Ministry of human resources and social security of the people's Republic of China

Source: according to the data released by the Ministry of human resources and social security on June 19, 2017 in the economic reference newspaper, by the end of 2016, the individual account of basic medical insurance for urban employees in China had accumulated 520 billion yuan, double that of four years ago Some experts believe that the large amount of capital precipitation reflects the low efficiency of fund operation, and suggest to expand the reasonable payment scope of individual account, and gradually reduce or even cancel the funds transferred from unit payment into individual account According to the 2016 statistical bulletin of human resources and social security development, the total income of urban basic medical insurance fund in 2016 was 1308.4 billion yuan, and the expenditure was 1076.7 billion yuan At the end of the year, the total balance of urban basic medical insurance co-ordination fund was 976.5 billion yuan (including the total balance of urban residents' basic medical insurance fund was 1993 billion yuan), and the individual account was 520 billion yuan By the end of 2012, personal accounts had accumulated 269.7 billion yuan This also shows that the individual account balance of medical insurance has doubled in four years The medical insurance for urban employees in China adopts the mode of "combination of unified account" which is composed of social overall account and individual account According to the policy determined in 1998, the unit pays about 6% of the salary, 30% of which is transferred into the individual account, and the individual pays 2% of the salary, all of which are included in the individual account From the perspective of local practice, individual accounts are generally closed management, which is used to pay for outpatient expenses, drug purchase in drugstores and other expenses below the starting line, while medical insurance co-ordination fund is used to pay for hospitalization expenses "On the one hand is the overall fund facing the risk of underperforming, on the other hand is a large number of" sleeping "individual account surplus funds, which restricts the healthy and sustainable development of the medical insurance system for urban employees." Some experts have pointed out that the large amount of capital precipitation also reflects the low efficiency of capital utilization At the same time, the situation of social pooling account is not optimistic, and some areas have seen the current deficit In fact, due to the restriction of the scope of use, some insured employees' personal account funds have been deposited for a long time, which has derived the demand of using personal account to purchase non drugs or even cash out, while some retail pharmacies and other designated medical insurance institutions actively cater to it, providing convenience for cash out, and even forming a cash out interest chain of medical insurance card According to the special audit results of medical insurance fund disclosed by the audit office from 2015 to the first half of 2016, 140 million yuan of medical insurance personal account funds were withdrawn in cash or used to purchase daily necessities and other expenditures, involving 539 pharmacies In order to solve this problem, some areas have implemented measures such as family sharing of personal account funds, purchase of commercial health insurance products, even allowing the use of personal account funds for physical examination, purchase of health cards and swimming cards The local policies and management of individual accounts of medical insurance have been in disorder "From the original intention of policy design, individual account has the function of fee control and accumulation Due to the imperfection of personal account regulations in some areas, there are some phenomena such as spending personal account funds and purchasing daily necessities with personal account funds There are also some people who have accumulated more personal accounts, others who have insufficient funds in their personal accounts " Chu Fuling, director of the social security research center of the Central University of Finance and economics, told the economic reference Based on the analysis of the fairness and efficiency of personal account, the dispute of saving or abolishing personal account has been launched in the society Some experts believe that there are defects in the system of personal account, which does not have the function of risk dispersion, and its fairness and efficiency are questionable At the same time, the cost of supervision is high, the accumulation of idle funds and hidden losses are relatively high, so the personal account should be diluted and cancelled Some experts also believe that although the local policies and management of personal accounts of medical insurance have been in disorder, there is still a need for personal accounts Professor Yang Yansui of the employment and social security research center of the school of public management of Tsinghua University, in an interview with the reporter of the economic reference newspaper, said that we should expand the reasonable payment range of personal accounts, gradually reduce or even cancel the funds transferred from unit contributions to personal accounts, and increase about 2% of the total contributions to social pooling funds, so as to increase the payment capacity of social pooling funds 。 She suggested that the policy of recording individual contributions into individual accounts should be maintained, and the scope of payment should be clearly defined according to law, especially for the payment of outpatient services and chronic disease management services of family doctors, or for long-term care insurance Chu also suggested that measures should be taken to regulate the use of personal accounts and realize the sharing of personal account funds among families "China's medical insurance system came from pay as you go At that time, the outpatient or inpatient expenses were reimbursed for a certain proportion, resulting in a sharp increase in outpatient expenses Since then, most areas only reimbursed hospital expenses, resulting in a sharp rise in the rate of hospitalization and the overall rise in medical expenses Therefore, the system of individual account management outpatient service and overall fund management inpatient service has been established " Chu Fuling believes that if the cancellation of personal accounts is actually a historical return, outpatient costs will rise sharply He suggested to establish a unified large-scale outpatient co-ordination, such as in Beijing, when the outpatient service exceeds a certain amount, reimbursement of a certain proportion, so as to alleviate the risk of serious illness outpatient service At the same time, it is suggested to open the personal account (directly transfer the personal account to the individual), and the general outpatient personal account should pay by itself "In this way, it can not only reduce the cost of account management, but also control the outpatient expenses and share the risk of large amount of outpatient expenses, which is a reform road worth exploring." He said.