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    Home > Active Ingredient News > Drugs Articles > The State Council clarified that more outpatient expenses will be included in medical insurance reimbursement during the 3-year transition period

    The State Council clarified that more outpatient expenses will be included in medical insurance reimbursement during the 3-year transition period

    • Last Update: 2021-04-24
    • Source: Internet
    • Author: User
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    Premier Li Keqiang of the State Council presided over an executive meeting of the State Council on April 7.
    The meeting decided to establish and improve the measures to establish and improve the basic medical insurance outpatient mutual aid guarantee mechanism for employees, broaden the scope of the use of personal account funds, and reduce the medical burden of the masses.



    The meeting pointed out that my country's new round of medical reform has established the world's largest basic medical insurance network that benefits more than one billion people, which has played an important role in reducing the burden of medical treatment and alleviating the cost of medical treatment.


    In recent years, outpatient chronic diseases such as hypertension and diabetes involving many patients have been included in medical insurance reimbursement.




    The next step is to deepen the medical reform, strengthen the mutual assistance and mutual assistance function of basic medical insurance for employees, and include more outpatient expenses in medical insurance reimbursement to further reduce the burden on patients.



    The meeting determined that one is to gradually include part of the general outpatient expenses for chronic, frequently-occurring, and common diseases that are harmful to health and burden heavy costs into the overall planning fund.


    Within the scope of the policy, the payment ratio will start from 50%, with an appropriate preference for retirees.
    In the future, the level of protection will be gradually increased as the fund's affordability increases.




    The second is to improve the method for crediting personal accounts.


    The individual contributions of the employees are still included in their personal accounts, and all the unit contributions are included in the pooling fund; the personal accounts of retirees are allocated from the pooling fund at a fixed amount, and the amount of the allocation is gradually adjusted to the average level of the basic pension in the year when the reform was implemented in the pooling area.
    Around 2%.




    The third is to broaden the scope of use of personal accounts and allow family members to help each other, which can be used to pay for medical treatment in designated medical institutions and the purchase of drugs, medical equipment and medical consumables in designated retail pharmacies that are borne by individuals.



    The fourth is to strengthen the supervision and management of the medical insurance fund, improve the audit and internal control systems, seriously investigate and deal with illegal hospitalizations, fraudulent insurance fraud and other violations, and improve the payment mechanism that is compatible with the outpatient mutual aid guarantee.



    The meeting emphasized that the provincial governments can set up a transition period of about three years to gradually achieve the reform goals in an orderly manner.


    The meeting also requested that the outpatient coordination of basic medical insurance for urban and rural residents should be improved simultaneously and the level of protection should be gradually improved.


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