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    Home > Medical News > Medical World News > Health care reform controversy: Is it a misreading to say it's shrinking personal income?

    Health care reform controversy: Is it a misreading to say it's shrinking personal income?

    • Last Update: 2020-11-17
    • Source: Internet
    • Author: User
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    Text . . The point of contentious conflict with Mr Wu may be: is the money in the personal account essentially insurance or saving? If you can't use it now, should it be left to the sick or old in the future, or should you help those who need it now, and get help from others when you need it in the future? With the last three days remaining, the time has come for the public to solicit opinions on the health-care outpatient benefit mechanism, known as the medicare personal account reform, which is of direct interest to 330 million people.
    August 26, the State Health Insurance Administration 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.
    this opinion, a total of five reform measures were proposed, the second of which was "improving the accounting of individual accounts".
    : CCTV video screenshot This is the first major nationwide reform of the employee health insurance personal account in the 22 years since the establishment of the employee health insurance system.
    was a controversial event that had been publicity in advance.
    on reforming personal accounts dates back to 2011, and the strongest voice is the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Health Care System, issued in February 2020.
    In the highest-level programmatic document, which is supposed to set the tone for China's health care reform in the next decade,
    has proposed gradually including outpatient medical expenses in the scope of payment of the Medicare Co-ordination Fund, reforming individual accounts, and establishing and improving the "outpatient mutual assistance guarantee mechanism".
    And in an earlier Xinhua article, the proposed path is the same as the current draft for comments: operationally can first gradually reduce the proportion of unit allocation, the use of reduced money into personal accounts to establish outpatient co-ordination, the function of personal accounts to protect minor illnesses by the co-ordination fund ... After the draft was released, most experts expressed support.
    of the main arguments of the current personal account is that a large amount of money "can not be used on the account", the cumulative balance of personal accounts more than 800 billion yuan.
    on the one hand, the personal accounts of middle-aged and well-off insured persons are deposited with large amounts of money, which breeds waste and fraudulent insurance, and on the other hand, the personal accounts of retirees and chronically ill persons are inadequate and cash is required to be paid when seeking medical treatment.
    a free-for-all system can solve this problem to some extent.
    And on the Internet, people's confusion, confusion and even opposition to the spread of the general, one of the core points is that the funds allocated to the personal account of health insurance will be reduced by about half, does this mean that the insured person's money is less, the interests are damaged? Seems to be based on the protection of the interests of the insured, why draw the opposite conclusions and attitudes? Source: Whose money is in the personal account for CCTV video screenshots? The medical insurance fee paid by each employee can be divided into two parts: 2% of the salary base paid by individuals, and the proportion of unit contribution varies from place to place, with 6% and 8% in Shanghai and 9.5% in Shanghai.
    The whereing of the medical insurance fee is also divided into two parts: the co-ordination account and the individual account, of which 2% of the individual contribution part is all into the individual account, 30% of the unit contribution part also goes into the individual account, and the other 70% goes into the co-ordination account.
    the average employee's personal account would be paid 3.8 per cent, based on a 6 per cent contribution.
    different ways of use, in general, the co-ordination account for hospitalization, personal account for outpatient.
    in general, the money in a personal account is used at the disposal of the individual, mainly for outpatient visits or for drugstores.
    According to the reform plan of the National Health Insurance Administration, the distribution of medical insurance premiums will change in the future, the portion paid by individuals will remain unchanged into individual accounts, and all unit contributions will be included in the co-ordination fund, that is, the original 30% of the individual accounts, will change where they go.
    example, suppose someone's monthly salary is 10,000 yuan, and his personal health insurance account would have been deposited at $380 a month.
    reform, his personal account will only be deposited at $200 a month, and another $180 will be included in the co-ordination fund.
    the intuitive feeling that individuals have less money and that new reforms are hurting the interests of the insured.
    however, Wang Zhen, a researcher at the Institute of Economics of the Chinese Academy of Social Sciences, believes that under current law, personal account funds are used by individuals, but the nature is still a health insurance fund, earmarked for funds, and this opinion expands the use of personal accounts (e.g., general outpatient expenses can be reimbursed, the scope of payment from I to spouses, children, parents).
    ", the reason for the establishment of outpatient co-ordination will 'damage' the rights and interests of the insured, is actually a misreading of the personal account fund attributes.
    Gu Xuefei, director of the Medical Security Research Office of the National Health and Health Development Research Center, said, "We do not participate in insurance, not to have to use money back, this is a mutual help mechanism, the essence is healthy people to help the unhealthy, young people to help the elderly."
    (where young people now use less) wait for us to get older and use more."
    so, if simplified, the starting point is to protect the interests of the two parties, the conflict lies in: the money in the personal account, is it essentially insurance, or saving? If you can't use it now, should it be left to the sick or old in the future, or should you help those who need it now, and get help from others when you need it in the future? The reform of the health insurance account directly involves 3.3 people, source: CCTV video screenshots of the establishment of personal accounts what is the original intention? The introduction of personal accounts into the health insurance system was primarily influenced by specific eras.
    In the mid-to-late 1980s, labor insurance and public health care funds gradually out of reach, "big pot rice"-style free health insurance system is unsustainable, coupled with the market economy advocated by the "efficiency first, taking into account fairness" reform orientation, so that the reduction of welfare and strengthen personal responsibility into the mainstream, workers' welfare from the enterprise to the state, enterprises, individuals to assume the three-way joint responsibility.
    -paying health insurance system on the stage of history.
    from "reaching out" to "taking your own part" takes time, so the practice that became popular in Chile early on - setting up personal accounts - became an important choice for system designers.
    the original intention was to clarify an individual's responsibilities in health insurance, an account with money similar to compulsory savings but only used to buy health care and privatized.
    do you encourage people to pay? The workable strategy is to have all the fees paid by the individual counted in the individual account, and a portion of the unit contribution is credited to the individual account, so that at least it seems that the insured person has not been harmed by the reform.
    reform has been brewing for a long time, in 1994 the two river pilot (Jiangsu Zhenjiang, Jiangxi Jiujiang) for the first time to practice personal accounts.
    1998, the State Council issued the Decision on the Establishment of a Basic Medical Insurance System for Urban Workers, which formally established the basic medical insurance system for the combination of joint contributions by units and individuals, social co-ordination and individual accounts.
    payment methods, Zhenjiang, Jiujiang as the representative of the "channel" and Hainan as the representative of the "plate" is the most typical.
    "channel" is the individual account can be used for outpatient or to pay hospital expenses, "plate" is the individual account and co-ordination account payment range separate, in which the co-ordination account is used to pay for hospitalization costs, the individual account to pay outpatient expenses.
    from now on, channel-type disadvantages are smaller, because general outpatient and in-patient treatment are co-ordinated reimbursement, the insured will not be tilted towards hospitalization.
    why did plate payments become mainstream at the time? This is mainly because there is less pressure on managers to pay in sectors.
    time, network information and regulatory technology is not developed, outpatient treatment although each cost is low, but the frequency is high, supervision is much more difficult than inpatient treatment.
    and general out-patient treatment does not use the co-ordination fund, when the cost is paid for by themselves, individuals will measure the level of expenditure, there is no need for excessive supervision.
    unexpected, plate-type payment methods for the future high hospitalization rate and co-ordination fund through the bottom buried hidden dangers.
    managers ignore the most important point, human nature.
    From the era of eating pot rice to the era of payment, people often remember to use the "money in the pot", outpatient self-funded personal account money, equivalent to spending their own savings of money, and hospitalization can be reimbursed.
    is this a phenomenon? Hospitalization rates have been rising year after year (see the eight-point report "Why do Chinese love hospitalization?) ), the pot of money is not enough, most of the co-ordination area of the money can not be paid, but the personal account of the money has been rising year after year, many people almost do not use.
    fund's co-ordination function is about to fail.
    example, in 2013, China's 225 regions of the workers' health insurance co-ordination fund overdraft, of which 22 regions spent accumulated balance, but during the same period, the total amount of workers' personal account funds in these 225 regions reached 332.3 billion yuan.
    , the more than $800 billion left in individual accounts have not been well utilized.
    have limited access to the personal accounts of healthy people, they may be thinking about how to use up their money and cash it out.
    the era of strict supervision of health insurance funds, it is not uncommon to go to health insurance fixed-point pharmacies to buy daily necessities, home appliances, health care products and so on.
    the sick and the elderly are often inadequate.
    the use of personal accounts and the original design of the opposite, gradually moving away.
    : CCTV video screenshots of attempts at personal account reform around the issue of personal account retention, around 2011 there has been a debate.
    although there is no direct causal relationship with the Social Security Act of 2010, it can be seen that the Act does not mention the health insurance personal account.
    there was speculation that experts had suggested that they wanted to cancel their personal accounts.
    Over the years, reform ideas for individual accounts have been emerging, with radical proposals for the direct cancellation of individual accounts and a detente that individual accounts can not be cancelled, but individual accounts should be activized to find ways to expand the use of personal accounts or change the funding model.
    how to expand the use of personal accounts, experts suggest that there are about three types of advice, and there have been attempts everywhere: 1, to extend personal accounts to the family, to improve the role of personal accounts to help each other.
    such as Zhejiang, if there is a balance in an individual account, it can be used by immediate family members to purchase basic medical insurance for employees, or it can be used by one or more close relatives.
    2, put personal accounts into the health prevention link, used to prevent disease and exercise.
    , such as Suzhou, the insured person's personal account balance has reached the required standards, used to designate a number of fitness programs in the gym.
    3, the balance of the personal account to buy commercial supplementary insurance, improve the personal account's ability to resist risks.
    such as Shanghai, according to the voluntary principle, the insured person can purchase for himself the CIRC, the municipal government unified medical insurance exclusive products.
    other places to start exploring services such as allowing individual accounts to buy vaccines.
    if we summarize the commonality of these explorations, it is mainly aimed at healthy people.
    At the same time, co-ordinated district management needs to spend more time considering and deciding what health-related consumption individual accounts can be used for, and which businesses and products can be targeted for service providers, resulting in higher management costs.
    , no place has dared to try radical measures so far: canceling individual accounts, because of the resistance.
    What is troubling to some reformers is that even if the above-mentioned attempts to insulish the funds in the personal accounts, but can not solve the fundamental problem, if the general outpatient payments do not achieve co-ordination, still only use the personal account payments, people still tend to hospital reimbursement to solve the problem, the co-ordination fund will become a rice-free cooking woman.
    , there have been areas overwhelmed, and even misappropriated personal accounts of money to advance the co-ordination fund hole, sooner or later the conflict will break out.
    , Shanghai, Guangzhou and Shenzhen began to try out the staff medical insurance outpatient co-ordination.
    Only slightly different, Guangzhou and Shenzhen outpatient co-ordination reimbursement no starting line, Shenzhen reimbursement ratio is 30%, Guangzhou slightly higher is 45%-80%, but there is a reimbursement limit, each person limit is 300 yuan a month.
    Although Beijing and Shanghai have a starting line, 1800 yuan and 1500 yuan, respectively, but the reimbursement ratio and reimbursement quota are very high, Beijing reimbursement ratio in 70%-90%, reimbursement limit is 20,000 / year, Shanghai reimbursement ratio in 50%-75%, there is no limit.
    the purpose of setting up reimbursement starting line is to guide the correct medical treatment, reduce the unreasonable expenses of the clinic, after all, to be reimbursed, you have to pay a higher amount of money.
    , Shenzhen and Guangzhou have not only achieved co-ordinated outpatient reimbursements, but have also begun to experiment with the practice of sharing health insurance personal accounts with families.
    , the balance of the personal account of health insurance more than 5,585 yuan, can be used to buy medicine for the family to see a doctor.
    in Guangzhou, no matter how much the balance of the personal account of health insurance, can give the family to see a doctor to buy medicine.
    Chengdu, although not to achieve outpatient co-ordination, but can also be shared by families, but also to use their own personal account money to pay residents health insurance.
    A pre-announced controversy over the NSA's plan appears to have raised previous explorations to the national strategy, adopting a non-radical approach: not moving money already in an individual's account, while expanding the use of funds in an individual account, reimbursable general outpatient fees, and shifting personal accounts from personal use-only to family sharing.
    50 per cent reimbursement for general out-patient care, appropriately tilted toward retirees, many of them elderly, who would benefit from the reforms because of the high demand for outpatient care.
    but the earliest version of this changed plan was a radical one: the cancellation of personal accounts.
    their idea is to increase the proportion of general outpatient reimbursements to the same level as inpatient reimbursements after the cancellation of individual accounts.
    The ideal model, discarding the much-spitting plate-type payment, regardless of inpatient and outpatient, are reimbursed in the same proportion, this time when the insured choose, will not consider which side of the reimbursement ratio is high, which side tilted to choose.
    is not unreasonable to suggest such a proposal.
    trend of medical development is that surgical outpatientization, surgery minimally invased, not inpatient or outpatient scenarios can be defined.
    further, in the age of chronic disease, many diseases require health management, both in and out of the hospital, online and offline. <
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