On August 26, the National Medical Insurance Bureau officially announced to the public the "Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism (Draft for Comment)." The opinion proposes to stipulate that ordinary outpatient expenses can be reimbursed by medical insurance, and the reimbursement ratio starts from 50%. At the same time, the method of accounting for employee medical insurance personal accounts will also be changed, and the part of medical insurance unit payment will no longer be included in personal accounts, and all will be included in the overall fund.
Since the implementation of the employee medical insurance system in my country for more than two decades, it has played an important role in motivating employees to participate in insurance and reducing their burden of seeing a doctor. However, with the passage of time and economic and social development, many problems have been exposed, and the current system is no longer suitable. The reform of the employee medical insurance system is necessary, and the core measures of the proposed reform are all adjustments oriented to problems and changes, which have multiple meanings.
From the perspective of the reform guidelines, the proposed sound medical insurance mutual aid mechanism is actually two types:
One is the outpatient mutual aid guarantee paid by the overall fund. Starting from 50%, minor diseases and common diseases in outpatient clinics have been included in the payment scope of the medical insurance overall fund, and a new medical insurance benefit has been added.
The second is family mutual aid in personal accounts. Originally it could only pay for the medical expenses of the employees themselves, and expanded to cover the expenses of the employees’ spouses, parents, and children. In the past, only the expenses of designated medical institutions could be paid, and it was expanded to cover the costs of purchasing drugs, medical consumables, and small medical devices in pharmacies .
Obviously, whether it is proposed to stipulate that ordinary outpatient expenses can be reimbursed by medical insurance, or to expand the scope of use of personal account funds, it is a change that the public expects. The former can reduce the burden on outpatients to see a doctor, and can also prevent hospitalization for minor illnesses from wasting medical resources. The latter can encourage employees to continue to participate in insurance and help reduce the family's medical burden.
Undoubtedly, the expansion of these two types of mutual aid insurance is in line with the expectations of the society, and can significantly enhance the sense of acquisition and convenience of insured employees to enjoy medical insurance. More importantly, the improvement of these two types of mutual aid protection does not increase the burden on employers and individuals, but starts from optimizing the design and payment structure of medical insurance accounts, and requires dividends from management.
The current medical insurance is divided into a pooled fund and an individual account. 2% of the individual payment base of the medical insurance and 30% of the unit payment are included in the individual account. This has actually led to insufficient supply and storage of the "big pool" of the overall fund, but there are many individual "small pools" with varying degrees of precipitation and savings. In this way, on the one hand, it restricts the "big pool" mutual aid function. If the cake is not made, it will not divide much; on the other hand, the scattered funds deposited in personal accounts, in addition to the low utilization rate, also bring " A series of management problems, such as "cashing out of medical insurance card shopping", weakened the function of medical insurance, and the insured employees were not satisfied.
The reform plans to put the part of the unit payment in the medical insurance pooling fund instead of the personal account. This move "damages the surplus and makes up for the deficiency". On the one hand, it is to enlarge the "big pool" of the overall fund for mutual aid on a large level. The guarantee creates conditions; on the other hand, it reduces the scale of "personal accounts" to prevent the precipitation of funds. "One increase and one decrease" is a symptomatic policy for precise adjustment.
At the same time, decentralize the management of medical insurance personal account payment, and strengthen the adjustment function between the individual accounts of family members, which is equivalent to integrating the "small pool" that cannot be connected between the original members into the "big pool" of the family. In this way, the efficiency of the use of account funds is improved, and by expanding the scope of payment, those who need to see a doctor can maximize account payment and reduce their own payment burden.
It is crucial to improve the mutual aid protection of medical insurance and make good use of the living medical insurance funds. Medical insurance requires a certain scale, but to determine the health and quality of medical insurance is actually the efficiency of the use of funds, that is, as far as possible, there is no deposit of funds to maximize the payment of the maximum medical insurance. Establishing a sound medical insurance mutual aid guarantee mechanism will benefit the insured employees, but the test is still the courage and wisdom in the reform and innovation of the medical insurance management system and mechanism.
Of course, this reform can only be carried out but not completed. With the economic and social development, economic growth and financial subsidies will nourish medical insurance, and the medical insurance fund will continue to increase the protection capacity. Then the proportion of general outpatient expenses medical insurance reimbursement should continue to increase in the future. The reform clarifies that localities can appropriately tilt to retirees, and as the aging deepens, the tilt will be greater in the future.
It also needs to be pointed out that after the unit payment part enters the medical insurance pooling fund, as the income of the medical insurance fund increases, the ability to monitor medical insurance funds should also be improved to prevent the medical insurance pooling funds from being defrauded, and be wary of outpatient clinics becoming new medical insurance funds. Black hole.
(Yangcheng Evening News commentator Mushu worm)