Improving the diversified financing mechanism with balanced responsibilities is an important guarantee mechanism to maintain the operation of my country's basic medical security system. It is the "hematopoietic organ" of my country's medical security system. It is also in line with China's national conditions and adapts to the people's livelihood in the context of socialism with Chinese characteristics entering a new era. Require.

The "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System" (hereinafter referred to as the "Opinions") proposes to "improve a sound, robust and sustainable financing operation mechanism", improve the financing sharing and adjustment mechanism, and balance the three parties of individuals, employers and the government.

Financing and payment responsibilities.

Improving the diversified financing mechanism with balanced responsibilities is to clarify the financing responsibilities of individuals, employers, and the government in the medical security system, and effectively ensure that the government assumes responsibility, and employers and individuals only bear responsibility, thereby clarifying the boundaries of the government's responsibilities.

Improve the responsibility awareness of insured persons and employers.

Comprehensive design needs to be carried out from the perspective of balanced definition of three-party financing responsibilities, clarification of key issues of balanced financing responsibilities, and establishment of a benchmark rate system.

The Party Central Committee and the State Council attach great importance to medical security. During the "Thirteenth Five-Year Plan" period, the top-level design of the universal medical security system has been strengthened. The system has become more complete, the system and mechanisms have become increasingly sound, key reforms have achieved significant results, and basic support has continuously consolidated the achievements in the reform and development of the medical security industry.

It has made breakthrough progress and played an important role in alleviating the problem of difficult and expensive medical treatment for the masses.

However, while making breakthrough progress, we must also be clearly aware that there are still some problems in my country's current medical security. In terms of financing, they are mainly reflected in the following aspects: First, compulsory insurance has not been fully implemented, and the social insurance of basic medical insurance has not been fully implemented. Attributes are insufficiently reflected.

This is reflected in the fact that the compulsory participation in employee medical insurance is not fully implemented. There are still some employees (mainly employees of small and micro enterprises) who are not covered by employee medical insurance. Compared with the number of urban employees and the number of employees covered by employee pension insurance, the number of insured persons is still relatively low.

big gap.

At the same time, the medical insurance for urban and rural residents still adheres to the principle of voluntary participation, which is incompatible with the basic attributes of social medical insurance, increases financing costs, and affects the further improvement of the medical security system with Chinese characteristics.

Second, the division of medical insurance payment responsibilities is unreasonable and individual responsibility is weak.

In the past, the welfare nature of medical insurance has been emphasized for a long time, and individual payment responsibilities have been relatively weak. Employee medical insurance is mainly based on enterprise contributions, and resident medical insurance is mainly based on financial subsidies. Personal responsibility is in a relatively weakened position. With the expansion of the scale of medical insurance fund expenditures, medical insurance funds

The expenditure gap is also widening, and individual payment responsibilities need to be further implemented.

Third, the fee base and rates lack unified objective standards and lack fairness.

The actual rates for low-income people are higher than the nominal rates due to the setting of the lower limit; the phenomenon of "average" wages of low- and middle-income people is prominent. Due to the long-term existence of a "pyramid-shaped" income distribution structure in my country, the average salary of employees is much higher. At the median value, the fee base has been raised again; the double bases of "total unit wages" and "sum of individual contributions and wages" coexist, and the inconsistency of fee base policies in various regions has exacerbated the unfairness of social insurance fund rights and interests between different groups and regions. .

In this context, the author believes that to improve the diversified financing mechanism with balanced responsibilities, it is necessary to clarify the respective roles of the government, employers, and individuals.

First, the government should assume three roles.

The first is the provider of the social basic medical insurance financing system framework.

As a public good, social basic medical insurance is non-competitive and non-exclusive. Unless the cost of externalities is taken into account when designing financing standards, there will be a supply shortage in the market.

my country's social basic medical insurance is a public undertaking. Therefore, the government, as the main provider and regulator of public services, needs to clarify the financing responsibilities of finance, enterprises and individuals, and classify them according to urban employees and urban and rural residents. Design and clarify the financing system framework to ensure that medical insurance financing is well-founded, clearly define responsibilities, set basic financing responsibility scope, and take into account fund operation conditions, social and economic development conditions, and emergencies of major public events Make flexible adjustments.

The second is the "gatekeeper" of fairness. Although my country has basically achieved universal insurance coverage, there are still gaps in the insurance coverage for floating population with registered residence, urban employees with bankrupt businesses, poor people, and people who are impoverished due to illness. unfairness.

As the "gatekeeper" of public interests that maintains social fairness, the government needs to assume the responsibility of raising funds for these vulnerable groups, and provide funding for insurance according to the various situations of different vulnerable groups, so as to ensure that vulnerable groups can also enjoy equal benefits.

Social basic medical insurance.

The third is the maintainer of system sustainability.

The orderly operation of social basic medical insurance needs to follow the basic principle of "determining expenditure based on revenue, balancing revenue and expenditure, and leaving a slight surplus". Therefore, the balance of medical insurance funds is crucial.

In this process, the government needs to build a risk prediction and monitoring mechanism for major fund expenditures, combine it with the established financing system framework for social basic medical insurance, and make timely adjustments to financing standards and proportions based on fund operating conditions to ensure the balanced operation of the fund.

Secondly, the employer should assume two roles.

First, the guarantor of employee health.

Employers' payment of basic medical insurance premiums for employees is a need to protect human resources and is also an important measure to promote social and economic development.