The major reform of Wuhan Medical Insurance was launched, and it is soliciting opinions

Wuhan Evening News July 15th (Reporter Hu Qiongzhi) According to the requirements of the national and provincial deployment, on July 15, Wuhan Medical Insurance Bureau released the implementation of the implementation of the implementation of the implementation of the basic medical insurance clinic for employees (solicitation "Draft for Opinions) (hereinafter referred to as" Draft for Soliciting Opinions "), and publicly solicited opinions. According to the "Draft for Soliciting Opinions", for medical insurance participants, including the employees of employees and retirees in our city, establish and improve the guarantee mechanism for the help of ordinary outpatient medical expenses, the payment ratio starts at 50%, and appropriately tilted to the retirees to the retirees. Essence This means that the minor disease and common diseases of outpatients and common diseases will gradually be included in the scope of payment of medical insurance overall funds. Before the end of this year, the reform of employees in our city will be fully launched.

Extension from key protection of major illnesses, hospitalization to small diseases, and outpatient clinics

Since the establishment of the employee's medical insurance system, the basic medical insurance system in our city is focusing on the hospitalization of hospitalization. According to reports, the medical expenses reimbursement ratio within the scope of hospital medical insurance in our city reached more than 80%, but the outpatient guarantee was relatively weak, which was relatively short -board.

On the one hand, the current combination of medical insurance for employees is combined. In addition to the limited number and high cost of outpatient clinics, the special diseases are included in the scope of the payment scope of the overall funding fund and enjoyed high treatment guarantee. Most of the other outpatient costs are mainly paid through personal accounts. On the other hand, the limitations of personal accumulation are gradually emerging. Most health groups have a large number of personal accounts, while a small number of elderly and weak people have personal accounts that cannot be eaten up, and their personal burdens are heavy. Personal account mutual aid functions cannot disperse the risk of costs between crowds.

According to reports, the reform of the medical insurance of the employee of Wuhan City, on the basis of not increasing the payment of employers and insured personnel in our city, through optimizing the structure of personal accounts, enhancing the overall overall funds, simultaneously expanding the scope of the fund's guarantee, and the general outpatient cost of employees' outpatient clinics Gradually incorporate the scope of medical insurance reimbursement.

The reform of the medical insurance of our city involves 3 core measures

According to the "Draft for Soliciting Opinions", there are three core measures for the reform of the medical insurance reform of our city.

The first is the establishment of an outpatient protection mechanism, and the reimbursement ratio starts from 50%. Incorporating minor diseases and common diseases into the scope of payment scope of medical insurance overall funds is a new medical insurance treatment. Increase the payment ratio of grass -roots medical institutions, of which in the city's first -level designated medical institution (including community health service agencies), the proportion of payment of the fund is developed to 80%, encouraging the insured to the first clinic at the grassroots level, alleviating the large hospital "seek medical treatment for medical treatment The problem of difficulty. Considering that the prevalence of common diseases, multiple onset, and chronic diseases is higher than young people, and the medical needs are greater. The proportion of personal payment of retirees will be drawn up to 80%of the personal payment ratio of the staff. Essence

The second item is that the inclusion method of the personal account of medical insurance will change. The personal account of the employee is included in a certain percentage of a certain percentage of the original unit and all of the personal payment. The personal account of the employee is determined by 2%of the basis for the payment of the insurance insurance, and all the basic medical insurance premiums paid by the unit will be included in the overall fund; according to the relevant national and provincial requirements, the personal account of the retirement shall be planned in principle shall be planned by the overall planning fund according to the fixed amount according to the quota. Entry, the standard is determined to be determined at 2.5%of the average level of basic pensions in our city in 2021. After the proportion of reforming personal accounts, all the increased funds entered the general outpatient fund of employees in our city. In principle, all of the employee clinics guarantee of our city. "The accumulation part of the personal account is still owned by individuals and is not affected."

In addition, the scope of personal accounts will expand. In the case of information system support, it is intended to allow the medical expenses incurred by the employees of our city and their spouses, parents, and children during the designated medical institution, as well as purchasing drugs, medical devices, and medical consumables at designated retail pharmacies The cost of incurred. At the same time, explore personal accounts for personal accounts and spouses, parents, and children to participate in the basic medical insurance and long -term care insurance for urban and rural residents.

Promote the guarantee of ordinary outpatient treatment of employees in our city in order

"Adhere to the principles of basic and low -level start, establish a system of help from employee medical insurance clinics, and enhance employee medical insurance outpatient guarantee capabilities."

According to the "Soliciting Opinions", the city will gradually adjust and improve the scope of disease -like diseases (chronic) diseases and diseases, and explore the transition from the type of disease to the cost guarantee. Adjust the standards for hospitalization in a timely manner, and do a good job of policy connection between ordinary outpatient clinics and hospitalization coordination. In addition, the city will explore the increase in the highest payment limit of employee medical insurance clinics in a timely manner in accordance with the improvement of funding standards, and gradually improve the level of guarantee.

[Edit: Yu Lina]

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