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    Home > Medical News > Latest Medical News > The reform of the personal account of workers' medical insurance "breaks the ice" and solicits opinions from the whole society.

    The reform of the personal account of workers' medical insurance "breaks the ice" and solicits opinions from the whole society.

    • Last Update: 2020-09-27
    • Source: Internet
    • Author: User
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    Medicine Network August 27 - The State Health Security Administration on the official website issued on the 26th "on the establishment and improvement of basic medical insurance outpatient co-assistance guarantee mechanism guidance (draft for comments)", on the improvement of staff medical insurance outpatient co-assistance protection, reform of personal accounts to the whole society for public consultation.
    system of medical insurance for employees with a history of more than 20 years, and implements a system model of combining funds and individual accounts.
    , the number of employees insured in China's health insurance is about 329 million, and the cumulative balance of the personal accounts of workers' health insurance is 827.6 billion yuan.
    personal accounts have played an important role in the reform of the employee health insurance system, but over time, it is the "hard bone" that must be chewed down in the new round of medical insurance reform, because the disadvantages of inadequate outpatient protection for insured persons and inadequate function of co-insurance protection are gradually emerging.
    according to the draft, the key point of the reform of the individual account of the employee's medical insurance is that the personal account of the employee's medical insurance is still retained, but the function of outpatient co-payment is enhanced.
    This includes three core initiatives: first, to establish and improve the general outpatient medical expenses co-payment guarantee mechanism, such as the general outpatient co-ordination coverage of all staff health insurance participants, the proportion of payment from 50%, etc., will gradually expand the scope of outpatient chronic diseases paid for by the co-ordination fund; The medical insurance department guides and coordinates the region to be determined in the light of local reality, and the third is to regulate the scope of use of individual accounts, expand the scope of payment from the insured person himself to the employee himself and his spouse, parents and children, expand the scope of payment to the medical expenses borne by the individual for medical treatment in the designated medical institutions of medical insurance, and the expenses of the individual to purchase medicines and medical supplies in the fixed-point retail pharmacies, and explore the expenses to be used to pay for the personal contributions of spouses, children, parents to participate in resident health insurance and so on.
    reform is also the implementation of the CPC Central Committee, the State Council on deepening the reform of the health care system.
    as a platform document for a new round of medical insurance reform, the opinions put forward that outpatient medical expenses should be gradually included in the scope of payment of the basic medical insurance co-ordination fund, the individual accounts of basic medical insurance for workers should be reformed, and the mechanism of outpatient mutual assistance should be established and improved.
    health care experts pointed out that according to the draft reflected in the reform ideas, the reform of the individual accounts of workers' health insurance remains unchanged, the current period of new money into the personal accounts will be "reduced", but the "decrease" part is actually translated into strengthening outpatient protection.
    fact, due to the increase in the level of reimbursement of outpatient medical expenses, the scope of use of individual accounts is broadened, the overall level of coverage of insured persons is improved, the efficiency of the use of health insurance funds will be further improved.
    , Beijing, Shanghai, Zhejiang, Guangzhou, Qingdao, Xiamen and other places have carried out the reform of individual accounts of workers' health insurance and outpatient expenses to coordinate the exploration.
    Wang Zongfan, a researcher at the China Academy of Labor and Social Security Sciences, said that the process of establishing and improving the co-ordination of medical insurance clinics for workers will gradually promote the targeted medical treatment of insured persons in primary medical institutions, pay-per-head, etc., which will help to motivate primary doctors at the source and promote the development of primary health care and chronic disease management.
    in that sense, the reform is not only about providing better and fairer outpatient coverage, but also about health insurance for health management.
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