1) Number of participants
1,024.83 million people participated in the national basic medical insurance for urban and rural residents (hereinafter referred to as resident medical insurance), a decrease of 0.3% over the previous year.
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Figure 6: Medical Insurance Income and Expenditure of Urban and Rural Residents (from the National Bureau of Statistics)
2) Income and expenses
The income of urban and rural residents' medical insurance fund was 857.5 billion yuan, and the expenditure was 819.1 billion yuan, an increase of 9.3% and 15.1% respectively over the previous year. The per capita medical insurance for urban and rural residents raised 781 yuan, the per capita financial subsidy was 546 yuan (subsidies from governments at all levels), and the residents paid 253 yuan out of pocket. The medical expenses of residents' medical insurance were 1,440.6 billion yuan, an increase of 35.7% over the previous year; the per capita medical expenses were 1,406 yuan, an increase of 18.8% over the previous year .
In a nutshell, the current medical insurance system has covered more than 95% of the country’s citizens. Under the background that the national GDP has maintained a growth of around 6%, the income and expenditure of the medical insurance fund has always maintained a double-digit growth of more than 10%. The medical expenditures of the insured persons of the two medical insurance systems are different. The per capita expenditure of employee medical insurance is 2.6 times that of urban and rural residents' medical insurance.
2. Different medical insurance systems in different countries
The medical insurance system is a manifestation of the human civilization system and one of the achievements of the progress of human civilization. The establishment of the medical insurance system is to make the society run more smoothly, like an umbrella in rainy days and a coat in winter. Let every life feel a reliable guarantee for their own health, the most basic human need.
In most countries, the national medical security system is the largest payer of medical services, accounting for more than 90% in the United Kingdom, about 70% in China, and the United States is dominated by the market, and only some special groups are guaranteed by the state. The United Kingdom and the United States are the most typical government-led and market-led medical insurance systems. China's medical insurance system is still improving, and it is likely to be between the United Kingdom and the United States.
1. UK health insurance
I don’t know if you still have an impression. At the core part of the opening ceremony of the 2012 London Olympics, an array of nurses and doctors appeared on the stage. This is the national health insurance system (NHS, Nation Health Service) that the British are proud of. . The British describe their health care system like this, "The core principle of the NHS is free access to treatment, which has become a symbol of British civilization and has been strongly defended by consumers." This sentence can be felt full of arrogance through the screen. Who was the word spoken to? It must be an American on the other side of the ocean.
The United Kingdom implements universal free medical care, and its medical system is divided into three levels. If the NHS is compared to a person, the primary medical system covering the whole country is the limbs and tentacles, and the secondary and tertiary hospital service system is the backbone and trunk of the system.
The first level is primary care, usually provided by general practitioners, called GPs, or vocational nurses and community nurses. These general practitioners, as the most basic medical care providers, are divided by region and provide 24-hour information, diagnosis and prevention services. Residents generally go to their region to register with general practitioners to establish a fixed service relationship. Therefore, it is also known as a family doctor. 99% of the residents in the UK have their own registered general practitioners.
The second level is the second- and third-level medical institutions, and the small-scale community hospitals with about 50 beds are closely connected with the services of general practitioners. Regional general hospitals provide comprehensive services for areas ranging from 150,000 to 200,000 people. Patients are referred by general practitioners for outpatient services, diagnosis and treatment.
The third level is the tertiary regional or cross-regional specialized hospital, which mainly receives patients referred from regional hospitals and provides treatment for specialized diseases with some high-tech equipment. These are generally large teaching hospitals that cooperate with universities.
General practitioners who serve as gatekeepers to health services are usually privately self-employed or join a group of doctors. The income of general practitioners comes from the government, and the government purchases the services of general practitioners and then provides them to residents free of charge. The services and charges of these GPs are the result of negotiations between GP representatives and the Medical Services Commission and the Ministry of Health, based on the number of residents in charge and the average cost. Doctors of the second and third levels are generally directly employed by the comprehensive medical service system, hired by the hospital council, and receive a fixed monthly salary.
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Figure 7: UK healthcare spending (from internet)
2. US Medicare
The United States is the country with the largest expenditure on medical and health care in the world. Whether it is the total medical expenditure, the proportion of GDP, or the per capita medical expenditure, it ranks first in the world. Although the United States is a big economic country, it does not implement a welfare medical system. The limited intervention of the government is an important feature of the American medical security system that is different from other medical security models.
Medical insurance in the United States can be roughly divided into two categories and three levels.
(1) On-the-job employees. The insurance is paid by the enterprise and enjoys the best medical insurance services in the United States, including the employees themselves and their families, and can choose the right to seek medical treatment independently.
(2) The public health care system of the US government. Including Medicare for the elderly and the disabled, Medicaid for the poor, unemployed, and disabled, military health care, veterans management, active duty, veterans' families and wills, public health departments Healthcare in areas such as the National Oceanic and Atomic Energy Administration, Medical Services Program for Indians, and more. Established by different federal and state and local governments, independent of each other. Medicare and Medicaid are the two most widely covered plans. Medicare country email list is a social medical insurance, and Medicaid is a social medical relief program.
(3) A medical security system provided by local government health agencies to the low-income, unemployed, and uninsured. It is also provided by public medical institutions, but the quality of service is relatively poor and lack of continuity.
Compared with European countries, the proportion of specialist doctors in the total number of doctors in the United States is very high, which has caused a shortage of primary general practitioners and family doctors. A large number of specialist doctors are engaged in primary medical work, resulting in waste and unreasonable allocation of resources. There is a surplus of specialists and a shortage of general medicines, which is the current state of American medical care.