"Outpatient help" reform led to four hot debate: why their own "money" for others to use.

Medicine Network September 9 - Recently, the State Health Insurance Administration on the promotion of outpatient assistance protection, reform of personal accounts of the document draft open to the public for comments.
, many reform measures involving the vital interests of the people have aroused heated discussion in the society.
out-patient help is their own "money" for others to use, is the young people's money for the elderly to use? Will adjusting the use of personal accounts affect the development of retail pharmacies? On these hot issues, the reporter interviewed health care experts and industry insiders.
Seatspot one: whether the reform because the co-ordination fund has no money for the staff medical insurance outpatient co-care reform simply said, that is, the staff health insurance participants' outpatient expenses were previously mainly through the "personal account" way to protect, is now through the "co-payment protection", that is, the overall reimbursement.
that the reform is because the co-ordination fund has no money, so use the money in the personal account to "fill the hole".
, Wang Zhen, a researcher at the Institute of Economics of the Chinese Academy of Social Sciences, said the view was due to the unclear state of income and expenditure of China's workers' health insurance fund.
, China's workers' health insurance co-ordination fund earned 927.9 billion yuan in 2019 and spent 793.9 billion yuan that year.
that is, without the use of accumulated balances, the co-ordination fund can fully achieve the current year's balance of payments.
, the "hole" of the Co-ordination Fund does not hold true.
Wang Zhen said that the way to change the way of outpatient protection to mutual assistance, co-ordination of reimbursement-based model, the main consideration is to improve the efficiency of the use of health insurance funds, so as to improve the level of outpatient treatment of insured people.
Spot 2: Why do you want to move the personal account of the "money" into the overall protection, a clear change is that the original from the co-ordination fund into the individual account part of the funds are no longer included, but remain in the co-ordination fund to help use.
, some view is that "their own money for others, young people's money for the elderly."
need to understand the meaning of "common help" here.
it is the essence of insurance, also known as the "law of large numbers", which means putting everyone's money together and giving it to people who have a risk event (disease) to jointly protect against the risk of disease.
imagine who can help you when people get seriously ill but their personal accounts are underpayed? Who can guarantee that there will be no major illness when you are young, and that the personal account funds accumulated when you are old and sick will certainly be able to afford it? Wang Zhen said, from the point of view of insurance, can not say that they paid the fee but do not use is "loss."
because insurance is about dealing with the risks of uncertainty.
, of course, individuals can use their income and savings to pay for illness, there is no "health insurance" to say.
But whether it is history or reality, what we see is completely dependent on individuals to deal with the risk of disease is not reliable, all have "old and old and old, young and young, and young", only then have "mutual assistance" institutionalized protection.
hot spot three: outpatient co-ordination can really reduce the burden of individuals as insured persons, outpatient medical treatment to be included in the overall protection, the most direct benefit is the treatment improved, the original can not be reimbursed now can be reimbursed.
But there is also a concern that after outpatient co-ordination, some drugs need to be issued to the hospital to be reimbursed, resulting in the original large number of drugstores can solve the problem concentrated in the hospital, increasing the burden of hospitals and personal medical expenses.
Wang Zhen explained, not to say whether the increase in outpatient treatment can offset this so-called "increase in medical costs", from the clinical safety and patient's medical behavior, before the reform should go to the hospital also have to go to the hospital, after the reform should not go to the hospital is not necessary to go.
, the reforms did not cancel personal accounts.
" the original drugs can be purchased in the pharmacy can still be purchased in the pharmacy, the original personal account how to use or how to use.
, the personal burden will not increase.
," Mr Wang said.
: Whether the reform will affect the fixed-point retail pharmacy operating income reform, the use of personal account channels, retail pharmacies accounted for a higher proportion.
view is that the reform will reduce individual accounts, retail pharmacy traffic will be reduced, operating income may decline, and even affect the development of pharmacies.
, an industry analyst said that in 2019, the total income of the personal accounts of workers' health insurance was 584.034 billion yuan, and the expenditure was 472.448 billion yuan.
, the cost of purchasing drugs in pharmacies amounted to 202.942 billion yuan, accounting for 42.96 percent of the total expenditure.
reform, the individual account still has nearly 400 billion yuan of annual income, plus the cumulative balance of 842.6 billion, it should be said that the personal account still has a very large size, enough to meet the needs of insured people in pharmacies to buy drugs.
He said that the further establishment of the outpatient co-ordination system means that the function of chronic disease protection has been strengthened, retail pharmacies as the main sales channel for chronic drugs, the potential market has been further expanded, meaning that a new round of development opportunities for retail pharmacies is coming.
zhejiang provides a good model in this regard.
the reform also proposes to broaden the use of individual accounts from individual-only payments to spouses, children, parents and other family members, from drug-only payments to medical supplies, medical devices, and so on.
" will also further increase the use of personal accounts in pharmacies, making pharmacies more important in terms of out-patient cost protection.
," Wang zhen said.
past, sports fitness, health care products and other products in the pharmacy income accounted for a considerable proportion.
the reform would make it clear that funds in individual accounts could not be used for such non-therapeutic products.
health care management said that the use of health insurance funds is a clear scope of the law, non-therapeutic products should not appear in the scope of payment of health insurance funds, not because of these illegal use of health insurance funds "originally" will continue.
(Reporter Qu Wei)