief to commercial insurance companies that start this business, and encourage more urban residents, especially retirees, to participate in commercial supplementary medical insurance.

(7) Appropriately move down the threshold of individual income tax, and give preferential tax reduction and exemption to individuals who participate in supplementary endowment insurance and supplementary medical insurance.

According to China's current personal income tax threshold, most people whose personal income is above the minimum living standard for urban residents do not need to pay personal income tax. In this way, it is difficult to encourage urban workers to actively participate in supplementary old-age insurance and supplementary medical insurance by reducing or exempting personal income tax, and it is also difficult to encourage retired and re-employed people to actively participate in supplementary medical insurance. Therefore, we believe that the threshold of personal income tax should be moved down to the income that exceeds the minimum living standard for urban residents, and the proportion of personal income tax paid by those whose personal income is between the old and new thresholds should be appropriately reduced. At the same time, it stipulates the personal income tax reduction rate of individuals participating in various supplementary endowment insurance and supplementary medical insurance, as well as the maximum insurance limit for tax reduction and exemption every year.

(8) Establish more civil society insurance fund supervision organizations as soon as possible to enhance the safety and sustainability of the operation of basic old-age insurance and basic medical insurance funds.

The State Council document stipulates that the management and supervision mechanism of urban basic endowment insurance fund and basic medical insurance fund should be improved. In the Decision on Establishing the Basic Medical Insurance System for Urban Workers, it is more clearly proposed to establish a medical insurance fund supervision organization with the participation of relevant government departments, employers, medical institutions, trade unions and relevant experts in the overall planning area, so as to strengthen the social supervision of the basic medical insurance fund. In the early stage, China's labor and social security departments, financial departments and auditing departments at all levels gradually strengthened the management of urban basic endowment insurance funds and basic medical insurance funds. However, social supervision organizations have not been established in many places. This is not only not conducive to ensuring the safe operation and effective value-added of urban basic endowment insurance and basic medical insurance funds, but also to resisting the unreasonable operation of these funds by party and government leaders at higher levels or at the same level. For example, the age of normal retirement and basic pension is clearly stipulated in the reform plans of various places, but some local leaders allow many employees to retire early just to alleviate the unemployment problem in cities and towns, and there is no corresponding regulation on the proportion of basic pension that needs to be reduced in early retirement. As a result, these early retirees and their units have paid less for basic old-age insurance for several years, and individuals have received more basic pensions, which has aggravated the difficulties in the normal operation of local basic old-age insurance funds. For another example, the relevant departments of the central government have clearly stipulated the normal adjustment mechanism of urban basic pensions. Every April, the average basic pension is adjusted according to 40% ~ 60% of the average wage growth rate of local employees in the previous year. If the excess basic pension is not paid according to this regulation, the normal operation of local basic old-age insurance funds will also be affected. Therefore, we suggest that social supervision institutions of urban social insurance funds, including basic old-age insurance and basic medical insurance, should be established as soon as possible in all co-ordination areas, so that more representatives of insured units, trade union representatives and relevant experts can participate, making the operation of urban social insurance funds more scientific, standardized and effective.

refer to

[1] Li. Establish a social security system with China characteristics [a]. Encyclopedia of Social Security in China [m]. Beijing: China Planning Press, 1998.9.

[2] Gui Shixun. Sustainable operation of the basic endowment insurance fund for urban workers in Shanghai [J]. Shanghai's comprehensive economy, 1998, (1 1): 30-3 1.

I work in a private partnership, and the unit pays us endowment insurance and medical insurance. Of course, I paid part of it myself, but there is a column of pension and medical insurance expenses 142.62 yuan on our payroll. Ask a friend and call the social security bureau. I learned that only 70 yuan of old-age insurance paid by the company was paid by myself, and the rest was paid by the company. So we paid more than 70 yuan for medical insurance. Check it on the website of Ke Cheng Social Security Bureau. This is true: the basic old-age insurance rate for individual partnership is 2 1% for individuals, the basic medical insurance rate for individual partnership is 8%, and that for individuals is 5%. Medical insurance was paid by the company, but now it is paid by our employees themselves. Can I apply?