What is the change in this health care reform, which will affect more than 300 million people?

China has been establishing and implementing health insurance for workers for more than two decades, and at the end of August announced the launch of the first reform of the opinion collection.
the so-called workers' health insurance, refers to the medical security for the urban employed population, its number of insured about 330 million people, covering all urban employers - including enterprises, institutions, institutions, social organizations and other units of the health insurance system - is China's earliest establishment of the health insurance system, started in the 1990s.
that is to say, as long as you have a unit in the city, you still have a job and you have to continue working for a long time to come, it belongs to the people who will be affected by this reform, you should be concerned about it.
The document, released on August 26th, was issued by the State Health Insurance Administration, and its full name, "Guidelines on the Establishment and Improvement of the Outpatient Assistance Guarantee Mechanism for Basic Medical Insurance for Employees" (hereinafter referred to as the "Guidance"), is said to be aimed at the whole society to solicit views on the reform of workers' health insurance, and the collection of opinions is as of September 6th. The core information of the
guidance has the following four points: First, adjust the fund structure of individual accounts, that is, the unit contribution part is no longer assared to the individual account, but into the co-ordination fund;
The reimbursement quota for employee health insurance accounts will no longer be limited to individuals in the future, but will be extended to medical expenses available to spouses, parents and children;
health insurance is the main body of urban medical insurance in China, which is composed of two parts, the co-ordination fund and the individual account.
reimbursement process, personal accounts are mainly used to cover low-level medical expenses, such as emergency medical expenses, retail pharmacy drug distribution costs, and the co-ordination fund is mainly used to cover outpatient major illnesses, hospitalizations, emergency observation rooms and other large expenses.
medical insurance shall be paid jointly by the employer and the employees.
, the unit contribution rate is about 6% of the total wages of employees, and the contribution rate of employees is generally about 2% of my salary income.
present, the portion paid by employees will be fully incorporated into the individual account, 30% of the unit contributions will be allocated to the individual accounts of employees, and 70% will be allocated to the co-ordination fund.
focus of this reform is that unit contributions will no longer be credited to individual accounts, but will all become co-ordination funds to establish an "outpatient co-payment guarantee mechanism".
, increase outpatient reimbursements.
short, the unit contributions originally as assosted to the individual account are to the co-ordination account, and then the reimbursement of outpatient services is increased on the reimbursement items of the co-ordination account.
clearly states that the proportion of reimbursement for outpatient medical expenses starts at 50 per cent and that the payment of treatment can be appropriately tilted towards retirees.
the scope of reimbursement of outpatient medical expenses will start with high blood pressure, diabetes and other long treatment cycle, economic burden of outpatient chronic diseases, and then gradually multi-incidence, common diseases and other general outpatient medical expenses into the scope of reimbursement.
is clear that the reform most wants to optimize the problem of inadequate outpatient care.
, China's medical insurance system to ensure inpatient-oriented, outpatient protection is relatively lacking.
If you have a little understanding of the process of hospitalization of the elderly at home, you should know that the elderly are always willing to be hospitalized even if it is only a minor illness, because only hospitalization is convenient for reimbursement.
Zongfan, a researcher at the China Academy of Labor and Social Security Sciences, said in an interview with the media that in 2019, the proportion of medical expenses reimbursed within the scope of the hospitalization policy for workers' health insurance reached more than 80%.
the lack of protection level of personal accounts, insured people will be more inclined to use the co-ordination fund when visiting, which also leads to China's hospital inpatient rate for a long time high.
Wang Zongfan believes that after improving the level of outpatient protection, patients can be reimbursed for medical expenses during outpatient visits, which will reduce unnecessary hospitalization.
, the system also leads directly to inadequate utilization of health insurance funds in individual accounts, making solving the problem of money precipitation a new problem.
since most outpatient expenses are paid through personal accounts, it is common for healthy people to have large balances in their accounts, while the accounts of the elderly and infirm are unable to make ends meet.
the 2019 Statistical Bulletin on the Development of Medical Security, issued by the State Administration of Health Insurance in June this year, the cumulative balance of individual health insurance accounts of employees is 842.6 billion yuan.
to remove the personal account fund precipitation of healthy people, the co-ordination fund also precipitated a large number of funds.
In 2019, The cumulative balance of China's basic medical insurance funds exceeded 2.7 trillion yuan, which is the fifth consecutive year that China's basic health insurance funds have maintained high growth rates of 19.9% since the balance of China's basic health insurance funds exceeded 1 trillion yuan in 2014.
of the funds, the health insurance balance of employees is about 2.18 trillion yuan, accounting for more than 80% of the total.
The World Bank in 2010 issued the "China Health Policy Report" analyzed the reasons for the accumulation of China's health insurance fund balances, there are two main reasons: in the formulation of premium amounts, the initial estimate is relatively conservative, the actual insurance coverage of health insurance is lower than premium income;
problems accumulated over the years, in the domestic, the academic community on the reform of the personal accounts of workers' health insurance has actually formed a consensus, but for the specific path there is a lot of discussion.
view that individual accounts should be cancelled, and the view was expressed that the unified accounting model could be retained and the function of individual accounts should be expanded on this basis.
the current path is a gradual reform approach , reducing the size of individual accounts to gradually replace them .
As an attempt to improve the overall means of funding, the idea of "outpatient mutual care guarantee mechanism" is mainly to "smooth" - reduce the funds allocated to individual accounts, in order to broaden the scope of use of funds and improve the utilization rate of funds.
the relevant person in charge of the State Health Security Administration said that this is a "benefit replacement" way to promote the reform of personal accounts and the establishment of outpatient security mechanism.
And the idea of outpatient mutual help lies in using the sleeping funds of healthy people, improving the turnover rate of health insurance funds, balancing the cost risk of different groups of people, and also using this part of the funds to test the water outpatient protection.
also a key point is that, with the gradual increase of China's aging population, in the coming long period, the country's overall medical costs will show a rapid growth trend.
health insurance fund mainly comes from individual and unit contributions, with the coverage of the whole population, the growth of contributions will also enter the platform period.
the contradiction between limited future growth and increased expenditure, health care fee control and precise management of funds are inevitable choices.
Therefore, with the advent of an aging society and the growing contradiction between rapidly growing health needs and inadequate social security capacity, we ordinary people must realize that under the country's existing health care system, health care can only play a "fundamental" role.
to better balance the risks of future household health care costs, commercial health insurance as a complementary role will become increasingly important and even necessary.
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