Research Of Delegated Administration In China’s Social Medical Insurance

Social health insurance is a security system that nation and Community set up for the workers, It refers to under the protection of national laws and regulations, when workers in patients lead to a difficult life, country and society offer certain support. In our country, social medical security system is composed of three parts, which are the enterprise (personal) subsidiary medical insurance, large medical aid and basic medical insurance.The development of social medical insurance is a process, foreign developed countries have also experienced the problems in insurance of social medical which are exist in our country.But in many developed countries, they taken measures to solve the problems existing in the social medical insurance according to their own national conditions. For example, In the United States, the commercial insurance mechanism is introduced into the social medical security system, which has formed an effective "management type medical model"; In Germany, the government departments and social organizations strengthen the supervision of medical insurance operation, they improve the efficiency of social medical insurance through the "management office separation" and "the third party pays". Essentially,the third party is introduced into the social medical insurance services, which have made great achievements; Dutch HIA social health insurance reform is successful, the Dutch government encouraged many commercial insurance companies to participate in product development and sales in social medical insurance。The applicant can choose the insurance company according to their own situation, competition is the core of the Dutch HIA mind; finally, in the British social medical insurance system reform, the government departments introduce the market competition and the third party management to the system, and optimize third-party management based on the social security fund, its reform is successful. Reforms in these countries each have each characteristic, but they all have one thing in common, that is, the market competition mechanism and third-party management model is introduced into the social medical insurance system.Social health care system reform in China since1994, after nearly20years of reform, China’s social security system has made obvious progress. On social medical insurance entrusted agency model, many areas in China dare to innovation, bold change, gradually formed some distinctive social medical insurance model, entrusted agency form are diversity, but overall, they belong to the two modes, one is "fund management" entrusted agency model, insurance company just charge a premium, and do not assume risk; Another is intervention with insurance company, insurance company participate in medical insurance management pattern in the form of contract, insurance company operate independently, self-financing, this pattern is known as the "insurance contract" entrusted agency model. These patterns made great effects, for example, social security rate soaring, operating costs reduced, the efficiency of social security improve. It also beneficial to the supervision of social security activities, and promote the development of the commercial insurance companies, etc.Although our country developed "fund management" handling mode and organization of "insurance contract" model.however, the two patterns of development in our country is still in the preliminary stage, and exists many shortcomings. The main defects are:commercial insurance company lack management competition main body, health care project which commercial insurers can participate in is less, the entrusted agency management pilot area is narrow, lack of competitive fund management subject, management oversight has not been effectively implemented.According to problems in entrusted management of organization of social medical insurance in China, in order to better serve the social medical insurance reform in our country, the author puts forward some Suggestions:First, carry out "managed competition", encourage competition, at the same time, put moderate management into practice. Second, Release the social security business to the management of commercial insurance companies. Third, expand the pilot delegated administration, and increase the successful experience in the promotion. Fourth, accelerate the formulation of the specification file of Social Security commissioned management expertise, no rules no standards. Fifth, encourage commercial insurance company to develop health care products. Sixth, strengthen the supervision of organization of social insurance of commercial insurance company business. In addition to rely on the government executive power, strengthen the supervision of organization of business of commercial insurance companies also need to develop relevant laws of business of organization, to punish them seriously in violation of the law, strengthen the mutual supervision of the industry, and commercial insurance company to make it mutual restriction and mutual promotion, and media supervision is an important aspect.This article altogether is divided into four chapters, the first chapter is the introduction part, this part is introduced some of the theoretical basis, research content, research methods and literature review in this paper; Second chapter respectively introduces entrusted agency management experience of the United States, Germany, the Netherlands and the United Kingdom, elaborated entrusted agency model of social medical insurance in these country. The third chapter describes the social medical insurance entrusted agency practice situation in our country, summarizes our country’s achievements in Social Security commissioned Managers; The last chapter summarizes the deficiency of Social Security commissioned Managers in China, and proposes the corresponding improvement Suggestions and measures.