Guiding Opinions of the General Office of the State Council on Establishing and Improving the Outpatient Mutual Aid Guarantee Mechanism for Basic Medical Insurance for Employees

The people's governments of all provinces, autonomous regions, and municipalities directly under the Central Government, all ministries and commissions of the State Council, and all directly affiliated institutions:

In order to further improve the basic medical insurance system for employees with mutual assistance and shared responsibility (hereinafter referred to as employee medical insurance), better solve the problem of outpatient protection for employees’ medical insurance participants, and effectively reduce the burden of medical expenses, in accordance with the Party Central Committee and the State Council’s proposal on deepening medical care With the approval of the State Council, the task deployment for the reform of the security system is hereby put forward the following opinions on the establishment and improvement of a mutual assistance mechanism for employee medical insurance outpatient services.

1.

(1) Guiding ideology.

(2) Basic principles.

2.

(3) Enhance the mutual aid guarantee function in outpatient clinics.

According to the capacity of the medical insurance fund, gradually expand the scope of outpatient chronic diseases paid by the overall fund, and include some outpatient expenses for diseases that have long treatment cycles, great health damage, and heavy cost burdens into mutual aid protection, and some are suitable for outpatient development , Special treatment that is more economical and convenient than hospitalization can be managed with reference to hospitalization benefits.

(4) Improving the method for crediting personal accounts.

(5) Regulate the scope of use of personal accounts.

(6) Strengthen supervision and management.

(7) Improve the payment mechanism that is compatible with the mutual aid guarantee in outpatient clinics.

Three, organization and implementation

(8) Strengthen organization and leadership.

(9) Actively and steadily advance.

(10) Pay attention to publicity and guidance.

Office of the State Council

April 13, 2021