CCTV attention: What does the new medical insurance mean? Are we winning or losing?

　　A person's life, the ancestors made an accurate summary with four words, that is, "birth, old age, sickness and death".

No stage of such a process is inseparable from hospitals, doctors and health concerns.

Therefore, any news related to medical health is easy to attract people's attention, because it is related to everyone.

No, in August this year, employee medical insurance and family mutual aid was officially launched in Shanghai, and in Tianjin, it was implemented in July. Looking at the whole country, this reform is also being comprehensively explored and promoted.

What is employee medical insurance and family mutual aid? Simply put, for those who participate in employee medical insurance, the money in the medical insurance personal account can only be used by himself when he sees a doctor. Used by family members such as parents and children, what does it mean?

Are we winning, or are we likely to lose?

convenient?

Is it fair and reasonable?

　　On Thursday, Ms. Zheng from Shanghai brought her son to the Children's Hospital for treatment.

The son is insured by the urban and rural residents' medical insurance in Shanghai. Compared with the employee medical insurance insured by her own, the proportion of urban and rural residents' medical insurance reimbursement is smaller, and the proportion of out-of-pocket payments is higher.

　　And this time to see a doctor, there will be a big change in payment.

Since August, Shanghai has officially launched the "family mutual aid" function of employee medical insurance, which means that the remaining money in Ms. Zheng's employee medical insurance personal account can be used not only by herself, but also by family members such as spouses, parents and children.

　　After binding the son's information, the medical insurance mutual aid account has taken effect.

Her son's medical expenses this time are 895 yuan, and his own medical insurance can reimburse 307 yuan, and the remaining 588 yuan is paid by the mutual aid account, that is, the balance in Ms. Zheng's medical insurance personal account.

　　In fact, the rules of family mutual aid for medical insurance are not complicated. After family members set up a mutual aid network, their original medical insurance benefits remain unchanged, but the money that was originally required to be paid by themselves has added a channel for family medical insurance to pay. .

　　Feng Jin, head of the Department of Public Economics, School of Economics, Fudan University: Even if the insured participates in the family sponsor's mutual aid network, the treatment rules he originally applied will remain unchanged.

It just gives him an extra convenience to use the personal account of the family member's employee medical insurance insured, without affecting the reimbursement rules and other treatments that he applies.

　　At present, more than 40,000 families in Shanghai have set up family mutual aid networks, which is still very low compared to the more than 15 million employees covered by medical insurance in Shanghai.

But at Pediatrics and Children's Hospitals, the use of Medicare mutual aid accounts was significantly higher.

　　Zhang Kunkun, Director of the Finance Department of Shanghai Children's Hospital: As of (August) 24th in our hospital, a total of more than 9,000 settlements and payments were made through the medical insurance mutual aid account, and the mutual aid accounts involved were 3157, accounting for our entire medical insurance. The proportion of accounts is 6% and shows a rising trend.

　　In April last year, the General Office of the State Council issued a document requesting that provinces introduce measures to implement medical insurance and family aid by the end of December last year.

Although the progress has been different, nationwide, medical insurance family mutual aid has been fully rolled out.

The background of this reform is that my country's employee medical insurance personal account has a large amount of balance. At the end of last year, the accumulated balance was 1.1 trillion yuan, and the cumulative balance of Shanghai employee medical insurance personal account was more than 300 billion yuan.

Excessive and idle personal account balances are not conducive to the function of medical insurance funds to share medical risks among different groups of people.

　　In the opinion of experts, if the medical insurance fund reimburses medical expenses for each patient, it is a kind of "great mutual aid", in order to achieve the goal of "I am for everyone, everyone is for me", then the employee medical insurance personal account The family mutual aid is a kind of "small mutual aid" within the family, in order to build a new security mechanism of "I am for my family, my family is for me".

　　After the family mutual aid of medical insurance was implemented in Shanghai, some experts reassured everyone with one sentence, that is: this reform has to be good or bad for everyone.

But after all, the implementation has just started, and many things have not been understood by everyone, and there are many question marks.

Looking back at Beijing recently, the news that Beijing employee medical insurance personal accounts will no longer be free to withdraw from September has been on the hot search for several times. Why?

Where will the next policy go?

　　Mr. Meng, who works in a state-owned enterprise, has paid employee medical insurance in Beijing for nearly ten years. Recently, a series of news about Beijing medical insurance has attracted his attention.

Unlike his wife, who works in his hometown of Shenyang, his medical insurance personal account can only be used for special purposes. In addition to a social security card for reimbursement, Mr. Meng also has a Beijing bank account where he can freely withdraw funds from his personal account, which makes him feel that Beijing employee medical insurance difference.

　　The news that "Beijing employee medical insurance personal accounts will no longer be free to withdraw from September this year" has led many insureds to withdraw money from banks in Beijing where funds can be withdrawn from their personal accounts, resulting in queues.

　　Although officials have clarified that the personal account funds that have been transferred before September can still be used at any time after that, the personal accounts after September are only limited to medical fields such as seeing a doctor and buying medicine, and the funds are dedicated.

But it still made many people pay attention to what is a personal account for the first time?

The so-called employee medical insurance personal account is equivalent to the "medical savings fund" accumulated by oneself. If the personal account is used in non-medical fields, its "usual accumulation, emergency rescue in case of illness" effect will not be reflected.

　　Feng Jin, Dean of the Department of Public Economics, School of Economics, Fudan University: Beijing personal accounts can be withdrawn from bank accounts. This is indeed a very special practice. Although the official clarification of the personal account funds that had been transferred before September, can still be used after that. You can use it at any time. Personal accounts after September are only limited to medical fields such as seeing a doctor and buying medicine, and the special funds are used exclusively.

But it still made many people pay attention to what is a personal account for the first time?

The so-called employee medical insurance personal account is equivalent to the "medical savings fund" accumulated by oneself. If the personal account is used in non-medical fields, its "usual accumulation, emergency rescue in case of illness" effect will not be reflected.

　　Feng Jin, Dean of the Department of Public Economics, School of Economics, Fudan University: Beijing personal accounts can be withdrawn from bank accounts. This is indeed a very special practice. In fact, this practice is also inconsistent with the original intention of medical insurance personal accounts. .

The supervision of personal accounts is still quite important. We have also seen some illegal behaviors before, such as using personal account money to buy some daily necessities, which are not directly related to health. This will lose our personal account itself. original intention.

In fact, this approach is also inconsistent with the original intention of the medical insurance personal account.

The supervision of personal accounts is still quite important. We have also seen some illegal behaviors before, such as using personal account money to buy some daily necessities, which are not directly related to health. This will lose our personal account itself. original intention.

　　Since the establishment of the Chinese employee medical insurance system in 1998, it has consisted of two parts: an overall account and an individual account.

The pool of funds in the pooled account belongs to all the insured, and the funds are not under the control of the individual to ensure the overall reimbursement of the insured; the personal account implements an accumulation system, and the funds are used by individuals to cope with their possible future medical risks.

　　Feng Jin, Dean of the Department of Public Economics, School of Economics, Fudan University: The original intention of launching the personal account was to encourage more people to be motivated to participate in insurance. Part of the money I paid was in my account, and the ownership of this account is relatively clear. .

The second is to control moral hazard. The so-called moral hazard is the risk of excessive medical treatment. The ownership of the money in your account is yours. If you spend more, you will also spend your own money, so you can control excessive medical treatment.

　　Although the early personal accounts played a certain role in enhancing the enthusiasm for participating in insurance and preventing excessive medical treatment, there were also practical problems in the operation of employee medical insurance for more than 20 years.

In recent years, people's expectations for improving reimbursement have gradually increased, and improving medical insurance benefits depends on whether the fund pool of the overall account is sufficient.

In addition, the number of retirees will increase in the future, and the expenditure of the overall account will increase accordingly, which will also increase the pressure on the expenditure of the overall account in many regions.

　　Feng Jin, Dean of the Department of Public Economics, School of Economics, Fudan University: If we put too much money in our personal accounts, we will not be able to play the mutual aid function of medical insurance. For some individuals, especially the elderly with frequently-occurring diseases Speaking of, it is very difficult to improve medical insurance benefits, so we are now reducing the plate of personal accounts and exerting the mutual aid function, which should be a very effective measure to improve medical insurance benefits.

　　Increasing the financial strength of the pooled account and revitalizing the personal account is not only the direction of reform in recent years, but also meets the expectations of the insured. For example, after the personal account of the Beijing employee medical insurance cannot be freely withdrawn from September, how to avoid the funds "squatting on the account" , how to better meet the medical expenditure needs, is also a topic of concern to the insured.

　　When everyone pays attention to the policy of family mutual assistance in medical insurance, many people may ignore the fact that the General Office of the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Assistance Mechanism for Employee Basic Medical Insurance" issued in April last year. The provincial governments should introduce the implementation measures of medical insurance family mutual aid by the end of last year, and a transition period of about three years can be set up, which means that all of us participating in medical insurance, no matter where you are?

will be related to this.

Therefore, in today's very frequent flow of people, in response to this policy, some people will directly ask whether the mutual aid between family members can also support medical treatment in other places?

　　Zhou Jun, 46, is a teacher at a rural primary school in Jinyun, Zhejiang.

The school teaches students mathematics, science, physical education and other subjects.

Before the new semester starts, he can spend more time with the second elder at home.

My father suffered from heart disease for nearly 20 years. After installing a pacemaker, he used the family mutual aid account under Zhou Jun's name to buy medicines every month.

　　Zhou Jun and his father's medical insurance payment place is in Jinyun.

My father's first two operations were completed in local hospitals, and related medical expenses were also directly settled locally.

I usually use my medical insurance account less often, and the family helps Zhou Jun’s account to use the money on his father.

The recent operation was more complicated than in the past and required him to take his father to a hospital in Hangzhou for treatment.

This is also the first time he used the family mutual aid account when he settled in a different place.

　　At present, when a family in Zhejiang Province forms a mutual aid account, all members need to pay medical insurance in the same place.

This is a letter selected by the Zhejiang Provincial People's Government in the comments of netizens in May this year.

The sender stated that he and his mother had participated in insurance separately in the province and wanted to use the balance of his past years for his mother.

The medical insurance department clearly replied that different insured places cannot enjoy the mutual aid of the family account, so the account balance cannot be used.

Zhou Jun's daughter is about to go to school abroad.

He also hopes that future policies will allow his account balance to be shared with his daughter.

　　Wang Lin, director of the Jinyun County Medical Insurance Service Center: I think the (demand) trend of family mutual aid can be mutually recognized and interconnected in this way.

Because many of our young children now go out to work across cities and provinces, it is still relatively common.

Then their medical insurance coverage must generally be cross-city or cross-province, and this may require a specific deployment by the provincial or national medical insurance department.

In this way, the scope of family mutual aid will be wider.

　　In fact, in recent years, many places in my country have been exploring and promulgating policies related to medical insurance and family mutual aid.

Two years ago, Fujian Province implemented the mutual aid of individual accounts.

As of July 31 this year, more than 848,000 family mutual aid accounts have been established, with more than 4.6 million consumptions, covering inpatient, general outpatient, outpatient special disease, drug purchase and other businesses.

At the beginning of this month, Xiamen City took the lead in implementing the new regulations of the national medical insurance for medical treatment in different places, and further optimized and improved the cross-provincial medical treatment services for insured people.

At the same time, there are also expectations that family mutual aid accounts will also play a role in off-site settlements.

　　Xiamen citizen Yu Na: My family mutual aid (account) includes me, my husband and my children. I hope more relatives can join in, such as my (in Liaoning) parents. it is good.

　　Dai Lin, chief representative of Xiamen Municipal Medical Insurance Bureau stationed in the Municipal Administrative Service Center: At present, nearly 500,000 families in Xiamen have established family mutual aid accounts.

Now many young people go to work in our provincial capital. His parents may be in his hometown (in this province), so as long as he binds the mutual aid account in Fujian Province, his parents can use the funds in the young man's mutual aid account. .

　　How big is the demand for medical treatment in other places?

According to the "2021 National Basic Medical Insurance Development Statistical Bulletin" issued by the National Medical Insurance Bureau, last year, 64.34 million people insured by employee medical insurance sought medical treatment in different places, and the cost of medical treatment in different places was 166.3 billion; The medical expenses were 298.5 billion yuan.

In the face of such a huge mobile reality, it is the norm for family members to work and live across provinces.

Allowing family solidarity to work more broadly both meets expectations and puts a test on policymaking.

　　Feng Jin, Dean of the Department of Public Economics, School of Economics, Fudan University: If we want to break through the cross-regional family mutual aid network, the current obstacle is essentially to improve the overall level.

If my parents are not in the same coordinating area with me now, if I add him to my mutual aid network, he will use the funds across the coordinating area.

In this case, it will cause many difficulties in the overall planning and use of medical insurance.

To break through this obstacle in the future is to do so by raising the level of overall planning. It is the general trend to use this mutual aid account across provinces and cities. I believe that there will not be too many problems at the technical level.

　　In every country, as long as it involves education and medical care, it is a big move that the whole people pay attention to, because it is related to the whole people, especially in China, a country with a large population.

The family mutual aid policy of medical insurance is certainly a progress, but it also puts forward high requirements for the management level of governments at all levels. How to pay more attention to efficiency and give everyone a sense of gain without bringing the risk of waste ?

And convenience and practicality are all challenges in operation. However, shouldn’t anything in China be faced, solved, and promoted in the course of reform?