중국 의료보장제도 개혁의 실태와 특성

Abstract

China's social security system was established and gradually improved since the People's Republic of China was founded, so far has formed a relatively complete social system, of which security system is the most important part. There are two main parts in the medical security system: medical insurance for urban workers and rural medical insurance. Here the medical insurance for urban staffs includes free medical service and labor-protection medical care. For a long time the Chinese government has been focusing on the medical system reform which is also the main object of this study. Based on a time sequence, this paper introduced medical security systems of different periods after New China was founded and analyzed their changes and characteristics in the development. After New China was founded, the social security system began to develop. In that situation urban medical system had played an important role of ensuring the staffs' health and social stability, which had been further developed after 1950s. And the government put forth a series of policies. But during the period of the Cultural Revolution from 1966 to 1976, the medical insurance was damaged greatly, besides there were many critical problems in medical security system itself. These caused big medical expense burden for both nation and enterprise, moreover, staffs took little responsibility individually, at the same time there was no effective way to control the rapid growth of the medical expenses. The urban medical system could not play its role anymore until reform and opening-up. China began to carry out the reforming and opening-up policy since 1978, which caused the rapid economic growth and the rise of the diverse forms of ownership. In order to comply with the social changes brought by structural reform and economic development, health care system must be adjusted accordingly. Therefore, China gradually carried out an exploration of health care reform, and the local government also enacted related policies to guide the development of the health care reform. Under the guidance of the Chinese Government in 1998, a new nationwide basic medical insurance system was carried out. The Chinese Government also stressed the reform of medical insurance fund sources in the reform of medical system of urban staffs. That is to say, the medical insurance fund sources will be burdened by the nation, enterprises and individuals, or both of enterprises and individuals. The individual should share parts of medical costs in the reform, the purpose of which was to effectively control the waste of medical resources. But there were also some new problems in this process of reform. This study proposes the solutions and opinions aiming at the occurrence of new problems occurred in the reform process of medical system for urban staffs. First we need to improve the insurance legislation to lay a solid foundation for ultimate establishment and development of medical insurance system. Secondly we should perfect the conducts of the parties in the system. Finally we should further the reform and development of medical insurance system by establishing the reasonable financing system, strengthening the management of medical overall finance and perfecting the controlling system of medical expense.