What impact does the reform of personal accounts in many places have on the insured?Interpretation

Recently, many places have been adjusted to the methods and scope of use of the funds and use of employees' medical insurance accounts in many places, which has caused public discussion. Today's "Follow", let's find out what is "personal account"? How should the money in this account be used? What impact will this adjustment on the insured?

Regulate employee medical insurance personal account improvement outpatient treatment level

The basic medical insurance of urban employees in my country adopts the combination of social overall accounts and personal accounts. Personal account funds are specially dedicated to the personal payment part of the personal expenditure in the medical expenses such as the medical expenses incurred by the medical institutions, medical institutions for medical institutions, and retail pharmacies. Because it is dedicated to the special fund, the personal account funds of the employee's medical insurance in most regions in my country cannot be withdrawn, and there are clear regulations on the field of use.

Recently, the Beijing Municipal Medical Security Bureau issued the "Notice on Adjusting the Relevant Policies of the Urban Workers' Basic Medical Insurance in the Municipality" clearly that from September 1 this year, personal account funds have implemented accounting management. Insured personnel cannot be freely withdrawn and achieved targeted orientation Use has changed the situation that Beijing's personal accounts can be freely withdrawn in the past 20 years.

Wang Zongfan, director and researcher of the Medical Security Research Office of China Institute of Labor and Social Security Sciences: We originally, for example, in Beijing's personal accounts can be freely withdrawn, do everything, and this money is gone when you need to pay for medical expenses. We participated in medical insurance to put the money from the left pocket on the right pocket, otherwise we do not need to establish medical insurance. I put the money in my own personal account.

And whether the personal account funds that have previously been dedicated to medical insurance are still freely withdrawn. The Beijing Municipal Medical Insurance Bureau stated that it has been assigned to the personal account of personal accounts in medical insurance before September 1, and insured persons can still use them at any time in the future.

Improve the level of home treatment, reduce the burden on the masses for medical treatment

There is also a place where everyone pays attention to the policy adjustment of this medical insurance account is to put all the unit's payment into the overall fund. We know that the original unit's money will be divided into a certain percentage of a certain percentage, and now this part is also included in the overall fund. The proportion of personal accounts and overall funds has been adjusted. What will affect the guarantee capacity of medical insurance funds?

According to the National Medical Insurance Bureau, as of the end of 2021, the national basic medical insurance fund cumulatively deposited 3.6 trillion yuan. Among them, the cumulative deposit of employee medical insurance accounts was 1.1 trillion yuan. With the development of socioeconomic and economy, the improvement of medical needs, the limitations of nearly one -third of the medical insurance fund's personal accounts have gradually become highlighted, mainly because the guarantee function is insufficient, the anesthesia is not enough, and the effect of reducing the burden is not obvious.

Wang Zongfan, director and researcher of the Medical Security Research Office of China Institute of Labor and Social Security Sciences: Coordinating is to put money together, that is, when you need it, you can use it as a fund pool for expenses.

In April last year, the State Council issued the "Guiding Opinions on Establishing and Improvement of the Affairs Protection Mechanism of Basic Medical Insurance Outpatient Clinics", which requires improvement of personal accounts into measures, increasing the guarantee function of medical insurance funds, and reducing the burden on the medical expenses of the masses. Taking Beijing as an example, although the unit's payment is no longer included in a personal account, at the same time, the guarantee of the outpatient clinic has been added. Pay standards, etc. Especially for the insured person who has a lot of visits due to major illnesses, the fund protection ability is more prominent, and the level of protection has been significantly improved.

Wang Zongfan, director and researcher of the Medical Security Research Office of China Institute of Labor and Social Security Sciences: This time we may be more to make a pool of a clinic (coordinated) through this reduction of personal accounts and improve the outpatient clinic (guarantee) Level, so we can provide better treatment. Including the expenses (upper limit) of the outpatient clinic this time in Beijing, now 20,000 to the unlimited limit, you can also reimburse according to 60%. This is a very good for some of these patients who have serious illnesses in the real outpatient clinic. Protection.

It is estimated that there is no closure of the Beijing outpatient treatment. It is expected to benefit about 170,000 insurers each year and reduce the burden of medical expenses about 1 billion yuan. After the employee's serious illness, it is expected that about 35,000 people will be benefited each year, and the burden will be reduced by about 120 million yuan.

Family Family Activation of Medical Insurance Personal Account Bargaining Funds

In the past, the personal account of medical insurance could only be used for reimbursement of myself. Since the beginning of this year, the medical insurance account has been implemented in many places in the country. Personal accounts can also be used to pay the personal burden of the spouses, parents, and children of the insured personnel in diagnosis and treatment. Activated the balance of personal accounts and built a new guarantee mechanism for "I am a family and family for me". At present, Shanghai, Chongqing, Guangdong, Hunan and other places have successively introduced policies and implemented it.

Recently, Ms. An took her son to the dermatology department of Shanghai Children's Hospital. After facial consultation, the doctor suggested conducting allergens to screen and prescribed some drugs for treating eczema. Ms. An found that the cost of taking a child for medical treatment for a child's medical insurance account was reimbursed, and the part that originally needed cash was deducted from her appreciation account.

Ms. An, a citizen of Shanghai: A total of 1003 yuan in a total of 1003 yuan, I have not paid a penny now. Some of the son's medical insurance should be reimbursed for 361 yuan, and then spent a total of 642 yuan from my foresmark account.

Shanghai Medical Insurance's personal account cannot be freely withdrawn, and special funds are dedicated, so the balance of medical insurance accounts with less medical needs will always accumulate but rarely use it. Shanghai has officially implemented family support from August. As of the 15th, about 1,800 families have used a lot of accounts while taking medical treatment at the Shanghai Children's Hospital, and used more than 400,000 funds to the a lot of accounts.

Yu Guangjun, Dean of Shanghai Children's Hospital: Often children's parents are relatively young, and their account funds have accumulated more, but children, especially when they are young, have a higher probability of incidence. Then the probability of using this medical insurance cost is also relatively high, and his benefit is the most obvious after using the amented account.

Wang Zongfan, director and researcher of the Medical Security Research Office of China Institute of Labor and Social Security Sciences: Young and healthy people, his personal account is here, without playing a role, family members, elderly people, and children need such a medical consumption. A help in the family. It may not be possible to use a personal account, and you have to pay with cash, then you can still reduce the burden on the family with your personal account.

(Source: CCTV News Client)

【Edit: Jinxin】

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