Chinanews client, Beijing, August 27th (Reporter Li Jinlei) At least three major changes will be made to employee medical insurance, which will benefit more than 300 million insured persons.

  On August 26, the National Medical Insurance Administration issued the "Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism (Draft for Comment)" to solicit public opinions.

Data map: Citizens line up for registration in the outpatient hall of the hospital. Photo by China News Agency reporter Yang Di

Employee medical insurance outpatient expenses are planned to be included in reimbursement

  The first major change is to establish and improve the general outpatient medical expenses overall guarantee mechanism, starting with the outpatient chronic diseases that are burdened by the masses such as hypertension and diabetes, and gradually including the general outpatient medical expenses of frequently-occurring and common diseases into the overall planning fund. General outpatient clinics cover all employees who are covered by medical insurance, and the payment ratio starts from 50%. This is a new medical insurance benefit.

  In accordance with the provisions of the draft for soliciting opinions, all localities can explore the gradual expansion of the scope of outpatient chronic diseases that are paid by the overall fund. Some special treatments that need to be carried out in outpatient clinics and are more economical and convenient than hospitalization can be managed with reference to hospitalization benefits.

  What are the benefits of outpatient mutual aid protection? The relevant person in charge of the National Medical Insurance Bureau said that general outpatient medical expenses can be reimbursed, and it is explored to expand the scope of outpatient chronic diseases so that outpatient services can carry out more economical and convenient special treatment.

  Previously, the basic medical insurance system focused on insuring hospitalization. In 2019, the medical expenses reimbursement rate within the hospitalization policy of employee medical insurance reached more than 80%, but outpatient insurance was relatively weak and relatively short.

  Yang Yansui, director of the Medical Service Governance Research Center of Tsinghua University and a professor at the School of Public Administration, told a reporter from Chinanews.com that in the past, outpatient expenses were mainly paid by personal accounts, but the money in personal accounts was relatively small. Some common diseases cost very high and cannot rely on personal accounts alone. To pay, some patients go to hospital for reimbursement, but in fact they are taking medicine. Therefore, the establishment of an outpatient mutual aid guarantee mechanism is to keep pace with the times and adjust policies according to the needs of the people.

  The new reform will benefit more than 300 million employee medical insurance participants. According to the 2019 National Medical Security Development Statistical Bulletin issued by the National Medical Insurance Administration, in 2019, 329.25 million people participated in employee medical insurance, an increase of 12.44 million or 3.9% over the previous year.

Data map: People swipe their cards to pay at a hospital window in Qinghai. Photo by Zhang Tianfu

Unit payment plans to no longer enter personal accounts

  The second big change is to improve the method for crediting personal accounts so that unit payments no longer enter personal accounts.

  The draft for comments proposes that the basic medical insurance premiums paid by individuals are included in the personal accounts of current employees. In principle, the accounting standard is controlled within 2% of the insurance payment base, and all basic medical insurance premiums paid by the unit are included in the overall fund.

  In the past, all personal medical insurance payments and 30% of unit payments were included in personal accounts. After the reform, the part of the unit payment was put into the medical insurance pooling fund, and no longer credited to the personal account. Only the individual payment was credited to the personal account.

  Therefore, the amount of money newly transferred to the personal account during the current period will decrease.

  So what is the use of this money? Used to strengthen outpatient protection. The draft for comments proposes that the reduction of funds allocated to personal accounts after the adjustment of the unified account structure is mainly used to support and improve the mutual aid protection of outpatient services and improve the benefits of outpatient services.

  Zhu Hengpeng, director of the Public Policy Research Center of the Chinese Academy of Social Sciences, said that based on the income of the employee medical insurance fund in 2019 (the overall fund is 1000.5 billion yuan, the individual account is 584 billion yuan), a rough estimate is that after the reform, the individual account will only be included in the personal payment part, and no longer will be allocated. In the part of unit payment, the overall fund will increase by about 200 billion yuan. Such an increase in the overall planning fund obviously provides a great possibility for improving the level of protection of insured persons and reducing the medical burden of patients.

  Zhang Yinghua, an executive researcher at the World Social Security Research Center of the Chinese Academy of Social Sciences, told a reporter from Chinanews.com that the cancellation of the part of unit payment and transfer to personal accounts means that the social pooling part of the medical insurance fund has been increased, and the mutual aid of healthy people to the sick has been strengthened. For healthy people, getting sick in the future will also get more mutual aid from members of the society.

  The relevant person in charge of the National Medical Insurance Bureau said that after the adjustment, the overall fund has a stronger protection function for outpatients, that is to say, the employee medical insurance system will provide better reimbursement for outpatients.

Data map: Photograph by Cai Jun when the patient enters the hospital

The use of personal accounts is planned to be extended to family members

  The third big change is the expansion of the use of personal accounts.

  In the past, the personal account could only pay for the medical expenses of the employees themselves. After the reform, it will be expanded to cover the expenses of the employees’ spouses, parents and children.

  According to the draft, personal accounts are mainly used to pay for out-of-pocket expenses incurred by insured employees in designated medical institutions or designated retail pharmacies. It can be used to pay for the medical expenses incurred by the employees themselves, their spouses, parents, and children in medical insurance designated medical institutions for medical treatment, and the expenses incurred by individuals for purchasing drugs and medical consumables in designated retail pharmacies. Explore personal accounts for personal payment for spouses, parents, and children participating in basic medical insurance for urban and rural residents.

  Experts pointed out that the previous personal accounts did not have the function of mutual assistance and could not spread the cost risk among the population, resulting in an abnormally heavy burden of outpatient expenses. Most of the healthy people had a large balance in their personal accounts, while a small number of the elderly and infirm people could not make ends meet. The personal burden is heavy.

  Zhang Yinghua pointed out that this will help realize family mutual aid. Healthy people and employees can use their own medical insurance personal account funds to "pay" and "pay" for their immediate family members. On the one hand, they can revitalize their idle account funds and on the other On the one hand, strengthen family mutual help and unity.

  Yang Yansui believes that the nature of medical insurance is social mutual aid, but the personal account mutual aid ability is poor, young and healthy people cannot use it, and the elderly are not enough. The expansion of the use of personal accounts will help strengthen family mutual aid. The whole family.

  Fan Weidong, deputy director of the Treatment Protection Department of the National Medical Security Administration, said that after the reform, not only will the medical insurance benefits not be reduced, but also personal contributions will not be increased. (Finish)