Research On The Power And Expenditure Responsibility Of Basic Medical Insuranc

Basic medical insurance plays significant role in protecting human beings’ health and improving living standards.It is one of important institutionalarrangementsof the state to protect citizens’ basic rights.It is clearly stated that of great essential to clarify the authority and responsibility relationship between the central and local governments through various ways,moderately strengthen the central authorities in many fields,such as intellectual property rights,basic pension and environmental protection,so as to realize the effective control of common authorities in the process of development by The Fourth Plenary Session of the 19 th CPC Central Committee.In July 2018,basic medical insurance subsidies and medical assistance for urban and rural residents were clearly identified as the joint financial authorities of central and local government.In February 2020,the policy of deepening the reform of medical security system clearly put forward the necessity to improve and perfect the basic medical insurance system in the future.Therefore,it is of great theoretical and practical value to divide the authorities of basic medical insurance,define the scope,objectives and nature of the authorities of basic medical insurance,standardize the expenditure responsibility corresponding to the authorities,and construct the legal system of the authorities of basic medical insurance and expenditure responsibility.The theoretical origin of the authority and expenditure responsibility includes financial federalism theory,political responsibility theory,public goods theory,welfare economics theory,equity and justice theory and normative power operation theory.The basic medical insurance authority and expenditure responsibility consist of three basic elements: the subject,the content and the expenditure responsibility corresponding to the exercise of authority.These elementsare the starting logical point to study the authority and expenditure responsibility.The goal of the devision of basic medical insurance authority and expenditure responsibility is to protect the basic health care rights and interests of citizens,clarify the responsibility boundary between governments,regulate fiscal expenditure,and prepare for constructing health welfare nation.The legal root of basic medical insurance right and expenditure responsibility is to protect citizens’ health right and property right.Among them,property rights include public and private property rights.Basic medical insurance authority includes powers of administrative and legal,basic medical insurance fund,daily affairs,information platform,organization and funding to agencies and etc.The definition of basic medical insurance rights and expenditure responsibility is that the government should exercise the management of basic medical insurance and the corresponding financial suport responsibility.The essay researches thedivision of basic medical insurance authority and expenditure responsibility in historical periods and its current development.The historical periods of China’s basic medical insurance authority and expenditure responsibility can be divided into five stages: the initial stage of foundation of new China,the period of planned economy,the stage of reform and opening up and period of new medical reform and new era.Among these five stages,the most critical and core period are the reform and opening up and the new era.Currently there are some problems in the division of the authority and expenditure responsibility of basic medical insurance,such as lack of systematic legal basis,unclear rights and interests,unreasonable division of authority,influenced by planned economy factors and so on.The way of division of powers of some countries are worthy of our reference.Germany adopts the model of shared responsibility,the Soviet Union adopts the model of family security dominated by the government,the UK adopts the model of fiscal and taxation with the government taking the primary responsibility,Sweden adopts the model of differentiated insurance with the government taking the secondary responsibility,and the US adopts the model of small government taking the responsibility dominated by the market.These models present different characteristics,characteristics,forms and contents.Our country can choose to refer to and learn from,so as to further perfect ourbasic medical insurance authority and expenditure responsibility division,better play the role of basic medical insurance,and constantly improve the basic medical insurance governance capacity and modernization level.The essay analyzes how to deal with the relationship between government and market to promote the efficiency of the government.It is of great significance to clarify the boundary between government andmarket in basic medical insurance for promoting the reform of administrative system,giving full play to the responsibility of basic medical insurance expenditure,and realizing the benign cooperation between the government,the market and the society.Theessay analyzes the current situation of the role of government and market in China’s basic medical insurance,reflecting the low efficiency,non-standard and other problems in the operation of China’s basic medical insurance system.China should improve the administrative power and expenditure responsibility of basic medical insurance from regulating the boundary between government and market.The improvement path includes: to formulate a specific law to effectively protect citizens’ right to health,to establish a basic medical insurance fund expenditure adjustment mechanism and related management mechanism,to unify the transfer and continuation of basic medical insurance relationship between provincial governments,and to establish a basic medical service mode to ensure appropriate security.Intergovernmental basic medical insurance rights and expenditure responsibilities refer to the responsibilities and obligations of the state,provincial,prefecture level city,county,township and provincial governments in basic medical insurance affairs.The division of intergovernmental power and expenditure responsibility is mainly to solve the financial subsidy responsibility of governments at all levels.There are two modes of liability for basic medical insurance expenditure from the aspect of the world,namely limited liability and unlimited liability.In a certain sense,the financial expenditure of basic medical insurance is the redistribution and readjustment of income and the planning of limited public resources.Therefore,China should learn from the limited expenditure responsibility state model to achieve the efficiency and sustainability of basic medical services.The government should bear the limited expenditure responsibility in the basic medical insurance.This essay analyzes the current situation of the division of authority and expenditure responsibilities between governments of basic medical insurance,which reflects that governments at all levels are not subject to regulations and constraints when they undertake the financial subsidy responsibility of basic medical insurance fund.The results show that the transfer and connection mechanism of inter provincial government medical insurance relationship is not perfect;the basic medical insurance and basic medical service system are lack of coordination;the rights and interests of basic medical insurance participants are not fully protected;the decentralization of basic medical insurance fund financial power leads to regional differentiation of basic medical service;the existence of basic medical insurance individual account hinders the overall use of the fund.The path to improve the authority and expenditure responsibility of inter governmental basic medical insurance includes: unifying the transfer and continuation of inter provincial basic medical insurance relationship;coordinating the basic medical insurance and basic medical service system;coordinating the preparation of basic medical insurance fund and general public budget involving basic medical service;deciding the coverage of basic medical insurance by the state authority;establishing the basic medical insurance system The reform of individual account system of basic medical insurance and the return of mutual aid nature of insurance.We should constructlegal system of basic medical insurance authority and expenditure responsibility.The system should include six elements: five principles,the establishment of the mode of exercising authority with basic medical insurance as the pillar,the establishment of dispute resolution mechanism for the division of authority,the overall levelof the insurance gradually from provincial government to central government,and finally the basic medical insurance becomes the first central administrative power,and the establishment of performance evaluation mechanism.The basic legal principles of system are limited intervention,differential regulation,dynamic adjustment,guarantee and sustainability.The dispute resolution mechanism of basic medical insurance right and expenditure responsibility should include apeal subject,dispute resolution mechanism carrier,resolution procedure and resolution content.The indicators of performance evaluation mechanism include health and capital efficiency.The indicators of health efficiency include: beneficiary group index,basic medical service accommodation index,differential floating index,dynamic adjustment long-term index,equity index of rights and interests protection and preventive index.Fund efficiency index includes per capita security standard index,overall fund allocation efficiency index,financial subsidy inclination index,fund operation efficiency index and individual account exit process index.