To improve the diversified financing mechanism with balanced responsibilities is to clarify the financing responsibilities of individuals, employers and the government in the medical security system, effectively ensure that the government bears the responsibilities, and employers and individuals share the responsibilities, so as to clarify the responsibility boundary of the government and improve the responsibility consciousness of the insured and employers. It is necessary to make a comprehensive design from the perspectives of defining the three-party financing responsibility in a balanced way, clarifying the key issues of balanced financing responsibility and establishing the benchmark interest rate system.
The CPC Central Committee and the State Council attached great importance to medical security. During the "Thirteenth Five-Year Plan" period, the top-level design of the universal medical security system was strengthened, the institutional system was more perfect, the institutional mechanisms were increasingly sound, the key reforms achieved remarkable results, and the basic support was continuously consolidated. Breakthrough progress has been made in the reform and development of medical security, which has played an important role in alleviating the problems of difficult and expensive medical treatment for the masses. However, while making breakthrough progress, we should also be soberly aware that there are still some problems in China's medical security at present.
In terms of financing, it is mainly reflected in the following aspects:
First, compulsory insurance has not been fully implemented, and the social insurance attribute of basic medical insurance is insufficient. It is reflected in the fact that the implementation of compulsory medical insurance for employees is not in place, and some employees (mainly employees of small and micro enterprises) are still not included in the employee medical insurance coverage. Compared with the number of urban workers and the number of workers covered by old-age insurance, there is still a 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, increasing the financing cost and affecting the further improvement of China's characteristic medical security system.
Second, the division of medical insurance payment responsibility is unreasonable and personal responsibility is weak. In the past, the welfare of medical insurance was emphasized for a long time, and the responsibility of individual payment was relatively weak. Employees' medical insurance is mainly paid by enterprises, and residents' medical insurance is mainly subsidized by finance, so personal responsibility is in a relatively weak position. With the expansion of the expenditure scale of medical insurance fund, the expenditure gap of medical insurance fund is also expanding, and it is necessary to further implement individual payment responsibility.
Third, fees and rates lack uniform and objective standards and fairness. The actual rate of low-income people is higher than the nominal rate because of the lower limit setting; The phenomenon that the wage level of low-and middle-income people is "averaged" is prominent. Due to the pyramid income distribution structure in China for a long time, the average wage of employees is much higher than the median, and the fee base is raised again. The double cardinal numbers of "total unit wages" and "sum of individual contribution wages" coexist, and the inconsistency of payment policies in different regions intensifies the unfairness of social insurance fund rights among different groups and regions.
In this context, the author believes that improving the diversified financing mechanism with balanced responsibilities,
It is necessary to clarify the respective roles of government, employers and individuals.
First of all, the government should assume three roles.
First, the supply side of the social basic medical insurance financing system framework. As a kind of public goods, social basic medical insurance is non-competitive and non-exclusive. Unless external costs are considered in the design of financing standards, there will be a supply shortage in the market. However, China's social basic medical insurance is a public enterprise. Therefore, the government, as the main provider and supervisor of public services, needs to clarify the financing responsibilities of finance, enterprises and individuals, design according to the classification of urban workers and urban and rural residents, clarify the financing system framework, ensure that medical insurance financing can be based on evidence, and clarify the division of responsibilities, set the scope of basic financing responsibilities, and combine fund operation, social and economic development and public interest.
The second is a fair "gatekeeper". At present, although China has basically achieved universal coverage, there are still unfairness in the coverage of floating population, urban workers whose enterprises are closed, poor population and people who are poor due to illness. As the "gatekeeper" of public interests to safeguard social equity, the government needs to undertake the responsibility of financing and subsidizing these vulnerable groups, and classify them according to the different situations of different vulnerable groups to ensure that the vulnerable groups can also enjoy social basic medical insurance equally.
The third is the defender of institutional sustainability. The orderly operation of social basic medical insurance needs to follow the basic principles of "fixed expenditure based on income, balance of income and expenditure, and slight balance", so the balance of medical insurance fund is very important. In this process, the government needs to build a risk prediction and monitoring mechanism for major fund expenditures, and adjust the financing standards and proportions in a timely manner according to the fund operation and the established social basic medical insurance financing system framework to ensure the balanced operation of the fund.
Secondly, employers should play two roles.
The first is the guarantor of employees' health. Employers pay basic medical insurance premiums for employees, which is not only to meet the demand of human resources, but also an important measure to promote social and economic development. Therefore, employers should collect medical insurance funds truthfully and on time according to the actual wages of employees, and at the same time, buy commercial supplementary medical insurance for employees according to the operating conditions of enterprises to ensure the healthy reserve of human resources and attract the increase of human resources.
The second is the undertaker of social responsibility. Enterprises should bear some social responsibilities according to their own operating conditions and serve the socialist economic construction. Specifically, on the basis of paying the employee medical insurance fund in accordance with the regulations, the internal risk reserve fund of the enterprise will be built according to a certain proportion of the turnover every year, and will be paid to the local government through charitable donations when public emergencies occur, so as to assume the social responsibility of fighting risks in a special period.
Finally, individuals should assume two roles.
One is in charge of your own health. Individuals are the first responsible person for their own health. Therefore, in the social basic medical insurance, individuals need to pay the basic medical insurance premium according to a certain proportion, and gradually adjust the proportion according to their personal income. At the same time, in the process of reimbursement of medical expenses, individuals still need to pay part of the expenses, take responsibility for realizing personal health, and prevent the occurrence of pan-welfare risks. Individuals and the government should share the responsibility according to a certain proportion, which should gradually transition to1:1.
The second is the builder of social economy. Every insured person has the obligation to bear the economic responsibility of social basic medical insurance, which requires the insured person to correct the awareness of participating in the insurance. Participating in social basic medical insurance is an act of preventing risks through mutual assistance, not a personal economic act of "whoever pays must enjoy the treatment". You can't refuse to pay, underpay or miss the payment because you don't enjoy the corresponding treatment.
In a word, the financing of social basic medical insurance is not only the responsibility of the government, enterprises and individuals, but also the foundation of people's livelihood to ensure the stable operation of Socialism with Chinese characteristics. To improve the diversified financing mechanism with balanced responsibilities, it is necessary to clarify the respective roles of the government, enterprises and individuals, clarify the boundaries of responsibilities, establish a correct sense of payment, and promote the high-quality development of China's medical security system.