Perfecting the diversified financing mechanism with balanced responsibilities is an important guarantee mechanism to maintain the operation of China's basic medical security system, and it is the "hematopoietic organ" of China's medical security system, which is in line with China's national conditions and meets the people's livelihood requirements under the background of Socialism with Chinese characteristics's entering a new era. The Opinions of the Central Committee of the State Council on Deepening the Reform of the Medical Security System (hereinafter referred to as the Opinions) puts forward the idea of "improving the stable and sustainable fund-raising operation mechanism", improving the fund-raising sharing and adjustment mechanism, and balancing the responsibility of individuals, employers and the government for fund-raising and payment. Perfecting 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 takes responsibility, and employers and individuals take responsibility, 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 a benchmark 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 mechanism was increasingly sound, the key reforms achieved remarkable results, and the basic support was continuously consolidated. Breakthrough progress was made in the reform and development of medical security, which played an important role in alleviating the problems of difficult and expensive medical treatment for the masses. However, while making a breakthrough, we should also be soberly aware that there are still some problems in China's 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 attributes of basic medical insurance are insufficient. It is reflected in the fact that the implementation of compulsory medical insurance for employees is not in place, and there are still some employees (mainly employees of small and micro enterprises) who are not covered by medical insurance for employees. Compared with the number of urban employees and the number of employees 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 individual responsibility is weak. In the past, the welfare of medical insurance was emphasized for a long time, and the personal payment responsibility was relatively weak. Employees' medical insurance was mainly paid by enterprises, while residents' medical insurance was mainly paid by financial subsidies, and personal responsibility was in a relatively weak position. With the expansion of the scale of medical insurance fund expenditure, the gap of medical insurance fund expenditure is also expanding, so it is necessary to further implement personal payment responsibility. Third, fees and rates lack unified 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. Because of the long-standing pyramid-like income distribution structure in China, 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 disunity of fee-based policies in different regions aggravates the unfairness of social insurance fund rights among 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 of all, the government should assume three roles. First, the supplier of the financing system framework of social basic medical insurance. As a public good, social basic medical insurance has the characteristics of non-competitiveness and non-exclusiveness. Unless the external cost is taken into account in the design of financing standards, there will be a shortage of supply 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, classify and design according to urban workers and urban and rural residents, and clarify the financing system framework, so as to ensure that medical insurance financing can be based on evidence, and make clear the division of responsibilities, set the scope of basic financing responsibilities, and combine the fund operation, social and economic development and heavy public interests. The second is a fair "gatekeeper". At present, although China has basically achieved universal coverage, there is still unfairness in the coverage of the floating population, urban workers with closed enterprises, poor people and people who are poor due to illness. As the "gatekeeper" of public interests to safeguard social equity, the government needs to bear the responsibility of financing and subsidizing these vulnerable groups, and classify them according to different situations of different vulnerable groups, so as to ensure that the vulnerable groups can also enjoy social basic medical insurance equally. The third is the maintainer 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 situation in combination with the established financing system framework of social basic medical insurance, so as to ensure the balanced operation of the fund. Secondly, the employer should assume two roles. The first is the guarantor of the health of employees. Employers pay basic medical insurance premiums for employees, which is not only the demand to protect 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, so as 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 part of social responsibilities according to their operation and business conditions, and help the socialist economic construction. Specifically, on the basis of paying the medical insurance fund for employees in accordance with the regulations, the internal risk reserve fund of the enterprise should be constructed according to a certain proportion of the turnover every year, and it should be paid to the local government through charitable donations when sudden public events occur, so as to assume the social responsibility of fighting risks in a special period. Finally, individuals should assume two roles. One is the person 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 the proportion should be adjusted progressively according to the personal income. At the same time, in the process of reimbursement of medical expenses, individuals still have to pay part of the expenses and take responsibility for realizing personal health to prevent the occurrence of pan-welfare risks. Individuals and governments should share the responsibilities according to a certain proportion, and this proportion should gradually transition to 1: 1. The second is the builder of social economy. Every insured person has the obligation to undertake 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 will definitely enjoy the treatment", so we should not refuse to pay, underpay or miss the payment because we do not 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 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 awareness of payment, and promote the high-quality development of China's medical security system.