The historical evolution of the medical insurance system

The historical evolution of the medical insurance system
In the developed countries, the United States is relatively late to medical insurance plan, is also the start to set up private health insurance plans.Through changing the development, the United States so far has formed is given priority to with private insurance system, national insurance and welfare insurance plans is complementary medical insurance mode.In this paper, we discuss in different periods, the American culture, the institutional environment, factors such as interest groups under the influence and role, is through the historical change of medical insurance system in the United States.

America's health-care spending is among the highest in the world, per capita health spending is now account for 13% of the per capita income.In the 1990 s, the national health spending has accounted for around 14% of GDP, growth to 15% in 2000.1) spending is higher than the military industry, health industry is the biggest industry in the national economy.But the United States the history of the development of modern medical insurance is not very long, by 1920, eight western countries have already established a mandatory social medical insurance system, (2) as the world's economic power of the United States at the time, until the 1930 s have formal medical insurance plan, and this was the mainstream of American culture and social development.After the civil war to the beginning of the 20th century, is the period of free competition in American history, social Darwinism is the main social thought, liberalism and Darwinian stress free competition, the government insists that the religious, charitable activities to address health problems and basic adopted a laissez-faire attitude of medical and health care.By the 1920 s, the situation changed, a gradual increase in demand for medical insurance, medical insurance system has given rise to the modern sense.A preliminary development, founded the private medical insurance system, and (in the 1830 s - 1945), in the late 1920 s, the growing demand for health insurance, the first is drug learn a major development in 20 s, especially the invention of antibiotics, make people aware of the effectiveness of health care, such as rosenberg says "to 20 s, hopeful the patient can be cured, the hope of inspiring, also attracted to pharmaceutical development will bring new picture -- is accurate, scientific and effective."(3) the development of industrialization, urbanization, make the space of the urban households is reduced, at home to take care of the patient becomes cramped up, so that people are willing to to the hospital for treatment.Is strict with the doctor's career in 1920 s, the industry standard for tougher, the issuance of license to the doctor and more strict, (4) so as to improve the professional quality and service quality of the doctor, the doctor the increased cost of services and improve the cost of medical service.With the progress of medical technology, the medical service of various fees seems more complicated.After the big crisis in the 1930 s, many people have no money to the hospital sees a doctor, led to the decrease of the doctors and hospital income.Doctors and hospitals begin to realize, if they have a stable income, can work better, will also be necessary to implement the new payment to ensure that patients pay their bills in a hospital.In 1929, Mr Berge (Baylor university hospital and the university of Dallas 1250 teachers, scheduled for 50 cents to get some medical services, is the first insurance health insurance plan in advance.California in 1932 and launched a community insurance plan, within a certain area to participate in the plan of the hospital will provide medical services for users to join the program, users only need to pay advance to the plan, which is blue cross association (BlueCrossPlan) plan, 1934 blue cross symbol used to denote a non-profit hospital plan in the first place.In the 30 s, after the big crisis blue cross plans this prepaid plans to gradually rise, mainly cover the long-term hospitalization and special medical service cost;Against the doctor service at the same time, especially surgery prepaid plans also appeared, is the "blue shield plans" (BlueShieldPlan).Blue cross and blue shield "called the" double blue "(the Blues), positioning for the private, nonprofit organization."Double blue" by the United States at that time big interests -- the American hospital association (TheAmericanHospitalAssociationAHA)

Encouragement.Because of a single hospital medical insurance plan will cause the competition between hospitals, AHA through the design guidelines of "blue cross" program, can reduce the price competition between hospitals, the hospital benefit maximization.To a large extent, double blue represents the interests of the doctor."Double blue" is classified as a non-profit, private organization operation, "fully enjoy duty-free policy is different from general insurance plans, and eliminate the demand of commercial insurance companies face the strict conditions".(5) the legal status of double blue caused great debate, first half of the states refused to grant double blue tax-exempt status.To show their non-profit stance, double blue take unified rate (communityrating), the community is a community to all residents to impose the same insurance cost, the actual subsidies to the old man and the poor people at high risk, and social insurance have similar place, the result of success.1935 11 states have 15 blue cross association, 1937, 800000 to participate in this program, increased to 6 million, 1940, 1945, 19 million subscribers, blue shield of 2 million users.6 pairs of blue enhances the growth of nonprofit organization dominance in the medical profession, to the early 40 s, two-thirds of the health insurance market is a non-profit program management, and is the main form of early American medical insurance system."Double blue" project is the United States in the modern sense of the establishment of private medical insurance system, the American public started to focus on the construction of the health care system.See a pair of blue through to sell insurance to hire people to solve the problem of insurance variety of successful experience, commercial insurance company to realize the great potential of medical insurance market, and one in the 40 s, private medical insurance system for later enter prosperous period laid the foundation.

Second, the expansion of the private medical insurance system (1945-1964) after the second world war, America's private medical insurance into the expansion period, largely driven by the government.First, the government in taxation policies, encourage the development of voluntary private insurance scheme.During the second world war in 1942, congress passed a "balancing act" (theStabilizationAct) perform a wage freeze in wartime, but adopted the employee health insurance plans, employers pay money for group health insurance plan is not included in taxable income within (exempt from federal, state and social security taxes), it is the welfare of the employees and employers are willing to accept.This kind of tax cuts and the government give financial support to a voluntary plan.In 1953-1958, the medical insurance coverage of americans grew from 63% to 75%, a large part due to tax subsidies.7) after the second world war, the United States Supreme Court ruled that the welfare of the employees (including medical insurance benefits) is a legitimate part of the labor contract management, which laid the legal basis for the development of health insurance.From then on, all kinds of medical insurance become employees enjoy the long-term benefits of a requirement, private insurance companies adapt to the need to actively expand insurance coverage.

In addition, the development of medical technology, the increase in population after the war, the high cost of health insurance, make insurance companies expand their business, has also led to increase in the number of private insurance company.Race relations, the war many insurance companies are not willing to provide health insurance for the black people, think "insurance for different ethnic habits of physique, temper, and environment should be different."Or think if black to provide health insurance, insurance premium "for the Caucasian race, will raise to a new percentage."Today to defuse racial discrimination in the field of medical treatment insurance, the U.S. census bureau statistics in medical insurance will be black on the equal position.So more and more insurance companies are willing to make more black insured persons, to expand the scope of health care insurance service coverage.Influenced by above national policy, social factors, the postwar 50 s is the most significant medical insurance in the United States development phase, the number of people attend insurance from 1940, 13 million soared to more than 100 million in 1955.Commercial insurance company's market share from 37% to 55% in 1940, private insurance form to become the dominant form of medical insurance market.Pet-name ruby insurance content is expanding quickly, including hospitalization, surgery, fee, etc.Commercial insurance company development increases the competitive pressure of private non-profit organizations.Commercial insurance companies tend to focus on specific groups, employees are generally those low risk group, risk than double blue community is unified tax rate is much lower.For group insurance is relatively cheap, in the 1950 s large group employees insurance from double blue plan to insure to commercial insurance company, faced with the pressure of competition of double blue in the '60 s had to give up the community unified tax rate, in fact is to reduce the high risk population coverage.The disadvantages of such marketization of medical insurance system is more and more obvious -- a lack of humanistic care, the lack of fairness, the poor and the elderly has become an object of private insurance companies are not willing to.It attracts people to the existing private insurance plans, review and the attention to vulnerable groups, this call the mandatory social insurance scheme.Turmoil in the 60's special times also boosted the establishment of the first American social medical insurance plan.Third, the establishment and development of national health insurance plan (1965-1982) after the second world war efforts to set up the system of national health insurance have stopped.Post-war Truman four submitted to establish universal health insurance scheme, but the American medical association AMA (AmericanMedicalAssociation) strongly opposed, against Truman's plan is the medicine of the "socialization", the plan complete abortion in the early 50 s.Mandatory health insurance program known as social medical (SocializedMedicine), atmosphere in the early years of the cold war, the term is weakened it's popularity.From the point of social environment, the postwar American although experienced some economic fluctuations, but the whole country, the society is still rich, has the highest standard of living in the world, society also
For stability, each social member seems to enjoy the benefits and high standard life, build system of national health insurance bill always has not been through.Kennedy period situation changed, the early 60 s, the political democracy movement swept across the country.Put forward the slogan of "war on poverty", Kennedy predicted the coming of the social welfare.But given the traditional pressure, the American hospital association, association of physicians and other health authorities to establish mandatory social medical insurance plan has consistently opposed, President Kennedy decided from the "old man and the poor" special group breach, in order to reduce resistance.And for the general public, the elderly are worth special care group, "they make a living ability is low, and medical costs more than any other age group - - this is not the fault of their own", they enjoy the welfare "perfectly legal", in the society to care for the poor is known for ten years, more and more people realize the large gap exists in the medical care in the United States.Attending in February 1963, Kennedy submit the elderly health insurance of the union address to congress, the topic is "aid our older citizens" (SpecialMessageonOurSeniorCitizens), plans to take money from social insurance fund payment the cost for the elderly, but by the senate.Kennedy's successor Johnson after the White House, the situation towards a favorable direction.Is also very important, Johnson is famous for its liberal Democrats took control of the parliament, all by creating the conditions for health care plan.In 1965, congress in 1935, in the form of the social security act amendment passed in 65 and 65 people over the age of medical care (Medicare), and for the poor medical treatment (Medicaid) program, the national health insurance program formally established.In addition to health care and medical aid, as President Johnson's "war on poverty" (WaronPoverty), the construction of the "great society" (GreatSociety) part of a grand plan, also passed the other health care plan, including maternal and child care, child added parenting plans, community health center, etc.In the 1960 s is to build a decent period of medical treatment insurance, health insurance in the United States in the 70 s costs surged into the ills of American society.Total costs increased from 1960 in 27.1 billion to 1970 in 74.3 billion, more than tripled.
Prevention, medical insurance organization, to improve efficiency, save 25% than traditional health insurance fees, supporting the HMO on the other hand, is the United States government intervention and interference of medical market, trying to reduce costs by introducing competition mechanism.Special events in the 1960 s led to the U.S. government established a special group medical insurance plan.The whole of the 60 s center of gravity is trying to provide decent health insurance for the American people.And along with the rising medical costs in the 70 s, the U.S. government begin to pay close attention to the shape of the medical market and cost control, and mainly through to interfere with the medical insurance market regulation and competition.Four, the medical insurance cost control phase (1983-1990) in the 1980 s, conservatism sign on behalf of President Ronald Reagan came to the United States has entered a "new liberalism" economy, Reagan's attitude toward public issue is clear, he would have expressed dissatisfaction with sexual government welfare subsidies, believes that relief groups for "cheat" and "irresponsible" and will continue to expand.Passivity blindly relief can only make economy was so tired in the hardship, finally got the whole nation's survival ability to reduce or disappear altogether.Ronald Reagan into the White House, the number of elderly population increase, increasing the political influence, the inflation and pay "index", make the retirement amount, the rapid increase of medical treatment of the whole social medical treatment.After entering the 80 s, the U.S. government have to start a comprehensive contraction medical security system.The Reagan administration to slash health spending, the main reduce funding for health care and medical rescue plan;Reagan introduce "new federalism" (NewFederalism) program, right down to state and local governments.Bright spot in the 1980 s reform is the introduction of expected payment system (Pro2spectivePaymentSystem, referred to as "PPS"), it was a profound influence of payment system reform.To carry out the basic purpose of PPS is to restrict spending every case, the introduction of the mechanism to slow the cost of medical care.,??In the 1980 s the United States government has risen from welfare to squeeze inflation period, the government of medical insurance market, mainly on the control of the medical expenses.Five, the comprehensive medical insurance system reform (1990 - present) since 1929 since the establishment of the medical insurance system, in which both the Roosevelt, Truman, John f. Kennedy and Johnson democratic government efforts to establish and expand health care coverage, and Nixon, ford, Ronald Reagan, George Bush's republican government contracting such as medical insurance policy measures, control measures are effective, Ronald Reagan in the 80 s but as

America's fiscal crisis, an aging population and other serious problems, the health insurance market in the 90 s on the difficult to escape the dilemma: one is soaring health-care costs make the government, corporate and private are overwhelmed;The second is the society more and more people have no health insurance.Campaign slogan of "medical reform", one of the democratic presidential candidate Hillary Clinton took office, in November 1993 to congress called the health protection, health care insurance reform.The plan advocates a unified national health insurance system, by the federal government, state and local governments, employees, the employer is collective burden, through the establishment of health alliance, medical institutions to restructuring, consumer freedom of choice and government regulatory intervention, to reform the health care system.Around Clinton proposed reforms, liberals and conservatives in congress on whether to set up the national health insurance system, launched a fierce debate whether the government intervention in the medical insurance market.Because the plan will make the federal government's spending is too big, not through the review of the congressional budget office.And Clinton proposed a utopian plan, much interest groups, consistency is very difficult.??。Also say the plan would lead to serious public corruption and high cost, and low efficiency.Late in the summer of 1994, the plan complete failure.Unified national health insurance system cannot be established in the United States, also has the social reasons, pursues the free market competition is the tradition of the United States, the public tend to market, emphasis on individual responsibility.Into conservative gradually prevailed in the 1980 s, the United States, in the 90 s the American public expectations of government welfare is not high.??,。Blue cross and blue shield, pulled open the prelude to the United States in the modern sense of medical insurance plan.Medical care system and medical relief system of legislation, is the beginning of the government official involved in medical market, to ensure the health of people plays an irreplaceable role, to become the foundation of health care system.Both for-profit hospitals and non-profit hospitals, are based on the value of a market economy under the rule of fair competition, the medical service provider to get reasonable compensation, promote the development of the medical career.But the medical insurance system of the third party pay and the existence of moral hazard and result in rising insurance costs, in the 1970 s, policymakers have recognized the problem, and take some of the cost control measures, efforts to build system of national health insurance in the 90 s failed again, American medical insurance in the political impasse.After nearly 80 years of development, the medical insurance system for the unprecedented improvement and perfect, has played a positive role to safeguard people's health.But has formed the objective state of influence on the later young people thought form, combined with the contradictions between various interest groups in the United States, federal and
States also have interests distribution between conflict, is not easy to find the best reform way.When we review the historical process of the medical insurance system and discusses the choice of the medical insurance system and the implementation of the plan at the same time, summed up the inner characteristics of the development of the medical insurance, can be used for reference in China's health system reforms.