(Economic Observation) China's employee health insurance reforms involving more than 300 million people usher in major moves
China News Service, Beijing, April 8th (Reporter Wang Enbo) Chinese Premier Li Keqiang presided over an executive meeting of the State Council on April 7 to determine measures to establish and improve the mutual aid guarantee mechanism for basic medical insurance for employees, broaden the use of personal account funds, and relieve the masses. Medical burden.
This means that China's employee medical insurance reform involving more than 300 million people has ushered in major moves.
China's current employee medical insurance system has a history of more than 20 years, and it implements a system model that combines overall funds and personal accounts.
Among them, the personal account is mainly used to pay for outpatient expenses of the insured; the overall fund is mainly used to pay for hospitalization and outpatient treatment of some chronic diseases.
According to the current regulations, all basic medical insurance premiums paid by individual employees are included in personal accounts; the basic medical insurance premiums paid by employers are divided into two parts, one is used to establish a pooled fund, and the other is allocated to personal accounts.
The specific ratio is generally "37%": that is, 30% is allocated to personal accounts, and 70% is allocated to the overall fund.
According to the official "Statistics Bulletin of Medical Security Development in 2020", as of the end of 2020, the number of people participating in basic medical insurance for employees in China was approximately 340 million, and the cumulative balance of personal medical insurance accounts for employees was 992.695 billion yuan.
Analysis believes that personal accounts have played an important role in the reform of the employee medical insurance system.
At the beginning of the design of the system, it helped the labor insurance medical and public-funded medical system to transition smoothly to the social medical insurance system. To a certain extent, compulsory personal savings is also conducive to the realization of risk inter-period apportionment.
However, over time, its disadvantages such as insufficient outpatient protection for the insured persons and the lack of mutual aid protection function have gradually emerged.
Zhu Hengpeng, deputy director of the Institute of Economics of the Chinese Academy of Social Sciences and director of the Public Policy Research Center, once wrote that because the fund accumulation system itself cannot realize transfer payments and income redistribution, and is constrained by the social financing ability, payment will be made (all individual payment + unit About 30% of the payment) is used for personal account accumulation, which will inevitably reduce the financing level of the pooling fund and weaken the function of medical insurance pooling and mutual assistance.
At the same time, the financing of the pooling fund is limited, and it is often prioritized for hospitalization expenses reimbursement. Most areas do not have better outpatient pooling, which makes the elderly with higher outpatient expenses a heavier burden.
Dong Dengxin, director of the Institute of Financial Securities at Wuhan University of Science and Technology, also pointed out that there are regional differences in the actual implementation of the current employee basic medical insurance system.
In areas with abundant local finances, individual outpatient expenses can also be paid by the pooling fund just like hospitalization expenses; however, in areas with local financial difficulties, the individual outpatient expenses are paid entirely by personal accounts or at their own expense, and there is no pooling fund to share the payment, which makes some difficulties. Workers will also lack sufficient ability to pay for outpatient visits.
Faced with the above-mentioned problems, the executive meeting of the State Council requested that the next step is to deepen the medical reform, strengthen the mutual aid and mutual aid function of basic medical insurance for employees, and include more outpatient expenses in medical insurance reimbursement to further reduce the burden on patients.
The meeting proposed four measures: one is to gradually include some of the general outpatient expenses for chronic, frequently-occurring, and common diseases that are harmful to health and costly, into the overall planning fund; second, to improve the accounting method of personal accounts; third, to broaden The scope of use of personal accounts; the fourth is to strengthen the supervision and management of medical insurance funds.
It is worth noting that in terms of improving the personal account accounting method, the meeting clarified that the personal payment of the employees is still included in the personal account, and all the unit payment is included in the overall fund.
This means that the “three-to-seven percent” of the employer's payment part mentioned above will become history, but it will be fully owned by the overall fund.
Does this mean to cancel the employee medical insurance personal account?
Medical insurance experts believe that this is not the case. The purpose of this move is to gradually transfer the outpatient protection functions of personal accounts to the overall planning fund, and carry out general outpatient overall planning, include common outpatient diseases and frequently-occurring diseases in the scope of reimbursement, and standardize the use of personal accounts to solve the problem. The insured person’s problem is that “there is not enough money if there is a disease, and there is no need for it”.
Zhu Hengpeng said that using personal account funds to establish a complete outpatient mutual aid protection system will also improve the overall sense of the insured person's sense of gain.
Participants with higher expenses for outpatient clinics (including chronic and serious illnesses) can get more pooled payments through mutual funds. Participants with fewer illnesses and lower expenses can also get outpatient protection and better hospitalization protection.
In addition, broadening the scope of use of personal accounts is also a move to enhance mutual aid capabilities.
For example, "allowing family members to help each other" means that the personal account can be used as a "family account" at the same time, which helps to improve the ability of family members to pay for mutual assistance in outpatient clinics, and also reflects the family's self-protection function.
In general, as the level of outpatient medical expenses reimbursement increases, personal account funds are used more flexibly, medical insurance fund supervision is stricter, and the use efficiency is higher, and the overall protection level of the Chinese people will also increase.
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