Differential analysis | The relationship between the medical insurance system and the multi -level medical insurance system

The burden of high medical expenses of patients with severe diseases is to be solved by the current system design of my country's current stage. Many people don't know the differences and connections between the medical security system of heavy diseases and the multi -level medical security system, and even mix the two to talk to each other. This situation is obviously not conducive to the development of related work. Therefore, it is necessary to analyze the relationship between the two.

1. The goals of the two are different

According to the State Council's General Office of the "Opinions on Improve the Extraordinary Disease Insurance and Rescue System" (Guoqi Fa [2021] No. 42), the goal of establishing a medical security system for major diseases is The burden of medical expenses of the disease, establish a long -term mechanism for preventing poverty due to illness, and strengthening basic medical insurance, major illness insurance, medical assistance (collectively referred to as triple system) comprehensive guarantee ... Promoting the comprehensive protection of triple systems and charity assistance, commercial health insurance and other collaborative development , Effectively connect, build a multi -level medical security system led by the government and participating in multiple parties. " It mainly focuses on reducing the burden of medical expenses for the major diseases of the heavy special diseases in difficult people, and is achieved by multi -level medical protection based on comprehensive protection of triple systems.

The goal positioning of establishing a multi -level medical security system, the Central Committee of the Communist Party of China and the State Council clearly stipulated in the "Opinions on Deepening the Reform of the Medical Security System" as "strengthening basic medical insurance, major illness insurance and medical assistance triple protection functions to promote complementary medical insurance complementarity Connect to improve the level of major diseases and diversified medical needs ". In other words, in addition to improving the level of protection for major diseases, another important goal is to better meet the people's personalized and diverse medical security needs.

2. The government -led strength is different

Medical protection of major diseases has obvious characteristics of government administrative leadership. Such as: categorically and sound poverty due to illness, and return warning mechanism for poverty due to illness, timely and accurately identify and determine the rescue objects; for difficult workers and urban and rural residents who have a heavy burden of medical expenses, implement classification assistance according to the category of rescue objects; strengthen information sharing between departments Compare the comparison of the inspection, and do a good job of risk research and treatment; strengthen the dynamic management of monitoring people, and timely be included in the scope of rescue in a timely manner. So and so on, more reflected in administrative leadership and government initiative.

In the multi -level medical insurance system, other triple systems outside the three -level medical insurance system, especially commercial health insurance, the government's role in it is more reflected in policy guidance, emphasizing the role of the market and society. Such as: commercial health insurance, emphasizing that strengthening the government's institutional construction, policy planning and market supervision responsibilities, through policy guidance of fiscal, taxation, industry and other policies, to play the decisive role of the market in resource allocation, encourage commercial insurance institutions to continuously increase health guarantee health guarantee Supply and improve service quality and efficiency.

Third, specific treatment standards are different

On the specific implementation path, the target group of medical insurance for major diseases is mainly difficult people. Therefore, the first is to ensure that the people in difficulty have the treatment of basic medical insurance. Fully funded the special difficulties, the quota funded the minimum insurance objects, returned to the poor to the poor, and ensure that the people in difficulties should guarantee the guarantee.

Secondly, moderate tilt in basic medical security treatment. In terms of major illness insurance benefits, it is clearly required to enhance the burden reduction function of major illness insurance, and explore and improve the tilt payment policy for minimalist insurance objects, special difficulties and poor people to return to the poor. The main policies are: the tilt policy of a minimum of 50%and the payment ratio of 5 percentage points for the poverty -stricken person's implementation of major illness insurance, and a comprehensive cancellation of the capacity of the poverty -stricken people in the establishment of the file.

In terms of medical assistance, it is stipulated that the individual pays for individuals within the scope of the policies below the starting line of basic medical insurance and major illness insurance will be included in the scope of rescue in accordance with regulations. In principle, the abolition of medical assistance and the starting payment standards for the subsistence allowance and the puzzled personnel are not available for the time being. Rescue starting standard. The medical expenses that the subsistence allowances and the special poverty -stricken persons meet the prescribed medical expenses can be implemented at a ratio of not less than 70%. The proportion of other rescue objects is slightly lower than the subsistence allowance objects in principle.

In principle, other non -difficult people cannot enjoy the above -mentioned tilt policy. Other medical insurance outside the triple protection system, especially commercial health insurance, is mainly the normal health body with payment capacity. Generally, non -healthy body insurance is excluded; while the company's supplementary medical insurance is mainly beneficial A kind of benefits of employees of good enterprises. In a strict sense, they are all guarantees for medical care that health personnel who have the ability to pay in the future. specialty.

4. There is a dependence relationship between each other

Obviously, solving the problem of high medical expenses of severe diseases cannot be simply relying on the power of the government on one aspect, objectively mobilizing and giving full play to all aspects of society, supplemented by multi -level medical protection.Although there are differences in the connotation and extension of the medical security and multi -level medical security in the major diseases, they have formalities in form.A subsystem of hierarchical medical security system.At the same time, there is also a relationship of interdependence and mutual promotion.On the one hand, the establishment and improvement of the medical security system for major diseases will strongly promote the continuous improvement of the multi -level medical security system.On the other hand, the development and improvement of the multi -level medical security system also laid the foundation, provide support, and promote development for the construction of a medical security system for major diseases.

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