The proposal of gradual reform of the medical insurance outpatient co-ordination of workers.

Introduction: 7 recommendations to see through the staff medical insurance outpatient co-ordination reform.
. The State Administration of Health Insurance has issued the Guidance on establishing and improving the mechanism for the protection of basic medical insurance outpatient co-care for workers (draft for comments), and has widely solicited social advice and opinions, and has also participated in it.
01 before some experts recommended the complete cancellation of personal accounts caused greater controversy, although the draft for comments retained individual accounts, but the unit to pay part of the full integration of co-ordination funds will still cause controversy.
will lead to the reduction of accounts usually do not see a doctor young people because they do not see a doctor and save money and accounts to receive state subsidies, usually do not see the elderly into medical institutions, increase the consumption and waste of health care funds.
proposed to gradually adjust, first the unit contribution into the individual account part of 30% into the overall, combined with the local outpatient reimbursement program and medical insurance fund status to examine the effectiveness of further exploration.
02 different basic situation, should not be one-size-fits-all.
The draft shall not be used for non-essential medical expenses such as public health services, sports and fitness, and it is recommended that, in the light of local conditions, conditional areas may be used for the purchase of health insurance, fitness, medical examination and vaccination, Internet medical treatment and other expenses for myself and close relatives.
early detection of major diseases and the spread of health education can effectively reduce future medical expenses.
03 At present, outpatient co-ordination has been implemented in some areas, payment standards are high and low, but it does not involve the reduction of the proportion of individual accounts, it is recommended to conduct full research and summary in the areas where it has been carried out, to understand whether the overall situation of the outpatient co-ordination of the health insurance fund is due to the increase in outpatient reimbursement and tightening, or because of the decline in hospital reimbursement to get a balance or balance.
the various situations and problems a arise in the co-ordination of out-patient clinics, according to the situation in various places to effectively explore and then further implement.
accounts in the draft can be used for immediate family members to expand the scope of the proposal to include at least close relatives, including siblings.
in real life, many long-term patients, seriously ill patients have been abandoned by their spouses, children, parents have been old or have died, can only rely on the native family brothers and sisters to help.
05 graded diagnosis and treatment can only be effectively implemented on the basis of the real improvement of the primary medical level, it is not recommended to directly take the elimination of large hospital outpatient clinics, the three-a-side outpatient expenses are not reimbursed less reimbursement and other extreme ways to avoid misdiagnosis, missed diagnosis, referral to bring more consumption of medical insurance resources.
while deversing accounts sharply and not reporting underreliars, the reform should improve public satisfaction while taking into account the balance of health insurance funds as a starting point, and the deficit should not be transferred to the public.
2006 National Workers' Health Insurance covers 329 million people in 2019, while China's population over 60 years of age has exceeded 249 million in 2018, with the arrival of an aging society, the pressure of health insurance funds has increased sharply.
if all young people do not seek medical treatment, save money to the elderly, the above scenario can be realized.
Outpatient co-ordination after the first reduction may be the pharmacy slow disease or more expensive medication, but once released after the increase in inspection costs will be considerable, less than a few hundred, more than a thousand, whether the real open source savings need to be actually demonstrated.
07 involving the country's adjustment program needs to be more complete, more rigorous, pull a hair and move the whole body.
In the overall decline in drug prices, and even the emergence of a surprising capsule drug bid price of less than 0.11 cents (hollow capsule costs will not be so low), and the cost of medicine has not been reduced or even lower, more effective combing the reasons, improve the details, carefully implemented to ensure the final results, to achieve multi-win.
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