Employee medical insurance will welcome 3 major changes Personal accounts are intended to be available to family members.

Medical network August 27th, workers' health insurance will usher in at least 3 major changes, more than 300 million people to participate in insurance.
August 26, the State Administration of Health Insurance issued the Guidance on establishing and improving the mechanism for the protection of basic medical insurance outpatients for workers (draft for comments) and solicited opinions from the public.
The first big change that the medical insurance outpatient expenses of employees should be included in the reimbursement is to establish and improve the overall guarantee mechanism of general outpatient medical expenses, starting with the chronic diseases of outpatients with heavy burdens such as hypertension and diabetes, and gradually including the general outpatient medical expenses of frequent and common diseases into the scope of payment of the co-ordination fund.
the general out-patient co-ordination covers all staff health insurance insured personnel, the proportion of payment from 50%.
this is a new health care treatment.
the provisions of the draft for comments, localities may explore the gradual expansion of the scope of outpatient chronic diseases paid for by the co-ordination fund.
of special treatment that needs to be carried out in outpatient clinics and is more economical than inpatient treatment can be managed by reference to inpatient treatment.
benefits of out-patient co-care? The relevant person in charge of the State Health Insurance Administration said that the general outpatient medical expenses can be reimbursed, explore the expansion of the scope of outpatient chronic special diseases, outpatient clinics can carry out more economical and convenient special treatment.
, the basic medical insurance system was centered on hospitalization, and in 2019 the proportion of medical expense reimbursement within the scope of the inpatient policy of medical insurance for employees reached more than 80%, but outpatient coverage was relatively weak and relatively short-term.
Yang Yanxuan, director of Tsinghua University's Medical Services Governance Research Center and a professor at the School of Public Administration, told ChinaNews.com that in the past outpatient expenses were mainly paid for by individual accounts, but the money in individual accounts was relatively small, some common diseases were expensive, and individual accounts alone could not be paid, and some patients went to hospital for reimbursement, in fact, in order to take medicine.
, the establishment of outpatient co-care protection mechanism, which is to keep pace with the times, in accordance with the needs of ordinary people to adjust policies.
new reforms will help more than 300 million workers to get health insurance coverage.
according to the 2019 National Health Insurance Development Statistics Bulletin issued by the State Health Insurance Administration, 329.25 million people participated in health insurance for workers in 2019, an increase of 12.44 million, or 3.9%, over the previous year.
the second big change that the unit payment is no longer intended to enter the individual account is to improve the method of accounting for the individual account, and the unit contribution will no longer enter the individual account.
The draft for comments proposes that the personal accounts of employees shall be included in the basic medical insurance fees paid by individuals, and that the standard shall, in principle, be controlled within 2% of the contribution base of my participation in insurance, and that all the basic medical insurance premiums paid by the units shall be included in the co-ordination fund.
past, 30 per cent of all individual contributions and unit contributions for health insurance were credited to individual accounts.
reform, the unit contribution part into the health insurance co-ordination fund, no longer into the individual account, the individual account only personal contributions into.
, the amount of money newly credited to a personal account will be reduced in the current period.
do you use the money? Used to strengthen outpatient care.
draft proposed that the funds allocated to individual accounts after adjusting the overall account structure should be mainly used to support the sound protection of outpatient co-payments and improve the treatment of outpatients.
Zhu Hengpeng, director of the Center for Public Policy Research of the Chinese Academy of Social Sciences, said that based on the income of the employee health insurance fund in 2019 (100.5 billion yuan for the co-ordination fund and 584 billion yuan for each account), the reform will only be allocated to the individual contribution portion, no longer into the unit contribution portion, and the co-ordination fund will increase by about 200 billion yuan.
increase in the Co-ordination Fund clearly offers great possibilities for raising the level of coverage and reducing the medical burden on patients.
Zhang Yinghua, an executive researcher at the World Social Security Research Center of the Chinese Academy of Social Sciences, told Xinhua that the abolition of the transfer of unit contributions to individual accounts means that the social co-ordination part of the health insurance fund has been increased, enhancing the healthy people to help the sick, for the healthy, they will be sick in the future can also get more help from members of the community.
the relevant person in charge of the National Health Insurance Administration said that after the adjustment, the co-ordination fund for outpatient protection function is stronger, that is, the staff medical insurance system for outpatient reimbursement treatment will be better.
the third major change in the use of personal accounts is that the use of personal accounts has been expanded.
personal account can only cover the medical expenses of the employee himself, the reform will be extended to cover the expenses of the employee's spouse, parents and children.
, according to the draft for comments, personal accounts are mainly used to pay out-of-pocket expenses of insured employees within the policy scope of fixed-point medical institutions or fixed-point retail pharmacies.
may be used to cover the medical expenses borne by individuals in medical institutions designated for medical insurance for employees themselves and their spouses, parents and children, as well as the expenses borne by individuals in the purchase of medicines and medical supplies at designated retail pharmacies.
to explore individual contributions for spouses, parents and children to participate in basic medical insurance for urban and rural residents.
experts pointed out that before the individual account does not have the function of mutual assistance, can not spread the cost risk among the population, resulting in the outpatient expense burden is abnormally heavy, the majority of healthy people have a large number of personal account balances, while a small number of elderly, infirm individual accounts can not be covered, the personal burden is heavy.
Zhang Yinghua pointed out that this helps to achieve family solidarity, healthy people, working people can use their own health insurance personal account funds for their immediate family members "payment", "payment", on the one hand, I idle account funds, on the other hand to enhance family mutual assistance and unity.
Yang Yanxuan believes that the essence of medical insurance is social mutual help, but the ability of individual accounts to help each other is poor, young people, healthy people can not use, the elderly are not enough, the scope of use of personal accounts expanded, help to strengthen family mutual help, one person to insure the whole family.
Weidong, deputy director of the Treatment and Security Department of the State Health Insurance Administration, said that after the reform, not only will the treatment of medical insurance not be reduced, but also no increase in individual contributions.
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