The proportion of medical insurance outpatient expenses to be included in the reimbursement shall start from 50%.

Medicine Network August 27 According to the website of the State Health Insurance Administration, August 26, the State Health Insurance Administration issued "on the establishment and improvement of basic medical insurance outpatient co-care guarantee mechanism guidance (draft for comments)", public consultation.
opinions proposed to provide that the general outpatient co-ordination covers all staff medical insurance insured personnel, the proportion of payment from 50%.
opinion pointed out that the function of enhancing out-patient co-care protection should be enhanced.
to establish and improve the general out-patient medical expenses co-ordination guarantee mechanism, starting with high blood pressure, diabetes and other people's heavy burden of outpatient chronic diseases, and gradually the incidence of frequent, common diseases of general out-patient medical expenses into the scope of co-ordination fund payment.
general outpatient co-ordination covers all employees of health insurance insured personnel, the proportion of payment from 50%, with the fund to enhance the affordability of gradually improve the level of protection, treatment payment can be appropriately tilted towards retirees.
for the characteristics of outpatient medical services, scientific measurement of the starting standard and maximum payment limit, and do a good job with the hospital payment policy.
According to the fund's affordability, localities can explore the gradual expansion of the scope of outpatient chronic diseases paid for by the co-ordination fund, and include some of the outpatient chronic diseases and special diseases with long treatment cycles, great health damage and heavy economic burden into the scope of payment of the co-ordination fund.
of special treatment that needs to be carried out in outpatient clinics and is more economical than inpatient treatment can be managed by reference to inpatient treatment.
with the gradual improvement of the outpatient co-care guarantee mechanism, explore the transition from disease protection to cost protection.
request to improve the way individual accounts are credited.
Scientifically and reasonably determine the method and level of accounting for individual accounts, the basic medical insurance premiums paid by individual employees shall be included, the standard shall be controlled in principle within 2% of the contribution base of my participation in insurance, and all the basic medical insurance fees paid by the unit shall be included in the co-ordination fund;
individual accounts are specifically to the proportion or standard, the provincial health insurance departments in accordance with the above principles, guide the overall planning of the region combined with local reality, the overall study to determine.
to reduce the amount of funds allocated to individual accounts after adjusting the overall account structure is mainly used to support the sound protection of outpatient assistance and improve the treatment of outpatients.
opinions and regulate the scope of use of individual accounts.
accounts are mainly used to pay out-of-pocket expenses of insured employees within the policy of a fixed-point medical institution or a fixed-point retail pharmacy.
may be used to cover the medical expenses borne by individuals in medical institutions designated for medical insurance for employees themselves and their spouses, parents and children, as well as the expenses borne by individuals in the purchase of medicines and medical supplies at designated retail pharmacies.
to explore individual contributions for spouses, parents and children to participate in basic medical insurance for urban and rural residents.
personal account shall not be used for other expenses such as public health expenses, sports fitness or health care consumption that are not covered by basic medical insurance.
improve and improve the use of personal account management methods, do a good job of income and expenditure information statistics.
, strengthen supervision and management.
improve management service measures, innovate the operating mechanism of the system, guide the rational utilization of medical resources, and ensure the stable operation of the medical insurance fund and the effect of system guarantee.
strict implementation of the fund budget management system, strengthen the fund audit system, internal control of the construction.
establish a dynamic management mechanism for the whole process of individual accounts, strengthen the use of personal accounts, settlement and other aspects of the audit.
strengthen the supervision of outpatient medical behavior and medical expenses, establish a fund security prevention and control mechanism, crack down on fraud and insurance fraud, and ensure the safe, efficient and rational use of the fund.
innovative management methods for outpatient medical services, improve the monitoring, analysis and assessment system of medical services, and guide medical institutions to control the cost of medical services.
to speed up the construction of information technology in accordance with the requirements of the construction of a unified medical insurance information platform, and explore the way to realize the settlement of outpatient medical treatment in different places.
to promote the construction of primary health care system, improve the family doctor contract service, long-term prescription system, etc., to guide the insured personnel to seek medical treatment at the grass-roots level for the first time.
improve the management measures of outpatient chronic diseases and special diseases, and standardize the diagnosis and treatment and referral of primary medical institutions.
also pointed out that the improvement of the characteristics of outpatient care payment mechanism.
Primary health care services can be paid per head, actively explore the combination of pay-per-head and chronic disease management, day surgery and eligible outpatient special diseases, the implementation of by disease and disease diagnosis-related sub-groups, not suitable for packaging and payment of outpatient fees, can be paid by project.
to speed up the development of medical insurance drug payment standards, to guide medical institutions and patients to take the initiative to use the efficacy of accurate, affordable drugs.
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