Medical Insurance 101（1）

Medical insurance generally refers to basic medical insurance, a social insurance system put in place to compensate workers for economic losses caused by the risk of illness. The medical insurance fund is established by the employer and the natural person to pay the fees. After the insured has incurred medical expenses, the medical insurance institution grants him some economic compensation.

The establishment and implementation of the basic medical insurance system brings together the economic power of the unit and the members of society. With government grants, sick members can obtain the necessary material assistance from society, reduce the burden of medical expenses, and prevent sick society. Members "become poor because of illness".

Origin and evolution

Medical insurance, in the traditional sense, means that a specific organization or institution manages to raise medical insurance funds from a certain group of people insured in a certain area through compulsory policies or voluntary contracts .

Medical insurance originated in Western Europe and dates back to the Middle Ages. With the success of the bourgeois revolution, family workshops were replaced by large industries and modern industrial ranks appeared. Due to the difficult working environment, the occurrence of epidemic diseases and industrial accidents prompted workers to seek the corresponding medical care. However, their wages are low and it is difficult for individuals to afford medical costs. For example, in many places workers spontaneously organized themselves to collect part of the money to spend when they were sick. But this form is not very stable, it is on a small scale and its capacity to resist risks is very weak. At the end of the 18th century and the beginning of the 19th century, private insurance developed in Western Europe and became an important means for the country to raise medical funds.

Medical insurance has the basic characteristics of social insurance such as obligation, mutual aid and sociality. Therefore, the medical insurance system is generally enforced by national law, establishing a fund system, expenses are paid by the employer and the individual, and medical insurance money is paid by the medical insurance institution to resolve medical risks caused by illness or injury of workers.

classification

Medical insurance, like other types of insurance, also deducts medical insurance premiums from people threatened with illness by contract, and creates a medical insurance fund; when the insured becomes ill and goes to a medical establishment for medical expenses, the medical expenses Insurance institutions grant certain economic compensation. Therefore, medical insurance also has two main insurance functions: transfer of risk and transfer of compensation. That is, the economic loss caused by the risk of illness to the individual is attributed to all members threatened by the same risk, and the centralized medical insurance fund is used to compensate for the economic loss caused by disease.

Commercial medical insurance

Can be divided into reimbursement medical insurance and compensation medical insurance.

Medical reimbursement insurance means that medical expenses spent by the patient in the hospital are reimbursed by the insurance company, generally divided into external medical insurance and internal medical insurance.

Compensatory medical insurance means that the patient is clearly diagnosed by the hospital as suffering from a certain disease specified in the contract, and the insurance company pays the patient for treatment and care according to the amount agreed in the contract . Generally divided into single health insurance and critical illness insurance.

The two types of medical insurance above have the same points but different points. The same point is that they can get insurance payment when they are sick. The main difference is that general medical insurance is of all types, that is, all kinds of illnesses can get insurance payment. Special medical insurance belongs to a special category, that is to say that an illness or an operation clearly listed in the insurance contract may be covered by insurance. The medical insurance launched by insurance companies is often associated with a combination of the two types of insurance above.