Medical insurance originated in western Europe and can be traced back to the Middle Ages. With the success of the bourgeois revolution, family workshops were replaced by large industries, and modern industrial teams emerged. Due to the harsh working environment, epidemics and industrial accidents, workers need corresponding medical care. But their wages are low, and it is difficult for individuals to pay medical expenses. Therefore, workers in many places spontaneously organized themselves to raise some money for expenses when they were sick. But this form is not very stable, and the scope is small, and the ability to resist risks is very low. /kloc-at the end of 0/8 and the beginning of 09, private insurance developed in western Europe and became an important way for the country to raise medical funds.
Medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality. Therefore, the medical insurance system is usually enforced by national legislation and a fund system is established. The expenses are paid jointly by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risks caused by the illness or injury of the employees. By the end of 2022 10, 2860 kinds of drugs had entered the national medical insurance catalogue, and 67% of the rare diseases listed in China were among them. During the period of 10, the number of medical insurance participants in China increased from 540 million to13.6 billion.
The basic medical insurance system implements the principle of combining social pooling with individual accounts, organically combines social insurance with savings insurance, and realizes the organic combination of "horizontal" social security and "vertical" individual self-protection, which is not only conducive to giving play to the advantages of social pooling and individual accounts, but also conducive to giving play to the advantages of individual accounts' incentive and restraint functions, which is more in line with China's national conditions and is easily accepted by the broad masses of workers. This medical insurance model conforms to China's national conditions and is a social medical insurance system with China characteristics.
The basic medical insurance fund shall, in principle, implement municipal co-ordination. The basic medical insurance covers all employers and their employees in cities and towns; All enterprises, state administrative organs, institutions and other units and their employees must fulfill the obligation to pay the basic medical insurance premium. The employer's contribution ratio is about 6% of the total salary, and the individual contribution ratio is 2% of my salary. Part of the basic medical insurance premium paid by the unit is used to establish the overall fund, and part of it is included in the personal account; The basic medical insurance premiums paid by individuals are included in personal accounts. Pooling funds and individual accounts bear different responsibilities for payment of medical expenses. The overall fund is mainly used to pay for the hospitalization and outpatient treatment of some chronic diseases, and the overall fund has a minimum payment standard and a maximum payment limit; Personal accounts are mainly used to pay for general outpatient expenses.
In order to ensure that the insured employees enjoy basic medical services and effectively control the excessive growth of medical expenses, the China Municipal Government has strengthened the management of medical services, formulated the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards, provided qualified medical institutions and pharmacies with basic medical insurance services, and allowed the insured employees to choose independently. In line with the reform of the basic medical insurance system, the state has also promoted the reform of medical institutions and drug production and circulation systems. By establishing the competition mechanism between medical institutions and the market operation mechanism of drug production and circulation, we will strive to achieve the goal of "providing better medical services at lower cost".
In addition to the basic medical insurance, large medical expenses mutual aid system is generally established in all localities to solve the medical expenses above the maximum payment limit of social pooling funds. The state has established a medical subsidy system for civil servants. Conditional enterprises can establish supplementary medical insurance for employees. The state will also gradually establish a social medical assistance system to provide basic medical security for the poor.
legal ground
Measures of Guangzhou Municipality on Medical Settlement and Personal Account Management of Social Medical Insurance Article 21 The medical treatment behavior of insured persons in other areas outside the overall planning area of this Municipality (excluding Hongkong, Macau and Taiwan Province Province, hereinafter referred to as "medical treatment in different places") is collectively referred to as "medical treatment in different places". The insured person can enjoy the corresponding social medical insurance benefits according to the regulations under the following conditions of medical treatment in different places: (1) Long-term medical treatment in different places: the insured person has lived, worked or studied in the same different place in China for more than 6 months, and has been hospitalized in the designated medical institution of local medical insurance due to illness (hereinafter referred to as the medical institution in different places), and the outpatient service has been designated for chronic diseases. (2) Emergency treatment in different places: emergency observation and hospitalization expenses incurred by the insured in medical institutions in different places in China due to emergency treatment and rescue. (3) Students seeking medical treatment in different places: patients with chronic diseases who return to their domicile or the prefecture-level city where their parents live during holidays or illness, or who are hospitalized in medical institutions in different places, and seek medical treatment in specific outpatient programs and outpatient clinics during their study and internship. (4) Referral in different places: After being confirmed by the medical insurance agency in this city, the insured persons in this city are transferred to different medical institutions for hospitalization. (five) other medical treatment in different places as stipulated by the policy.