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U.S.A. all industrialized country only to give all people their offer basic medical treatment service country directly, but it has comparatively complete business insurance, the government has offered the medical guarantee to the elderly and low income crowd. This text attempt, through investigate, analyze system, medical insurance of U.S.A., combine of our country fundamental realities of the country and medical security system current situation, obtaining and setting up and amplifying the medical security system needs fully considering the fundamental realities of the country, need, reflect society fair and efficiency, need, in pace with system reform of medical and health, need multicell to lay many route ensure enlightenment together, put forward and construct the medical security system idea suitable for the national conditions.

I have investigated U.S.A.'s medical insurance system especially during learning to investigate in U.S.A., attempt to use this as a guide and mirror, must use enlightenment, combine the fundamental realities of the country of our country and medical security system current situation, put forward the idea of constructing the medical security system suitable for the national conditions.

First, medical insurance system overview of U.S.A.

The system of medical insurance of U.S.A. is formed by private medical insurance and social medical insurance. U.S.A. all industrialized country only to give all people their offer basic medical treatment service country directly, but have special public medical care of charge free to the population under certain poverty line, but if a family income exceeds this poverty line, have no right to enjoy such free medical care. The medical insurance system of U.S.A. is roughly as follows:

(1) private medical insurance

A big characteristic of U.S.A.'s private insurance is that an employer pays the insurance premium (Employer-Provided Insurance) for employees, this kind of situation accounts for 90%. This is a kind of accident result implementing salary and price control of government during World War II. It is not the salary welfare because of health care of medical insurance, not controlled by the government at that time, the employer attracts workers with it. Certainly, this kind of situation has a reason on some clauses in American income tax tax law too.

Before the eighties, most private methods of paying insurance premium of insurance company were all to reimburse the cost (Cost-Based Reimbursement), but this kind of mechanism is unfavorable to encouraging people to save, face the sharply surging hospitalization cost, the insurance company tries to use other methods instead, among them the main one " charges the method according to people " (Capitation-Based Reimbursement). In this way, the medical unit collects certain hospitalization cost according to people every year. It is organized, take this kind of method as the core by a larger medical insurance that " medical treatment ensures organizing " (HMOS). However, this kind of method has a drawback, is mainly that an alternative is relatively bad.

(2) social medical insurance

The medical insurance of the U.S. government is that a kind of social insurance system referred in particular to belongs to the social insurance project of government's subsidy. It originates in 1965, offers the medical insurance to the elderly to 65, second only to the second major government finance expenditure in the social security project. The medical insurance project is managed by federal government, the policy is unified among every state.

The government has set up three kinds of main medical insurance projects: The medical insurance (Medicare), replenish (Medicaid) in medical treatment and through implying and replenishing to private insurance of tax system of federal income tax. Government medical treatment replenish project, function with financial transfer payment to a great extent. The difference of replenishing the project and medical insurance project of medical treatment is, the former is designed for poverty person, it is probably including hospital treatment expenses of the low income person 80% for medical treatment not to replenish, insufficient component improve, charge, solve through hospital to person who insures individual. The latter is designed for the elderly, has not got in touch directly between the two. Because private insurance company oneself competent at scale to be so huge involving surfacing so wide medical insurance while being impossible, the government gets involved on market of the elderly's medical insurance. The implicit government replenishes according to the federal tax law in the medical insurance, the personal salary income needs to pay social insurance salary tax and Individual Income Tax at the same time. The medical insurance premium paid by the employer needn't be paid duty on. The private owner employed oneself, 25% of the medical insurance premium are duty-free.