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Research On The Scope Of Benefits Of The Basic Medical Insurance For Workers

Posted on:2019-10-24Degree:MasterType:Thesis
Country:ChinaCandidate:L Y QiuFull Text:PDF
GTID:2416330548958585Subject:Economic Law
Abstract/Summary:PDF Full Text Request
The scope of benefits of the basic medical insurance for workers determines what the insured can get from the system.Determining the scope of benefits correctly is very important for the insured to realize their right.The scope of benefits is consisted of coverage and compensation.The coverage shows the medical service that the insured can get from the basic medical insurance for workers.The compensation is the reimbursable amount that the insured can get from the basic medical insurance for workers.The system of the legislation is also of great importance for determining the scope of benefits correctly.The determining mechanism of the scope of benefits is defective,and the risk of disease can't be spread effectively.The coverage of the basic medical insurance for workers is listed by catalogues.The concept of the coverage is unsure and the adjustment circle of the catalogues is too long.The principle of reasonable price has been paid so much attention that the principle of necessary medical services is ignored.All of the problems make the insured can't get necessary medical services from the basic medical insurance for workers.Deciding the reimbursement rate by the level of hospital limits the insured that seriously ill to go to the high level hospital.The setting of the maximum payment makes the high medical expenses can't be paid.The scope of benefits of the basic medical insurance for workers is regulated by the administrative regulatory documents.This makes the scope of benefits is arbitrarily determined by the government.This also causes an excessive expansion of administrative power.The State establishes the basic medical insurance for workers to fulfill its obligation of medical guarantee.And the basic medical insurance for workers is the main way for the state to provide medical guarantee for workers.The scope of benefits should share the risk of disease effectively.The coverage should include all the medical services which are necessary for the insured to recuperate and maintain basic survival.The compensation should share the high medical expenses.In order to ensure the safety of the funds and the system's sustainability,the scope of benefits needs to accord with economy.The scope of benefits should fit in with the level of the economy development and only pay for the medical service that is necessary.The law should regulate what the coverage ought to be and pay for the medical services not listed in the catalogues if necessary.The principle of necessary medical services should be basic and the principle of reasonable price should be complementary.The dynamic adjustment mechanism of the catalogues should be established.The reimbursement rate should be divided into several sections,the higher the medical expenses,the higher the reimbursement rate.And the maximum payment should be cancelled.In order to prevent excessive consumption,a special reimbursement rate can be set for the people who don't referral as required premise if the referral system is perfect.And the unnecessary medical services should not be paid.The scope of benefits concerns the realization of the basic right of the insured.They are also related to the fulfillment of the obligation of the State.In the process of determining the scope of benefits,the principle of law reservation should be adhered to.But the scope of benefits should not all be determined by the legislature.The legislature should authorize the administrative agency to determine the specific scope of benefits.The authorization must be clear.The legislature should limit the contents and procedures for the determination of the scope of benefits.
Keywords/Search Tags:the basic medical insurance for workers, scope of benefits, coverage, compensation, system of legislation
PDF Full Text Request
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