How will the medical insurance system for urban and rural residents be perfected? The National Health Insurance Administration has made it clear that

The 19th National Congress of the Communist Party of China proposed to "improve the unified basic medical insurance system for urban and rural residents and the insurance system for major diseases".
After the establishment of the National Health Insurance Administration, this work accelerated on the basis of the original, 2018 and 2019 residents' health insurance policy documents for urban and rural residents' health insurance and major disease insurance system construction has put forward clear work requirements, the two systems have basically achieved a comprehensive and integrated management.
, what has the National Health Insurance Administration done to establish a unified health insurance system for urban and rural residents, and what is the next direction of reform? This work was comprehensively combed in the "Response of the State Health Insurance Administration to Recommendation No. 6358 of the Third Session of the 13th National People's Congress" issued by the State Health Insurance Administration on October 27.
(1) The establishment of a unified medical insurance system for urban and rural residents has basically achieved that the state attaches great importance to the integration of the medical insurance system for urban and rural residents, and the State Council has issued the Opinions on the Integration of the Basic Medical Insurance System for Urban and Rural Residents (Guofa (2016) No. 3), deploying and guiding local integration of basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) and a new type of rural cooperative medical insurance (hereinafter referred to as the new agricultural joint) system, and establishing a unified basic medical insurance system for urban and rural residents.
provinces (districts, cities, including military corps) combined with their own reality, in accordance with the requirements of the state to vigorously promote the implementation of the work.
the end of 2019, all 32 provinces in the country have fully established a unified basic medical insurance system for urban and rural residents in accordance with the requirements of the state.
can be said that China has basically achieved the establishment of a unified medical insurance system for urban and rural residents.
In practice, various places in accordance with the "fund-raising is not high, treatment is not high, catalog is not narrow" principle to promote integration, to achieve urban and rural residents in the coverage, financing policy, coverage, medical insurance directory, fixed-point management, fund management on the unity, and synchronous integration of the operation of services and information systems.
While integrating the basic medical insurance system for urban and rural residents, the local government has also simultaneously integrated the insurance for urban and rural residents for major diseases, and gradually transitioned the disease-based protection implemented by the former new agricultural co-production to cost-based insurance, in accordance with the requirements of the State Council, expanding the benefits.
, the proportion of hospital expenses paid within the policy of medical insurance for urban and rural residents has reached about 70%, the starting line for insurance for major diseases has been reduced to 50% of the disposable income per capita in the previous year, and the level of payment within the policy has been raised to 60%.
At the same time, the insurance for the major diseases to the poor to implement the tilt payment policy, the starting line reduced by 50%, the proportion of payment increased by 5 percentage points, the complete abolition of the file card for the poor people of the big disease insurance cap line, and further reduce the medical burden of the sick, the difficult masses.
Overall, the integration of urban residents' medical insurance and the new agricultural integration system has solved the problems of uneven treatment resulting from the division of urban and rural areas, weak ability of funds to help each other, and the level of utilization and security of medical services for rural residents has generally improved.
The integrated medical insurance system for urban and rural residents has played a major role in ensuring the fight against poverty through medical insurance, strongly supporting the fight against poverty, and achieving the reform objectives of more equitable enjoyment of health care rights and interests by urban and rural residents, promotion of social equity and justice, and promotion of people's well-being.
(2) The relative weakness of the medical insurance team at the township level still exists in the new round of institutional reform in the country, the State Health Insurance Administration was officially established in 2018, and the institutional reform of the local health care sector has been followed up simultaneously.
, 32 provincial health insurance bureaus have been set up, and the municipal, district and county health insurance bureaus have been basically set up and completed, achieving up-down correspondence.
local medical security departments have unified their responsibilities and authority through the special establishment of medical security administrative organs and institutions, strengthened their management functions, improved their coordination capabilities, improved their team building, and achieved remarkable results in institutional reform.
, but at the same time, we see that the relative weakness of the health care workforce at the township level does exist.
In practice, local institutions at the township level set up generally co-ordination agencies to prepare resources, by a grass-roots institutions to undertake the tasks of multiple higher-level institutions, township level generally did not set up a special medical insurance agencies, relying on township government centers, service centers and other institutions to set up health insurance service windows and service posts, or rely on township social security institutions and health hospitals to work, some places also actively explore arrangements for special posts to do a good job of health insurance management services.
year, the State Council of the CPC Central Committee on deepening the reform of the medical security system put forward the task of exploring and promoting vertical management of medical security departments below the municipal level.
next step, the State Health Insurance Administration will work with relevant departments to guide the local government in the process of exploring practice, research and strengthen the construction of township medical security team, promote the sinking of services, more convenient for the masses.
(iii) will further explore the improvement of the dynamic adjustment mechanism of urban and rural residents' medical insurance financing stable and sustainable financing mechanism is an important guarantee for the long-term stable operation of the medical insurance system.
in order to encourage residents to participate in insurance, urban and rural residents' health insurance (including the integration of urban residents' health insurance and new agricultural integration) has been established since the beginning of the establishment of financial assistance and individual contributions combined financing methods.
Governments at all levels, while granting universal insurance contribution subsidies to residents' medical insurance insured persons, also provide subsidies for individual contributions to the difficult groups in accordance with the provisions through the policy of medical assistance to ensure that they are guaranteed full coverage.
Residents' medical insurance to implement fixed fund-raising, dynamic adjustment of fund-raising standards according to the annual adjustment of fund-raising standards, since the establishment of the system, the state has steadily increased financial input, year by year to increase the standard of financial assistance, individual contributions increased simultaneously, from 2003 to 2019, the standard of financial assistance from 10 yuan per person per year to 520 yuan, the guidance standard for individual contributions from 10 yuan per person per year to 250 yuan.
, the increase in government investment is much larger than individual contributions and is the most important source of residents' health insurance funds.
The background of the increasing level of financing is the rapid progress of medical technology, the continuous growth of medical expenses, the gradual release of residents' medical needs and the steady improvement of the level of treatment, and the corresponding reasonable increase in the standard of medical insurance financing for urban and rural residents to support the long-term and stable development of the expenditure and institutional function of the medical insurance treatment of insured persons.
the fund-raising standards are regularly increased, mainly to improve the level of treatment of the insured people.
, the proportion of hospital expenses paid within the scope of residents' medical insurance policy has reached about 70%, which is twice the level of protection at the beginning of the establishment of the new agricultural co-construction.
To carry out outpatient co-ordination in general, and to arrange special safeguards for outpatient medical expenses for some chronic diseases and special diseases with long duration and high medical expenses, and in 2019 establish a drug protection mechanism for high blood pressure and diabetes outpatient care for urban and rural residents, so as to further reduce the burden of outpatient clinics for the masses.
basis, the comprehensive implementation of residents' major illness insurance, the high medical costs of patients with major diseases on the basis of basic medical insurance increased by about 13 percentage points, in 2019 further improved the level of treatment of major diseases insurance.
from the point of view of institutional practice, the current financing methods and methods have played a positive role in promoting the participation of urban and rural residents in insurance and rapidly expanding coverage, and provided strong support for enhancing the awareness of urban and rural residents participating in insurance, consolidating and improving the medical insurance of residents and improving the level of security.
However, since residents' medical insurance has not yet established a mechanism to link individual financing with residents' income growth, the standards under the current financing mechanism are increased every year, and the grass-roots level has reflected the difficulty of organizing insurance contributions.
, the State Health Insurance Administration will work with relevant departments to improve the dynamic adjustment mechanism of urban and rural residents' medical insurance financing.