Health insurance off-the-go settlement must balance interests

The latest data released by the National Health Insurance Administration on September 4th showed that by the end of July, the number of designated medical institutions in different provinces had broken 10,000, an increase of 443 from the end of last month. Previously, the relevant person in charge of the State Health Insurance Administration has said that the State Health Insurance Administration will promote the basic medical insurance cross-provincial hospitalization costs direct settlement work, accelerate the realization of migrant workers and foreign employment entrepreneurs full coverage, while accelerating the expansion of targeted medical institutions coverage.
present, China's basic medical insurance co-ordination level is low, mostly at the county and municipal level as the co-ordination unit, it is difficult to achieve off-the-go network settlement. If the health insurance platforms of these pilot provinces can be interconnected, when the conditions are ripe, simply connect the provincial health insurance information platforms with the national health insurance information platforms, and immediate reimbursement for cross-provincial medical treatment will be technically feasible. However, it needs to be clarified that cross-provincial reimbursement of medical insurance has not progressed very fast in recent years, technical reasons are not the main constraints, interregional interests are difficult to co-ordinate is the most difficult to overcome. On the one hand, the level of medical insurance contributions and the treatment of medical insurance in different regions are uneven, which makes the current medical insurance system in a fragmented pattern, on the other hand, to promote the reform of immediate settlement of medical treatment in different places, the essence is to reshuffle the interests of various regions, which is directly related to the balance of health insurance funds between the inflow and outflow of people, inevitably encounter resistance.
there is an image of the analogy, insured residents in the local medical treatment, money is "from left to right pocket", and cross-provincial medical treatment is "put money in other people's pockets." Usually, the economically developed areas of health insurance contribution base is high, the return rate is also high, off-site medical reimbursement will make the developed regions feel that they are "spending money to buy losses." Therefore, to promote medical reform measures for medical treatment reimbursement in different places, on the one hand, to improve the level of medical insurance co-ordination, first to achieve provincial co-ordination, and then gradually achieve national unity, and finally break the localized management pattern of the medical insurance system. Only by managing the National Health Insurance Fund in an integrated way can we balance the health care gap in various regions by means of transfer payments. On the other hand, behind the cross-provincial settlement of medical treatment is also hidden the unfair demand of the multi-track system of health insurance. Public-cost medical care, urban workers' medical insurance, urban residents' medical insurance, new agricultural health insurance system and other health insurance system into a unified medical insurance system, will still be a long-term gradual process.
still a long way to go to break the fragmentation of the health care system, which requires that the overall reform aimed at balancing regional interests be put on the agenda as soon as possible. (Health News)