China's medical insurance system was established in 195s. For a long time, China's medical insurance system is mainly divided into three types, one is the labor insurance medical system suitable for employees of enterprises, the other is the free medical system suitable for staff of government agencies and institutions, and the third is the cooperative medical system suitable for rural residents.

The labor insurance medical system was established according to the Labor Insurance Regulations of the People's Republic of China promulgated by the State Council on February 26th, 1951. This system is mainly applicable to employees of state-owned enterprises and some collective enterprises. Labor insurance medical expenses were all borne by enterprises before 1953; In 1953, it was changed to 5% ~ 7% of the total wages according to the nature of the industry. In 1969, the Ministry of Finance issued regulations requiring that the reward fund, welfare fund and medical and health expenses of central state-owned enterprises be combined and withdrawn, and the employee welfare fund that is uniformly withdrawn according to 11% of the total wages of enterprises is directly included in the cost. The main contents of labor insurance medical treatment include: (1) The employees report to the group for medical treatment or non-work-related expenses, and the required medical expenses, operation expenses, hospitalization expenses and general medicine expenses are all borne by the enterprise, and the expensive medicine expenses, hospitalization meals and medical expenses are borne by me. If my financial situation is really difficult, I can make a discretionary subsidy under the labor insurance fund. (2) When an employee stops working for medical treatment due to illness or non-work-related injury, if the period of stopping working for medical treatment is less than 6 months continuously, the enterprise will pay him sick pay, which is 6% ~ 1% of his salary. If the medical treatment in frontier areas has been stopped for more than 6 months, the monthly sickness relief fee will be paid under the labor insurance fund, and the amount will be 4% ~ 6% of my salary until I can work or be determined to be disabled or dead. (3) After the medical treatment of an employee who is injured due to illness or non-work-related injuries ends, he is determined to be disabled and completely loses the ability to work. After he resigns, his holiday salary or sickness relief fund will be stopped, and he will be paid the non-work-related injury relief fund under the labor insurance. The criteria for determining the disability relief fund are: 5% of his salary for those who need help in their daily life, and 4% of his salary for those who don't need help in their daily life until they recover their ability to work or die. Time limit. (4) When an employee's immediate family member falls ill, he/she can make a free diagnosis and treatment in an enterprise medical clinic, a hospital, a special hospital or a special Chinese and western doctor, and the cost of surgery and general medicine shall be borne by the enterprise by 1/2. In view of the heavy burden on enterprises and the state in labor insurance medical care, in April 1966, the Ministry of Labor and the All-China Federation of Trade Unions issued the Notice on Several Issues Concerning Improving the Labor Insurance Medical Care System for Enterprise Employees, which made some new provisions on labor insurance medical care, such as stipulating that employees should bear the registration fee and visiting fee for medical treatment; Expensive drugs needed for medical treatment shall be borne by enterprises, but the expenses of taking nourishing drugs shall be borne by employees.

the system of free medical care was established in June, 1952, which was issued by the State Council, "Instructions on the prevention of lying by the staff of state organs of people's governments at all levels, political parties, organizations and their subordinate units". The implementation scope of the socialized medical care system includes the staff of state organs, political parties and people's organizations at all levels who are divorced from culture, education, scientific research, health, sports and other institutions, disabled revolutionary soldiers, students in colleges and universities, etc. The funds for free medical care come from the financial budget of the state and governments at all levels, which are managed and used by the health administrative departments or financial departments at all levels, and are spent from the project of "free medical care funds" of the unit and earmarked for special purposes. The medical expenses, operation expenses, hospitalization expenses, outpatient expenses or medicine expenses prescribed by the engineer in the hospital for the outpatient and hospitalization of medical personnel at public expense shall be allocated by the medical expenses; However, the meals and medical expenses for hospitalization shall be borne by the patient himself. If there are difficulties according to the facts, the organ may give subsidies and reimburse them within the administrative funds.

The cooperative medical system is mainly suitable for rural areas. Different from labor insurance medical care and free medical care, it is not established by national legislation, and there is no financial support from the state. Instead, it is a mutual aid system in rural areas that raises medical funds through collective and individual funds to provide medical care services for farmers. The cooperative medical system appeared in the late 195s and was widely implemented in the mid-196s. In 1965, the Central Committee approved the Report of the Party Committee of the Ministry of Health on Putting the Focus of Health Work in Rural Areas, which emphasized the strengthening of health care at the grassroots level in rural areas and promoted the development of the rural cooperative medical system. By the end of 1965, some cities and counties in more than ten provinces, autonomous regions and municipalities directly under the Central Government, such as Shanxi, Hubei and Jiangxi, had implemented the cooperative medical system, and by 1976, 9% of farmers in the country had participated in the cooperative medical system. The rural cooperative medical system is based on the collective economy and the principle of voluntary participation of farmers. The cooperative medical fund is in the form of collective investment and individual fund-raising, or a combination of collective investment and individual fund-raising. The principle of cooperative medical care is to live within our means, and people only need to pay a small amount of fees for medical treatment, most of which can be reimbursed from the cooperative medical fund. Therefore, the system has been widely welcomed by farmers and has become an important part of the collective welfare of villages. However, since the end of 197s, due to the economic system reform in rural areas, the household contract responsibility system was generally adopted, which made the rural cooperative medical system lose its original economic foundation and led to the almost extinction of the rural cooperative medical system all over the country.

in a certain period and historical stage, medical insurance meets the requirements of the times, but when social progress and economic development enter another higher level, the original and traditional medical insurance no longer meets the requirements of social and economic development, showing its own lag, which may become a resistance to social and economic development if it is not well done. Therefore, in the final analysis, the reform of medical insurance system is to study and solve the problem of how the medical insurance system, scale, structure and realization form adapt to modern society. After more than 2 years of reform, China has entered the period of socialist market economy. The reform of medical insurance system must be based on the specific requirements of socialist basic politics, economic system, national customs and cultural traditions, and correctly handle the relationship between special and general medical insurance under the conditions of socialist market economy, which not only reflects the essential requirements of socialism, but also conforms to the operation mode of market economy, and reform the traditional medical insurance system. In December, 1998, the State Council's Decision on Establishing the Basic Medical Insurance System for Urban Workers put forward the general idea and specific objectives for promoting the reform of China's medical insurance system, and drew a clear institutional framework, which provided scientific guidance for promoting the reform of China's medical insurance system.

1. Establish a reasonable level of access and security for basic medical insurance. The traditional dual-track medical insurance has many disadvantages, the biggest of which is the strict access standard, which clearly limits the beneficiary's occupation and the nature of unit ownership. Reforming the traditional medical insurance system is to change the dual-track medical insurance system for urban workers into a single-track system, lower the access standards, establish a unified basic medical insurance system for urban workers, and achieve wide coverage. The system can be expressed as follows: according to the inherent requirements of the socialist market economy, the basic medical security mechanism for urban workers is constructed, and all urban workers are included in this safety net, so as to prevent urban workers from affecting the production and reproduction of the labor force because the basic medical care is not met, thus causing great shocks in the operation of the market economy. The defining standard of basic medical insurance should be the affordability of finance, enterprises and individuals. Under the realistic needs and possible circumstances, the policy choice of reform must be to solve the most basic medical needs of urban workers. This is completely determined by China's social situation and economic development level, which conforms to the basic characteristics of China's primary stage of socialism. The history of the development of medical insurance in China tells us that medical demand is a basic living condition for workers, and the state must provide them with this demand, which is an inevitable trend of social development. This medical insurance system should be built on the basis of breaking the original barriers of ownership and units, and aim at establishing a unified medical insurance system. However, as far as the reality of our country is concerned, the supply of medical insurance is restricted by all aspects of finance at this stage, and it can only be basic, and the satisfaction degree of medical insurance demand can only be basic, that is, low level, wide coverage and ensuring basic medical needs.

2. Choose a scientific basic medical insurance fund model. Fund is the core of medical insurance, and the determination of fund model is the key to the success or failure of medical insurance system reform. The choice of China's medical insurance fund model is a combination of the reform experiences of countries all over the world and their own countries. On the basis of emphasizing the obligations of employers, personal responsibility is linked with medical insurance benefits, which is both an incentive and a constraint. The social pooling fund embodies the "law of large numbers" of social medical insurance mutual assistance, which is conducive to realizing the overall adjustment of medical insurance funds in a certain social scope, balancing the burden of medical expenses, dispersing medical risks and realizing social equity. Personal account, on the other hand, embodies the responsibility that individuals should bear, which is conducive to enhancing employees' awareness of health investment, prompting employees to accumulate medical insurance funds when they are young and healthy, and to establish a vertical personal accumulation guarantee mechanism; At the same time, personal accounts are owned by individuals, which improves the personal sense of responsibility, urges employees to self-discipline in medical consumption, and strengthens the restriction mechanism of expenses. The basic medical insurance fund combines social pooling with individual accounts, which realizes the combination of the horizontal social mutual aid function of the medical insurance fund and the vertical accumulation guarantee function of individuals, gives consideration to fairness and efficiency, and is conducive to dispersing medical risks. In recent years, the practice of reform in various places has fully proved this point. According to the regulations, the employee's basic medical insurance premium is paid by both the employer and the employee. The employer's contribution rate should be controlled at about 6% of the total wages of employees, and the employee's contribution rate is generally 2% of my salary income. With the development of economy, the contribution rates of employers and employees can be adjusted accordingly. The basic medical insurance combines social pooling with individual accounts, and all individual contributions are included in individual accounts, and the unit contributions are included in individual accounts by about 3%, and the rest are established as a pooling fund. The principal and interest of an individual account are owned by the individual and can be carried forward and inherited. Pooled funds and individual accounts should define their respective payment ranges and be managed separately, with the purpose of defining their respective responsibilities and avoiding the overdraft of individual accounts by pooled funds. It is necessary to formulate the Qifubiaozhun and the maximum payment limit of the overall fund. The Qifubiaozhun is controlled in principle at about 1% of the average annual salary of local employees, and the maximum payment limit is controlled in principle at about 4 times of the average annual salary of local employees. Medical expenses below Qifubiaozhun shall be paid from personal accounts or by individuals themselves. Medical expenses above Qifubiaozhun and below the maximum payment limit are mainly paid from the overall fund, and individuals also have to bear a certain proportion. Medical expenses exceeding the maximum payment limit can be solved through commercial insurance and other means.

3. Realize effective management of basic medical insurance. Socialization is the fundamental principle of the reform of basic medical insurance system. It breaks the traditional pattern of compartmentalization, decentralized management and decentralized decision-making, rationalizes the basic medical insurance management system, and enables urban workers to eliminate unfair and unreasonable treatment caused by ownership and occupational differences in the unified basic medical insurance system. To realize socialized management of basic medical care, it is necessary to establish a system of separating politics from affairs and separating execution from supervision. The main tasks of the government are planning, decision-making and policy guidance, and social insurance agencies are specifically responsible for fund collection, management and treatment payment. A supervisory body composed of the government, mass organizations and individual employees shall effectively supervise the behavior of social insurance agencies. The socialization of basic medical insurance also includes the socialization of basic medical services, the socialization of treatment payment and high-quality community services.

4. Construct a low-cost and high-efficiency drug, medical and health supporting system. The distribution of medical institutions in drug production and the efficiency of diagnosis and treatment are directly related to the level of medical costs, and then directly related to the reform of medical insurance system. According to relevant newspapers and periodicals, since 1978, China's pharmaceutical economy has been growing at an annual rate of about 18%. Its growth rate ranks first in all industries in China, and it is also higher than that of major pharmaceutical countries in developed countries. In terms of pharmaceutical production, by 1997, there were 6,391 pharmaceutical production enterprises in China, including more than 1,7 foreign-funded enterprises, which produced more than 1,35 kinds of raw materials, more than 4, kinds of preparations and more than 8, kinds of Chinese patent medicines. Among more than 6, pharmaceutical manufacturers, more than 3 enterprises (workshops) meet the requirements of good manufacturing practice (GMP), among which only 59 enterprises, 38 workshops and 13 varieties have obtained GMP certificates. China's pharmaceutical production enterprises are small in scale, with a large number of enterprises, repeated products, low technical level, poor economic benefits, products with no characteristics, similar varieties, few brand-name products, and low-level repeated production problems are very serious. Take norfloxacin as an example. According to incomplete statistics, there are 828 enterprises producing norfloxacin in China at present, including as many as 75 in some provinces. From the operating situation, by the end of 1998, there were 16,519 pharmaceutical wholesale enterprises and more than 6, retail enterprises in China. There are only 13 pharmaceutical wholesale enterprises in the United States, of which 5 wholesale enterprises account for 85% of the total national business. There are only 13 pharmaceutical wholesale enterprises in France, the largest of which accounts for 45% of the total national business. Judging from the use situation, in 1998, there were 15,219 hospitals at or above the county level, 51,535 township and street health centers and 125,264 individual clinics in China. Together with sanatoriums, specialized prevention and treatment institutes, maternal and child health stations (institutes), health care stations (institutes) and clinics, there are 39,7 medical institutions of all kinds in China, employing more than 5.27 million people. In 1997, there were 4,45 general hospitals in the national health department, with a total income of 82.178 billion yuan. Drug revenue was 42.394 billion yuan, accounting for 51.59% of the total revenue. Among them, 61.36% of outpatient income and 49.69% of inpatient income were from drugs. The difference income of medical units in selling drugs in the whole year was 16.56 billion yuan, and the profit and rebate of drug trading enterprises was about 8 billion yuan, totaling 24.56 billion yuan. According to the statistics of the health department, in 1997, China's drug consumption was 83.8 billion yuan, and the per capita drug consumption was 66.51 yuan, including 175 yuan in urban areas and about 25 yuan in rural areas. In the same period, the per capita drug consumption in moderately developed countries was 4 to 5 dollars, about 16 dollars in western European countries and more than 3 dollars in the United States.

China's medical and health system has been consistent for decades, and it has been unable to meet the needs of medical insurance system reform in many aspects. The structure of medical and health service system is unbalanced, medical and health resources are excessively concentrated in big cities, and in cities, they are excessively concentrated in big hospitals. However, community medical services that are close to employees' lives, convenient for employees to seek medical treatment and low in service cost are underdeveloped, and employees need to go to big hospitals for minor injuries and illnesses. The unreasonable distribution of medical and health resources has increased the cost of medical services, which is an important reason for the waste of medical insurance funds. The structure of medical service is unreasonable, and the proportion of medical service in medical service is too large. Some medical institutions seek benefits unilaterally, and focus their services on providing pharmaceutical services and high-tech large-scale equipment inspection. Unreasonable inspection and irrational drug use are serious, which is to increase medical insurance funds.