Chinese medical security theory, system and operation

Author: Zhang Qi
Publisher:
Publish Date: 2003-07-01
Features: The medical security system is an important component of the social security system, as well as a project with the widest scope and the most complex operating mechanisms. It plays a significant role in national health, as well as in economic and social development, and is one of the basic socio-economic systems of the state. This book takes the reform and practice of China's medical security system as its main thread, conducting a historical, objective, rational, and systematic reflection and research on China's medical security system, especially the changes that have occurred over the past 20 years since the reform and opening-up. The main research content is as follows:
1. The research object of this book. Medical security is a highly complex topic, and different perspectives can lead to different understandings. From the perspective of the medical security system, the basic relationship is the supply-demand relationship. However, the of medical security lies in its involvement of dual supply-demand relationships, forming a complex relationship between medical security providers and demanders, as well as between medical service providers and demanders. From the medical perspective, the research content of medical security is very rich, involving preventive services, primary health care, and medical services, among others. This book focuses on the dual supply-demand relationship, i.e., taking the medical security system itself as the research object, emphasizing the financial system that ensures citizens' access to necessary medical services, while not delving deeply into the relationship between medical service providers and demanders.
2. Reflection on the history of medical security. Objectively speaking, the establishment of any system has its historical background and needs. Due to changes and developments in the economic development, social structure, political forms, ideology, and people's needs that sustain society, the adjustment and reform of the medical security system have also become inevitable. China's medical security system was established during the planned economy period. After the 1980s, with the reform and opening-up and the transition from a planned economy to a market economy, various reforms and explorations took place. Therefore, this book first systematically summarizes and reflects on the changes in China's medical security system over the past 50 years since the founding of the country, especially the reform practices of the past 20 years, and evaluates the medical security system from a historical perspective, laying a foundation for current and future research on the system.
3. Defining basic medical care. The reform of China's medical security system has proposed a new concept: basic medical care, and it aims to establish a new system: basic medical insurance. This is not just a change in name but also reflects the government's realistic repositioning of its functions. No country in the world can provide health services that meet all the needs of its population, so governments can only seek reasonable ways to ensure the basic medical needs of their people based on their own economic development levels. This requires us to reasonably define the level, scope, items, and methods of guarantee for "basic medical care." This book conducts a comprehensive theoretical analysis of basic medical care from the perspectives of economics, sociology, medicine, and insurance, and explores the technical basis for defining it.
4. The positioning of supplementary medical security. Due to the reform of China's medical security system, the goal is to establish a multi-tiered system with one primary form of security and others as supplementary, to address the issue of interest adjustments during the transition from the old to the new system, while also adapting to the development trends of medical security systems worldwide. This means that in the process of promoting the implementation of the basic medical insurance system, it is also necessary to quickly study and formulate other forms of supplementary medical security, establishing a multi-tiered, multi-form, and selectable medical security system that supplements and enhances the basic medical insurance system. Currently, whether in academic discussions or practical explorations in China, we are still in the initial stages and need corresponding theories to guide us. This book conducts a rational positioning and feasibility study of supplementary medical security, proposing principles and characteristics for the development model of supplementary medical security, and strives to achieve positive comprehensive effects through a three-dimensional combination of multiple levels and types.
5. The design of supplementary medical security plans. The immediate priority, in addition to enhancing the incentive role of basic medical insurance and focusing on economic efficiency, is to establish and improve various supplementary medical security levels and systems in line with the principle of survival and development. Therefore, this book treats the medical security system as a systematic project and conducts a systematic planning and design of various forms of supplementary medical security from an operational perspective. It separately explores the key points and requirements of various supplementary medical security models, such as social supplementary medical insurance, enterprise supplementary medical insurance, medical assistance for civil servants, medical mutual insurance for employees, commercial medical insurance, and social medical aid, especially their funding, payment, and management issues. It strives to effectively solve problems and resolve contradictions through the construction of new systems within the specific political, economic, and socio-cultural context of China.
6. Rural medical security issues. China's rural cooperative medical care was spontaneously formed under the guidance of industrialization in economic development and the constraints of limited resource allocation. Throughout the history of cooperative medical care in China, its emergence, development, peak, decline, and resurgence all had their specific historical backgrounds and realistic reasons. Although cooperative medical care has played a certain role in politics, the economy, and ensuring the health of farmers, with the development of the rural economy, the further improvement of farmers' living standards, and the diversification of medical security needs, the cooperative medical care system has encountered significant problems in its operation. It is urgently necessary for us to seek and establish a new rural medical security system.