What impact will the small amount of money in the personal account of the employee's medical insurance have on the medical institutions?

The author Xu Weicai since August 26, the State Health Security Administration official announced that the establishment of a sound staff basic medical insurance outpatient co-assistance mechanism guidance public consultation, the community has reacted strongly, some people think that this reform is good, some people think that the outpatient account funds have shrunk, in the past "by" brushing outpatient account funds pharmacies, social clinics and outpatient medical institutions will be seriously damaged, so how to see this problem? The author is talking to you today.
Outpatient account money is less, the money available to the clinic is not necessarily reduced, if in accordance with the draft for comments implemented the staff basic medical insurance outpatient co-payment protection mechanism, although there is no cancellation of the outpatient personal account, and the outpatient personal account can be extended to family members, in addition to I also include spouses, parents, children in the health insurance designated medical institutions or It is an indisputable fact that the purchase of medicines and medical supplies at a fixed-point retail pharmacy is a medical expense borne by the individual, but since the individual account is only allocated to the 2% portion of the individual contribution and no longer a portion of the unit contribution (about 30%) is included, in fact, the "income" of the individual account is now significantly reduced.
from this perspective alone, the "income" of medical services "income" from pharmacies, Chinese medicine clinics, clinics (including dental, pediatrics, etc.) that used to "rely" on health insurance cards will have an impact.
, according to the draft for comments, the core of this reform of the staff health insurance outpatient is not to reduce the transfer of funds into individual accounts, but to enhance the function of outpatient co-care protection.
The specific idea is: to establish and improve the general outpatient medical expenses co-ordination guarantee mechanism, from high blood pressure, diabetes and other people's heavy burden of outpatient chronic diseases, and gradually the incidence of frequent, common diseases of general outpatient medical expenses into the scope of co-ordination fund payment.
According to the fund's affordability, localities can explore and gradually expand 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, which are harmful to health and have a 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, which is more economical and convenient 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.
That is to say, outpatient co-ordination does not exclude social clinics, Chinese medicine clinics, oral, pediatrics and other specialized clinics and pharmacies, patients in these institutions to see a doctor, the cost of drug purchase is also in the scope of outpatient co-ordination, so the money available to clinics is not limited to outpatient accounts, so it is not necessarily reduced, even because of the expansion of the scope of personal account payments, more conducive to the release of precipitation funds in the past, the funds available to clinics may increase.
The ability to serve special chronic diseases determines the future survival of clinic-type institutions and, in accordance with the reform ideas of the above-mentioned outpatient mutual assistance guarantee mechanism, starts with the chronic outpatient diseases such as hypertension and diabetes, and gradually brings the general outpatient medical expenses of frequent and common diseases into the scope of the co-ordination fund.
In the future, 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.
tells us that the clinic's ability to serve "special" chronic diseases will directly determine the clinic's ability to receive visitors and "suck money".
although we are not yet aware of the "outpatient co-ordination payment catalogue", "diagnosis catalogue" and "drug catalogue" identified by the local health care department, the policy direction is clear.
same time, the draft also provides that some of the special treatment that needs to be carried out in outpatient clinics, which is more economical than inpatient care, may be managed by reference to inpatient treatment.
It is clear that outpatient minor surgery, outpatient chemotherapy, acute and chronic renal failure renal dialysis, obstetrics and gynecology, ophthalmology, surgical minor surgery, etc. may be included in the scope of outpatient co-ordination payments.
this actually provides more opportunities for the future development of the "clinic" and hospital outpatient businesses.
, with the gradual improvement of the outpatient co-care guarantee mechanism, explore the transition from disease protection to cost protection.
Of course, the outpatient co-ordination in the end how to pay, the draft also pointed out that the general outpatient co-ordination covers all staff health insurance participants, the proportion of payment from 50% to start, 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.
the "starting standard" and "payment ratio" here determine whether patients choose outpatient co-ordination or hospitalization, but also determine whether the outpatient co-ordination system can play an active role.
the cost of massage for the blind can be swiped health insurance card is not necessarily a good thing recently, from the media learned that Quanzhou, Fujian province has allowed eligible blind medical massage institutions to apply for health insurance fixed-point.
it is understood that the aim is to further play the role of basic health insurance personal accounts, the media evaluation is: This is following the 2019 Quanzhou City issued the "further strengthening of health massage institutions for the blind notice", for blind institutions and their practitioners to send another policy dividend.
specific benefits are: the insured person in the fixed-point blind medical care massage facilities occurred in the health care massage expenses swipe social security card to settle, by the insured person's basic medical insurance personal account to pay, not included in the cumulative medical insurance costs.
simple, this is actually another mouthful of spending for employees who have already "shrinked" their health insurance personal accounts.
to see again, its application for health insurance fixed-point conditions, let people feel a little "high in the cold" feeling.
In accordance with the Quanzhou City Medical Insurance Fund Management Center recently issued the "Quanzhou City blind medical care massage institutions medical insurance fixed-point agreement management regulations", blind medical massage institutions, blind health massage institutions to apply for medical insurance fixed-point should have 9 conditions.
Among them, blind medical massage institutions are required to obtain a Medical Institution Practice License, have not less than 80 square meters (including 80 square meters, the same between 3 beds), massage beds are not less than 3 beds;
Blind health massage institutions shall be operating normally for more than 1 year (including 1 year, the same between 2), have not less than 100 square meters of fixed operating space, massage beds not less than 8 beds;
A blind masseuse shall hold a valid "People's Republic of China Disabled Person's Certificate" or "People's Republic of China Disabled Military Certificate" and, within the legal working age, after at least 6 months of professional study, training and obtain a certificate of qualification (completion) for health massage;
standards are really not low.
, it is also a question of whether it is clear that paying for health care massages from the insured person's basic health insurance personal account meets the requirements of the draft.
request for comments requires that the scope of use of personal accounts be regulated.
: Personal 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.
note that this is a "out-of-the-policy out-of-the-money fee."
draft also clearly stipulates that personal accounts 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.
the "health care consumption" here and the previous "health care massage costs" how to define, is indeed a difficult problem.
, establishing and perfecting the mechanism of basic medical insurance outpatient co-care for workers is indeed a reform that must be implemented as soon as possible, but how to implement it? At present, the draft is only a principle, a lot of details to be determined, but overall, the implementation of medical insurance outpatient co-ordination, regardless of the type of disease, reimbursement ratio, starting payment standards should be different from the inpatient payment project standards, not only pay attention to the inpatient co-ordination to do a good job of convergence, but also pay attention to play a positive role in outpatient co-ordination, guide patients, hospitals and medical insurance funds to move correctly, and ultimately achieve a win-win situation.