China s health insurance problems, China s medical insurance problems

Legal analysis: The medical expenses of the insured persons who pay the basic medical insurance premiums according to the provisions of the insurance drug list, diagnosis and treatment items, medical service facility standards, and medical expenses such as emergency and rescue shall be paid from the basic medical insurance in accordance with the provisions of the state, and shall not be included in the reimbursement of medical insurance in accordance with some scopes stipulated in the Social Insurance Law of the People's Republic of China.

Legal basis: Social Insurance Law of the People's Republic of China

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**: (A) shall be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall be borne by public health; (4) Seeking medical treatment outside the country. Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance.

After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

Since the 50s of the 20th century, China has gradually established a medical insurance system with the characteristics of the times and has played a major role. However, with the development of the economy, the shortcomings of the previous medical insurance system have gradually been exposed. Starting from the shortcomings of the current medical insurance system, this paper analyzes the causes of the problems, and proposes to intensify the reform of medical insurance and build a medical insurance system with Chinese characteristics.

1. China's medical insurance system: China's employee medical insurance system was established in the early 50s of the 20th century, including two parts: public-funded medical care and labor insurance medical care. Over the past several decades, this system has played a positive role in ensuring the health of workers and workers, reducing their personal and family burdens, and improving the health level of the whole nation, promoted economic development, and maintained social stability, and has played an important role in China's political, economic, and social life. However, with the reform and opening up and the development of the market economy, the shortcomings in China's medical insurance system have been increasingly exposed.

It is mainly manifested in the following aspects: (1) the state and enterprises have too much medical expenses, heavy burden, poor management, and lack of effective cost control mechanism, resulting in great losses and waste; (2) The coverage of medical insurance is narrow, the degree of socialization of services is low, the basic medical needs of some employees are met and the waste of medical resources coexists, and the public-funded medical care and labor insurance medical systems are not unified. Because the original medical insurance system no longer meets the requirements of the development of the market economy, it has even hindered the further deepening of the structural reform.

Therefore, in December 1998, the "Decision on the Establishment of the Basic Medical Insurance System for Urban Employees" Guo Fa (1998) No. 44 (hereinafter referred to as the "Decision") was issued to deploy the comprehensive promotion of the reform of the medical insurance system for employees nationwide, and required the basic establishment of a new basic medical insurance system for employees in 1999. Since the promulgation of the "Decision", all provinces and municipalities across the country have stepped up the construction of the basic medical insurance system for urban workers and made significant progress in accordance with the principle of "low level, wide coverage, burden on both sides, and integration of unified accounts". All provinces and cities have basically established the basic framework of basic medical insurance for urban workers according to the actual situation, established a social medical insurance agency (social security basic office), established a basic medical insurance ** social co-ordination ** and personal accounts, and the social security ** office is responsible for reviewing and selecting the designated medical service institutions and designated pharmacies, and formulating the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards and corresponding management measures.

In addition to basic medical insurance, a large-scale medical expense mutual aid system has also been established in various localities to solve the medical expenses above the maximum payment limit of social pooling.

Hope. Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

Summary. When you pay social insurance premiums on time and in full in accordance with relevant regulations:1

A monthly pension is payable upon reaching the required retirement age. 2.When you are hospitalized and buy medicine at designated pharmacies, you can use your medical insurance personal account to swipe your card to consume and reimburse relevant medical expenses.

3.In the event of unemployment, unemployment insurance benefits are available. 4.

During childbirth and maternity leave, women are entitled to maternity allowances and reimbursement for prenatal check-ups and childbirth-related expenses. 5.In the event of a work-related injury, the applicant may apply for disability allowance and disability allowance after verification and confirmation.

Dear, hello, I used to pay social security in Zhejiang, and now I work in Hefei factory, where is this social security paid in Zhejiang?

No, the social security you pay now is in Hefei.

It's been five years since Zhejiang handed over, can't I continue to pay it?

You can transfer social security from Zhejiang to Hefei. Because your current unit is in Hefei.

If you don't turn it, you can't continue to hand it in.

Kiss. OK.

Different co-ordination areas and change city work: Before the social security was not paid, there was no shadow for the new company to pay, and the new company paid was a new account opening. However, it is generally recommended to pay one, because repeated payments can only enjoy one social security benefit.

The previous years of social security payment will not be cleared, and it can be transferred and merged when the retirement year is closed.

Is there a disconnection between your two social security payments?

When you pay social insurance premiums on time and in full in accordance with relevant regulations:1A monthly pension is payable upon reaching the required retirement age.

2.When you are hospitalized and go to a designated pharmacy to buy medicine, you can use your personal account to swipe your card to consume and reimburse relevant medical expenses. 3.

In the event of unemployment, unemployment insurance benefits are available. 4.During childbirth and maternity leave, women can enjoy maternity allowances, reimbursement of expenses related to prenatal examinations and childbirth delays.

5.In the event of a work-related injury, it is verified that you can apply for disability allowance and disability allowance.

Zhejiang's side is broken.

It was broken for 3 years. After a break of 3 years, did you pay it in Hefei?

Hehe, just ask me, listen to me slowly, and tell you how the medical insurance money is paid first.

1. Payment. 1. Unit: 9% of your salary, of which 70% goes to the overall part and 30% goes to the personal account;

2. Individual: Pay 2% of your salary, all into your personal account;

For example, if your salary is 3,000 yuan, the unit pays 270 yuan, and you pay 60 yuan, the monthly entry into your personal account is 270 * 30% + 60 = 141 yuan, and the overall part is 270 * 70% = 189 yuan.

Note: You understand the personal account, the so-called co-ordination is that all the insured people put the money together, who is sick and who uses, the 189 yuan is no longer your personal exclusive, so there is no money in your co-ordination account, there are billions of funds in it, stored in the local ** financial account).

I'll tell you how to use the money below, because it's too professional, and I'll try to write it to make you understand.

2. Use. 1. Personal account: It is accumulated from your monthly salary of 9% * 30% + 2%, you can buy medicine in the pharmacy, you can pay the out-of-pocket expenses in the hospital, and you will have to pay cash when you run out.

2. Co-ordination part: If the money in the personal account is limited, then there is no number for the co-ordinated money. Generally, pooled money is used for your hospital stay and outpatient expenses for chronic diseases (e.g. high blood pressure, etc.), e.g

Someone has XX disease hospitalization spent 8000 yuan, according to the regulations, more than 1000 yuan will be reimbursed, 1000-8000 part can be reimbursed 85%, then you have to pay 1000 + 7000 * 15% = 2050 yuan, medical insurance reimbursement 7000 * 85% = 5950 yuan, and the 2050 yuan you pay can also be paid with the balance of the personal account, and the insufficient part is paid in cash.

Therefore, the purpose of medical insurance is that everyone pays for it, and whoever is sick uses it, which is a form of mutual aid.

Purely handmade, it doesn't give me a sense of intolerability, hehe

Now the state also has regulations on medical insurance for flexible employees without formal work, regardless of gender, in order to enjoy medical insurance after reaching the statutory retirement age, you must reach the minimum payment period, 30 years for men and 25 years for women, otherwise you will have to make up for it at one time. China's medical insurance started late and has a thin foundation, so the current insurance premiums are high, which is a great burden for flexible employees who do not have formal jobs. If you are in good health and young, I suggest you choose a commercial insurance plan and plan your medical insurance.

For individuals, hospitalization uses more money for medical insurance, but if you pay through your husband's own company, it may be about the same, if you are in Shanghai. Because the company pays money, it not only has to pay medical insurance, pension, unemployment, maternity, and work-related injuries, but also pays more money. It is recommended that you enroll in the Resident Health Insurance if you meet the requirements:

You are registered in Shanghai town, or your husband is registered in Shanghai, or your husband is a residence permit for imported talents (starting with CW9), and you have an attaché certificate. As long as you pay 480 a year for resident medical insurance, it is more cost-effective for you to be hospitalized, 50% directly, and 50% for outpatient more than 1000, and if the company pays money, it will take 45 days before the medical insurance can take effect, and the resident medical insurance can be used as long as the second day of payment. For your second question, the company stopped paying after the surgery, of course this is okay.

Medical insurance is a very important type of social insurance, which can be reimbursed when we are hospitalized in daily life, saving a lot of money.

The only possibility is to find a relationship to exchange it for the bill of the hospital that can be reimbursed by medical insurance, otherwise there is no way.

Yes, you have already started to do a self-funded project, if you want to brush social security, you have to transfer, in fact, the amount is not much, you can pay for yourself, if you want to transfer, there will definitely be more expenses, who has not made a mistake, right, you don't have to blame others, I have also encountered, I paid for it, the money for medical insurance will not be reduced in it, rest assured, forget.

First, make sure you're participating in the country where you're enrolled**.

Then you have to have a health insurance card.

Then the 1A hospital generally reimburses 40%-75% of the proportion, according to the registration score in Guangzhou.

I want to ask, our unit is bankrupt and now we don't buy medical insurance, we buy it ourselves, but I want to buy the residents' medical insurance but I can't buy it now, if I don't buy it now, will I have to break the insurance?