The Legal Constitutions Of Basic Medical Service Payment Under The Social Insurance System

At present,China’s basic medical insurance system has basically covered all citizens,forming a social basic medical insurance system that includes basic medical insurance for employees(including maternity insurance)and basic medical insurance for urban and rural residents.According to the relevant provisions of the Social Insurance Law,basic medical insurance agencies manage medical institutions through agreements to provide "reasonable and necessary medical services" for insured personnel,thereby guaranteeing citizens’ access to basic medical services.This also constitutes the obligation of the state to provide basic medical security for its citizens as established in the Law on the Promotion of Basic Medical and Health Care.Thus,the State’s payment of basic medical service to citizens is different from the administrative payment made unilaterally to the counterpart by the administrative organ,which needs to be paid through a third-party social institution.That is,the medical institution signs a service agreement with the agency to provide basic medical services to the insured.Therefore,the problem of what kind of the characteristic of the this type of payment in the nature of behavior,the content of rights and other legal constitution is worthy of in-depth theoretical research.The introduction part of this paper introduces the social phenomenon that it is difficult for the insured to obtain the required medical services and medical insurance benefits.By sorting out the relevant provisions of the Constitution and laws,it is concluded that the state has the obligation to provide basic medical services to citizens.Then,according to the relevant provisions of the Social Insurance Law,it is proposed to discuss the obligation of basic medical service payment and the legal constitutions of the payment.The first chapter systematically discusses the constitutions and nature of the behavior of basic medical service payment under the basic medical insurance system,clarifies that the legal relationship behind this behavior involves multiple subjects,and then analyzes the nature of the behavior of basic medical service payment through this legal relationship structure.The following three chapters take Article 31 of the Social Insurance Law as the starting point,and provide a specific study of the subjects,recipients and contents of the payment covered by this article,with a view to clarifying the mechanisms and contents of citizens’ access to such basic medical services provided by the State.In this regard,the determination of the subject of payment,the medical institution,is subject to the approval of the administrative organ and the signing of an agreement;the citizen needs to join the basic medical insurance and complete the obligation to pay contributions in order to become the recipient “the insured person”,and the determination of the insured person when they are applying for medical insurance benefits is subject to the approval of the administrative organ.The payment content "reasonable and necessary medical services" is strictly regulated by law and regulations,which is based on the catalogue.Of course,limited to the level of economic development,the administrative organ can make administrative discretion.The fifth chapter of this paper,which integrates the first four chapters of the study,analyzes the existing theoretical composition of the basic medical services payment in China from a theoretical perspective.Under the social insurance system in China,the payment of basic medical services is provided by the agreed medical institutions through administrative agreements.The state is the main responsible subject for providing basic medical services to citizens,and the subject of the obligation to pay.The government ensures the payment of basic medical services through the establishment of a basic medical insurance system,and the medical security administrative department and the agency perform the corresponding functions respectively.Through signing a service agreement that is more appropriate to the administrative contract,the designated medical institution will become the main body of the payment administrative task.In this way,citizens can obtain basic medical service payment according to law,which is different from the medical service provided by the autonomy will of both sides between patients and hospitals in civil law.