The Legal Dilemma and Reform Reconstruction of the Individual Account in Basic Medical Insurance for Employees
Clarifying the ownership of individual account funds and their operational mechanisms from the perspective of basic medical insurance law is essential for addressing the cognitive challenges in reforming the individual account system.Individual account funds are"constructed"on the basis of employee basic medical insurance funds and are part of the statutory public funds.The individual account system is embedded in and integrated throughout the entire process of employee basic medical insurance.Insured individuals,by fulfilling their obligations to pay insurance premiums,have the right to request benefits such as outpatient services and medication from their individual accounts.The establishment of the individual account system has played a positive role in promoting the transformation of the traditional healthcare system to a social medical insurance system.However,it has inherent flaws due to its origins in the planned economic system,violating the principle of social collective responsibility in basic medical insurance and the pay-as-you-go financial operation rules.The fundamental approach to reform lies in returning to the legal principles of basic medical insurance.This reform should focus on structural optimization through a systematic overhaul of the individual account system.Specifically,the reform should involve incorporating all individual account funds into the pooled funds,eliminating the fragmented and heterogeneous operational mechanisms between individual and pooled accounts,reshaping the mutual aid and risk-sharing mechanism,redefining the rights and obligations of insured individuals,and guiding the basic medical insurance system towards stability and embedding it within a legal governance framework.
individual account of employee basic medical insurancerisk-pooling and solidarity mechanismsocial collective responsibility principlepay-as-you-go
万方数据
维普
