An Analysis Of Basic Medical Insurance Institutions’ Legal Positioning

Three major pillars of China’s basic medical insurance are urban workers’ basicmedical insurance, urban residents’ basic medical insurance and new rural cooperativemedical insurance. Compared with other countries, China’s medical insurance policyreform has been lately launched with wide coverage&large size. It isgradually developing towards the direction of national health care insurance. Duringthe development&implementation of basic medical insurance, medical insuranceinstitutions’ position has become more&more significant. To achieve fairnessand efficiency of social security system, social insurance institutions requireappropriate legal position&functional transformation.In reality, people’s obtaining benefits from social medical insurance must be wellmanaged&clearly reflected. The balance of different parties’ interests can only bereached under circumstance that medical institutions, patients, social institutions forma stable triangle system. The relationship between medical insurance institutions andpatients is sort of administrative while also attached with payment relationship.Meanwhile, the relationship between medical insurance institutions and medicalinstitutions is administrative. Above two relationships are maintained&restrainedthrough "Basic medical service agreement”. However, medical insurance institutionsare not standing for one party of the contract but also the judge of the contract. Thispositioning has made the rights and obligations unable to achieve equivalence.In the administrative structure of government, a basic principle foundation of social insurance institutions is to "separate governance&affairs”. In another word, socialinsurance institutions are government executive body covering both “technology andservice”. Nevertheless, from the perspective of medical insurance operation, there isan issue of government function dislocation. Legal rights and obligations of socialinsurance institutions are not specified&granted. They are not property owners ofsocial Medicare fund. Backed by the government’s natural monopoly position, currentposition of social insurance institutions has caused a lot of drawbacks in practice, suchas service concept, operational efficiency, policy arrangement as well as responsibilityfulfillment etc. All above issues are not fully adapting to actual social needs. The"Social insurance law" does not specify medical insurance institutions as medicalinsurers. If legal relationship occurs between a medical institution and a patient, it isdifficult to identify clear rights and obligations.In the process of deepening medical and health system reform, medicalinsurance organizations shall improve ability, accelerate the pace of balance urban andrural medical insurance system&help improve the doctor-patient relationship.Germany and USA are perfect examples and provide a useful reference in terms ofdeveloping medical insurance system, especially the "orderlycompetition" theory, which has high degree of fitness in the social security lawfield under China market economic reform and macro-control. Social medicalinstitutions shall not only move towards independence and specialty in long term, butalso correspondingly develop healthy nationwide fund distribution system andmutual negotiation system. They should respect and handle interests of all parties andpreventing increasing fragmentation system further in the meantime, straighteningthe role of government and prepare for future financialpressure, avoiding possible mechanical backward that may occur after achievingnationwide health insurance.