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    Home > Medical News > Latest Medical News > Health care overhaul! The outpatient operating room may re-emerge.

    Health care overhaul! The outpatient operating room may re-emerge.

    • Last Update: 2020-09-26
    • Source: Internet
    • Author: User
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    Medicine Network August 28th- Is there an outpatient operating room in your hospital? It seems to have been gone for the last twenty years.
    don't you think it's gone? Because with the expansion of health insurance coverage, and the health insurance policy does not support the reimbursement of outpatient surgery expenses, so has been widespread at all levels of medical institutions in the outpatient operating room gradually disappeared.
    , however, with the reform of the health-care system, the department, which has been gone for years, is likely to re-emerge in hospitals.
    August 26, the State Health Insurance Administration officially released to the public "guidance on establishing and improving the basic medical insurance outpatient co-care guarantee mechanism for workers (draft for comments).
    the opinion to provide that the general outpatient expenses of medical insurance can be reimbursed, the reimbursement ratio from 50%.
    to include outpatient minor and common diseases in the scope of payment of the Health Insurance Co-ordination Fund.
    the media think: this is a new health care treatment.
    , in accordance with the provisions of the draft for comments, some operations carried out in outpatient clinics are also included in the scope of reimbursement of the co-ordination fund, with reference to in-patient reimbursement management.
    why should we set up the medical insurance outpatient co-insurance guarantee mechanism? In 1998, since the establishment of the employee medical insurance system, the implementation of the integrated funds and individual accounts of the system model.
    co-ordination fund is mainly used to cover medical expenses within the policy range above the starting standard and below the maximum payment limit.
    accounts are mainly used to protect outpatient minor illnesses and to cover medical expenses that are personally covered by the Co-ordination Fund.
    in accordance with the Social Insurance Law and the relevant provisions of basic medical insurance, all employers and their employees shall participate in the medical insurance of employees in the co-ordination area in accordance with the principle of territory, and the expenses shall be paid jointly by the employing units and employees.
    employer's contribution rate is generally about 6% of the total wages of employees, and the contribution rate of employees is generally 2% of my salary income.
    basic medical insurance fund consists of an integrated fund and an individual account.
    medical insurance fees paid by individual employees shall be included in the personal account.
    medical insurance fee paid by employers is divided into two parts, one for the establishment of an integrated fund, one part into the individual account, the general transfer to the personal account is 30%.
    Due to the small amount of personal (family) account protection is insufficient, poor ability to help, easy to induce abuse, often appear "the elderly, chronically ill and other needs are not enough, young people and so on do not need to use up", and some insured people often think that "individual (family) account money is their own" "waste without use", and easy to cause abuse.
    the establishment of the new agricultural cooperative system in 2003, in order to increase the enthusiasm of rural residents to participate in insurance, expand the coverage of the system, the establishment of individual (family) accounts, mainly used to pay for small outpatient expenses.
    addition to the above problems, the personal account also appeared the balance of funds "lying on the account can not spend out" problem.
    According to the National Health Insurance Administration's 2019 National Health Insurance Development Statistics Bulletin, the current balance of the personal accounts of employees' health insurance was 111.6 billion yuan, with a cumulative balance of 842.6 billion yuan, and the funds that lay on the accounts that could not be spent had in fact been depreciating and shrinking, in disguise resulting in a "waste" of health insurance funds.
    , reform of the health care outpatient system is necessary.
    benefits of including outpatient minor and common diseases in the scope of payment of the Medicare Co-ordination Fund? On the one hand, it solves the problem that the patient's outpatient can't be reimbursed.
    , the health insurance fund is divided into two parts, outpatient treatment costs can only be paid by the individual account, and the personal account funds are limited, some people are not enough, some people do not need.
    now set up an outpatient co-ordination mechanism, the implementation of outpatient co-ordination, outpatient expenses according to inpatient reimbursement, effectively solve the problem of outpatient reimbursement.
    , on the other hand, has also saved health-care funds significantly.
    because of the implementation of outpatient co-ordination, the small operations that could have been performed in the clinic no longer have to choose inpatient treatment, and no longer crowd out the tight medical resources, not to increase the burden of health insurance funds.
    do you say that? The so-called outpatient surgery is not inpatient, in the outpatient operating room can do small surgery, dozens of minutes or hours can be done, simple and convenient, but also save money.
    e.g. lipoma (including sebum cyst) excision, mastectomy, tendon cyst removal, cataract surgery (artificial crystal implantation), wing-like mastectomy (stem cell transplantation), cervical polyps, diagnostic scraping, such as common injuries The removal of clean-up stitches, the removal of benign tumors on the body surface, the removal of nails of meth, shallow vegetation, warts, etc., surgery with too long foreskin or tubers, some outpatient conditions are better, outpatient surgery, tendon matching surgery, etc.
    outpatient operating room has always been one of the important departments of the hospital.
    of course, the disappearance of outpatient operating rooms is not only because health insurance is not reimbursed, as a hospital, in addition to considering medical safety, more consideration is the economic benefits, is income.
    , many hospitals have withdrawn their out-patient operating rooms, and the non-reimbursement of health insurance is just an excuse.
    the outpatient surgery can be reimbursed, the outpatient operating room can be red hot? Not necessarily.
    interests may be the main lever to pry.
    all this is expected to be accompanied by the deepening of the reform of the health care payment system.
    are the specific health care payment systems? For example, total advance payments, pay-per-disease payments, DRGs, and so on, with the arrival of a series of policies such as medicare strategy purchase, may be able to make the once-disappeared hospital outpatient operating room once again red-hot.
    , of course, day surgery, which has been affected by Medicare payments for years and cannot be advanced more quickly, will certainly be valued for being more cost-effective.
    that's the direction of health care reform.
    .
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