the State Council's decision on establishing the basic medical insurance system for urban workers

Guo Fa [1998] No.44

People's governments of all provinces, autonomous regions and municipalities directly under the Central Government, ministries and commissions and institutions directly under the State Council:

Accelerating the reform of the medical insurance system and ensuring the basic medical care for employees are objective requirements and important guarantees for establishing the socialist market economic system. On the basis of earnestly summarizing the pilot experience of medical insurance system reform in recent years,

I. tasks and principles of reform

the main task of medical insurance system reform is to establish a basic medical insurance system for urban workers, that is, to adapt to the socialist market economic system and establish a social medical insurance system to ensure the basic medical needs of workers according to the affordability of finance, enterprises and individuals.

the principles of establishing the basic medical insurance system for urban workers are: the level of basic medical insurance should be adapted to the level of productivity in the primary stage of socialism; All employers and their employees in cities and towns should participate in basic medical insurance and implement territorial management; The cost of basic medical insurance shall be borne by both the employer and the employee; The basic medical insurance fund combines social pooling with individual accounts.

II. Coverage and payment methods

All employers in cities and towns, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.), government agencies, institutions, social organizations, private non-enterprise units and their employees, must participate in the basic medical insurance. Whether township enterprises and their employees, owners of urban individual economic organizations and their employees participate in basic medical insurance shall be decided by the people's governments of all provinces, autonomous regions and municipalities directly under the Central Government.

in principle, the basic medical insurance takes the administrative regions above the prefecture level (including prefectures, prefectures and leagues) as the overall planning units, and counties (cities) as the overall planning units. In principle, the three municipalities directly under the Central Government of Beijing, Tianjin and Shanghai implement overall planning within the city (hereinafter referred to as the overall planning areas). All employers and their employees should participate in the basic medical insurance in their overall planning areas in accordance with the principle of territorial management, implement unified policies, and implement unified collection, use and management of basic medical insurance funds. Enterprises and their employees with high mobility in cross-border production such as railways, electric power and ocean transportation can participate in the basic medical insurance in different places in a relatively centralized way.

the 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.

Third, establish the basic medical insurance pooling fund and individual account

Establish the basic medical insurance pooling fund and individual account. The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts. The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish the overall fund and the other part is included in the personal account. The proportion of individual accounts is generally about 3% of the contributions paid by the employer, and the specific proportion is determined by the overall planning area according to the payment scope of individual accounts and the age of employees.

Pooled funds and individual accounts should delimit their respective payment ranges, and be accounted for separately, and shall not be crowded out of each other. It is necessary to determine 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 and industrial medical insurance. The specific Qifubiaozhun, maximum payment limit and the personal burden ratio of medical expenses above Qifubiaozhun and below the maximum payment limit of the overall planning fund shall be determined by the overall planning area according to the principle of fixed income and expenditure and balance of payments.

IV. Improve the management and supervision mechanism of the basic medical insurance fund

The basic medical insurance fund shall be included in the management of special financial accounts, which shall be used for special purposes and shall not be misappropriated.

Social insurance agencies are responsible for the collection, management and payment of basic medical insurance funds, and should establish and improve the budget and final accounts system; Financial accounting system and internal audit system. The business expenses of social insurance agencies shall not be drawn from the fund, and shall be solved by the financial budgets at all levels.

Bank interest calculation method for the basic medical insurance fund: the part raised in the current year will bear interest according to deposit interest rate; The fund principal and interest carried forward from the previous year shall bear interest at the bank deposit rate of lump-sum deposit for three months; The deposited funds deposited in the financial special account of social security shall bear interest according to the three-year zero deposit and lump-sum savings deposit interest rate, which is not lower than the interest rate of this grade. The principal and interest of an individual account are owned by the individual and can be carried forward and inherited.

Labor and social security and financial departments at all levels should strengthen the supervision and management of the basic medical insurance fund. Audit departments should regularly audit the fund income and expenditure and management of social insurance agencies. In the overall planning area, a medical insurance fund supervision organization shall be established with the participation of representatives of relevant government departments, employers, medical institutions, trade union representatives and relevant experts, so as to strengthen social supervision of the basic medical insurance fund.

V. Strengthening the management of medical services

The service scope and standards of basic medical insurance should be determined. The Ministry of Labor and Social Security shall, jointly with the Ministry of Health, the Ministry of Finance and other relevant departments, formulate the scope, standards and medical expense settlement methods of basic medical services, and formulate the national basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and corresponding management measures. The administrative departments of labor security of all provinces, autonomous regions and municipalities directly under the Central Government shall, in accordance with the provisions of the state, jointly with relevant departments, formulate corresponding implementation standards and measures in their respective regions.

the basic medical insurance is managed by designated medical institutions (including Chinese medicine hospitals) and designated pharmacies. The Ministry of Labor and Social Security shall, jointly with the Ministry of Health, the Ministry of Finance and other relevant departments, formulate measures for the qualification examination and approval of designated medical institutions and pharmacies. Social insurance agencies should be responsible for determining designated medical institutions and pharmacies according to the principle of combining traditional Chinese and western medicine, giving consideration to grass-roots units, specialist units and comprehensive medical institutions, and signing contracts with designated medical institutions and pharmacies to clarify their respective responsibilities, rights and obligations. When determining designated medical institutions and designated pharmacies, it is necessary to introduce a competitive mechanism. Workers can choose a number of designated medical institutions to seek medical treatment and purchase medicines, or they can buy medicines in a number of designated pharmacies with prescriptions. National Medical Products Administration shall, jointly with relevant departments, formulate measures for handling drug purchase accidents in designated pharmacies.

All localities should conscientiously implement the spirit of the Decision of the Central Committee of the Communist Party of China and the State Council on Health Reform and Development (Zhongfa [1997]3), actively promote the reform of the medical and health system, and invest less money to enable the people to get good medical services and promote the healthy development of medical and health undertakings. It is necessary to establish a system of separate accounting and management of medicines, form a competitive mechanism between medical services and drug circulation, and reasonably control the level of medical expenses; It is necessary to strengthen the internal management of medical institutions and pharmacies, standardize medical service behavior, and reduce staff and increase efficiency. Reduce the cost of medicine; It is necessary to rationalize the price of medical services, reasonably increase the price of medical technical services on the basis of implementing separate accounting and management of medicines and reducing the proportion of drug income in total medical income; It is necessary to strengthen professional technical training and professional ethics education to improve the quality and service quality of medical service personnel; It is necessary to rationally adjust the layout of medical institutions, optimize the allocation of medical and health resources, actively develop community health services, and incorporate basic medical services in community health services into basic medical insurance coverage. The Ministry of Health shall, jointly with relevant departments, formulate plans for the reform of medical institutions and relevant policies for developing community: health services. The State Economic and Trade Commission and other departments should seriously cooperate with the reform of the drug circulation system.

VI. Properly solve the medical treatment of relevant personnel

The medical treatment of retired personnel and the old Red Army will remain unchanged, and the medical expenses will be solved according to the original funding channels. If it is really difficult to pay, the people's government at the same level will help solve it. The medical management power and laws of retired personnel and the old Red Army shall be formulated by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.

The medical treatment of disabled revolutionary servicemen above Grade II and Grade B remains unchanged, and the medical expenses are settled according to the original funding channels. Separate account management by social insurance agencies: the insufficient payment of medical expenses will be solved by the local people's government.

retirees participate in the basic medical insurance, and individuals do not pay the basic medical insurance premium; Give appropriate care to the amount of retirees' personal accounts and the proportion of personal medical expenses.

on the basis of participating in basic medical insurance, national civil servants enjoy the Medicaid policy. Specific measures shall be formulated separately.

In order not to reduce the existing medical consumption level of employees in certain industries, supplementary medical insurance for enterprises is allowed as a transitional measure on the basis of participating in basic medical insurance. The part of enterprise supplementary medical insurance premiums within 4% of the total amount of capital shall be paid from the employee welfare funds, and the part of insufficient welfare funds shall be included in the cost after being approved by the financial department at the same level.

The basic medical insurance premiums for laid-off workers from state-owned enterprises, including unit contributions and individual contributions, are paid by the re-employment service center based on 6% of the average salary of local employees in the previous year.

VII. Strengthening organizational leadership

The reform of the medical insurance system is highly policy-oriented, involving the vital interests of the broad masses of workers and related to national economic development and social stability. People's governments at all levels should earnestly strengthen leadership, unify their thinking, raise awareness, do a good job in propaganda and political and ideological work, and make the broad masses of workers and all sectors of society actively support and participate in this reform. All localities should carefully organize and implement the basic medical insurance system for urban workers in accordance with the tasks, principles and requirements, combined with local conditions, to ensure a smooth transition between the old and new systems.

The establishment of the basic medical insurance system for urban workers started in early 1999 and was basically completed by the end of 1999. The people's governments of all provinces, autonomous regions and municipalities directly under the Central Government shall, in accordance with the requirements of this decision, formulate the overall plan for the reform of the medical insurance system and report it to the Ministry of Labor and Social Security for the record. The overall planning area shall, according to the planning requirements, formulate an implementation plan for basic medical insurance, which shall be implemented after being submitted to the people's governments of provinces, autonomous regions and municipalities directly under the Central Government for examination and approval.

the Ministry of labor and social security should strengthen the guidance and inspection on the establishment of the basic medical insurance system for urban workers, and study and solve the problems in the work in time. Finance, health, drug supervision and management departments should actively participate in, closely cooperate with and work together to ensure the smooth progress of the reform of the basic medical insurance system for urban workers.

December 14th, 1998

Guiding Opinions of the State Council on Launching the Pilot Program of Basic Medical Insurance for Urban Residents

(Guo Fa [27] No.2)

People's governments of all provinces, autonomous regions and municipalities directly under the Central Government, ministries and commissions of the State Council and institutions directly under it:

The CPC Central Committee and the State Council attached great importance to solving the medical security problems of the broad masses and constantly improved the medical security system. In 1998, China began to establish the basic medical insurance system for urban workers, and then launched the pilot of the new rural cooperative medical system, and established the urban and rural medical assistance system. At present, there is no medical security system arrangement mainly for urban non-employed residents. In order to achieve the goal of basically establishing a medical security system covering all urban and rural residents, the State Council decided to launch a pilot program of basic medical insurance for urban residents from this year (hereinafter referred to as the pilot program). All localities and departments should fully understand the importance of this work, regard it as an important task to implement Scientific Outlook on Development and build a harmonious socialist society, attach great importance to it, make overall plans, standardize and guide it, and make steady progress.

I. objectives and principles

(1) pilot objectives. In 27, two or three cities were selected to start the pilot project in qualified provinces, and the pilot project was expanded in 28, aiming to reach more than 8% of the pilot cities in 29, and it will be fully promoted throughout the country in 21, gradually covering all urban non-employed residents. It is necessary to explore and improve the policy system of basic medical insurance for urban residents through pilot projects, form a reasonable financing mechanism, a sound management system and a standardized operation mechanism, and gradually establish a basic medical insurance system for urban residents with serious illness as a whole.

(2) pilot principle. The pilot work should start at a low level, reasonably determine the financing level and security standards according to the level of economic development and the affordability of all aspects, focus on ensuring the medical needs of non-employed urban residents for serious illnesses, and gradually improve the security level; Adhere to the principle of voluntariness and fully respect the wishes of the masses; Clarify the responsibilities of the central and local governments, the central government determines the basic principles and main policies, and the local governments formulate specific measures to implement territorial management of insured residents; Adhere to overall planning and coordination, and do a good job in connecting basic policies, standards and management measures among various medical security systems.

II. Coverage and financing level

(III) Coverage. Students in primary and secondary schools (including vocational high schools, technical secondary schools and technical schools), children and other non-employed urban residents who are not covered by the basic medical insurance system for urban employees can voluntarily participate in the basic medical insurance for urban residents.

(4) the level of financing. The pilot cities should properly determine the financing level according to the local economic development level and the basic medical consumption needs of different groups such as adults and minors, and considering the affordability of local residents' families and finances; Explore the establishment of a mechanism linking the level of financing, payment period and treatment level.

(5) payment and subsidy. The basic medical insurance for urban residents is mainly based on family contributions, and the government gives appropriate subsidies. Insured residents pay the basic medical insurance premium according to the regulations and enjoy the corresponding medical insurance benefits. Conditional employers can subsidize the insured payment of employees' families. The state formulates tax incentives for individual contributions and unit subsidy funds.

The government will give the insured residents in the pilot cities an annual subsidy of not less than the per capita 4 yuan, in which the central government will make an annual special transfer payment from 27, and give subsidies to the central and western regions according to the per capita 2 yuan. On this basis, the government will, in principle, subsidize the part of the family contributions required for students and children who belong to the minimum living allowance or are severely disabled to participate in insurance, and the central government will subsidize the central and western regions according to the per capita 5 yuan; For other low-income recipients, severely disabled people who have lost their ability to work, elderly people with low-income families over 6 years old and other difficult residents who need to pay for insurance, the government will give subsidies every year at a rate of not less than the per capita 6 yuan. Among them, the central government will give subsidies to the central and western regions at a per capita 3 yuan. The central government will give appropriate subsidies to the eastern region with reference to the subsidy measures for the new rural cooperative medical system. The specific scheme of financial subsidy shall be determined by the financial department, labor and social security, civil affairs and other departments, and the subsidy funds shall be included in the financial budget of governments at all levels.

(6) payment of fees. The basic medical insurance fund for urban residents is mainly used for inpatient and outpatient medical expenses of insured residents, and areas with conditions can gradually try out outpatient medical expenses as a whole.

the use of the basic medical insurance fund for urban residents should adhere to the principle of fixed expenditure based on income, balance of payments and a slight balance. It is necessary to rationally formulate the minimum payment standard, payment ratio and maximum payment limit of the basic medical insurance fund for urban residents, improve the payment methods, and reasonably control medical expenses. Explore medical services and payment methods suitable for the economic affordability of non-employed residents in difficult towns, and reduce their burden of medical expenses. The basic medical insurance fund for urban residents is used to pay medical expenses within the prescribed scope, and other expenses can be paid through