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

Text . . Lin Ling State Health Insurance Bureau recently promulgated the "guidance on the establishment and improvement of basic medical insurance outpatient co-care guarantee mechanism for workers (draft for comments) ", widely solicited social advice and opinions, and also to participate in this."
1. Some experts suggested that the total cancellation of personal accounts caused greater controversy, although the draft for comments retained individual accounts, but the unit contribution 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.
2. The basic situation is different from place to place and 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 popularization of health education can effectively reduce future medical expenses.
3. At present, outpatient co-ordination has been implemented in some areas, payment standards are high or low, but it does not involve the reduction of the proportion of individual accounts, it is recommended that the first in the areas where full research and summary has been carried out, to understand 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.
4. The individual accounts in the draft for comments could be used for immediate family members to propose an expansion of the scope, at least to 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.
5. Hierarchical diagnosis and treatment can only be effectively carried out on the basis of the real improvement of the primary medical level, and it is not recommended to take the extreme methods of eliminating the outpatient clinic of a large hospital, not reimbursing the expenses of the three-a-side clinic and reducing reimbursement, so as to avoid misdiagnosis, missed diagnosis and 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 not transfer all the deficits to the public.
. The national health insurance for workers will cover 329 million people in 2019, while China's population over 60 years of age will exceed 249 million in 2018, and with the arrival of an aging society, the pressure on 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.
7. The adjustment programme involving the whole country needs to be more complete, more rigorous, and move the whole body.
In the overall decline in drug prices, and even the appearance of a surprising capsule drug bid price of less than 0.11 cents (hollow capsule cost 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 ultimate effectiveness, to achieve more win.