In Shanghai to implement a medical insurance family, do insurers make money or make money?What signal is released?

Can the money in the personal account of medical insurance can be used for family members. Is this good or bad? Do you want to try our family? Since the launch of the medical insurance family for the network in July, many citizens have actively responded, and some citizens have muttered in their hearts.

The so -called personal account of family support refers to "personal accounts can be used to pay for insured spouses, parents, children, or fixed -point retail pharmacies. Personal payment for the basic medical insurance for urban and rural residents in the spouse, parents, and children. In other words, the residual funds for employees' medical insurance accounts have been used from the employee themselves to the use of the employees to the use of family members such as spouses, parents and children.

In April 2021, the General Office of the State Council issued the "Guidance Opinions of the General Office of the State Council on Establishing and Improvement of the Great Protection Mechanism of the Personal Insurance Clinic of Practitioners", clarifying that the provincial people's governments must be planned in accordance with requirements, scientific decision -making, in 2021, 1221 12, 1221, 1221, 1221, 1221, 1221, 1221, 1221, 1221, 1221, 1221. 1221 Before the end of the month, the implementation of the medical insurance family's good luck. At that time, it attracted widespread social attention.

Today, this policy is officially launched in Shanghai and other places. What signals are released? To this end, the reporter interviewed the experts in the field of medical insurance, a professor at the School of Economics of Fudan University, and the director of the Department of Public Economy.

Shanghai implementation policy conditions are mature

"Before the State Council's" Opinions "came out, the industry had discussed the problem of medical insurance personal accounts for a long time." Feng Jin introduced that the basic medical insurance for urban employees in my country adopted a combination of overall accounts and personal accounts. According to the statistical bulletin of the National Medical Security Development in 2021, as of the end of 2021, the national basic medical insurance fund cumulatively deposited 3.6 trillion yuan, of which the cumulative deposit of personal medical insurance accounts for employee medical insurance was 1.1 trillion yuan.

"If there is a lot of personal accounts, it is not conducive to the function of the medical insurance fund to share the function of sharing medical risks between different health groups." For balance, relatively, some elderly medical insurance personal accounts are far from enough to cover the expenses of daily medical medicine. At the same time, children, students, and elderly people who participated in urban and rural residents have no personal account. If they suffer from major illnesses, they will lead to a heavy burden on individuals and family medical care.

In this context, the use of personal accounts for personal accounts can undoubtedly improve the efficiency of medical insurance funds, avoid excessive precipitation of personal account funds, thereby reducing the burden of medical expenses for insured personnel, and achieving a more fair and sustainable medical insurance system.

Before the "Opinions" was introduced, there have been corresponding explorations in various places. In 2017, Zhejiang became the first province in the country to introduce medical insurance funds among family members to help each other. Since then, Sichuan, Chongqing, Guangxi, Fujian and other places have followed up. There are some differences in the implementation rules of all provinces and cities, which are similar in general.

Specifically, Feng Jin pointed out that the structure of Shanghai medical insurance insured personnel is different from other provinces and cities, and employee medical insurance rather than residents' medical insurance. As of now, the accumulated accumulated of more than 3,000 billion yuan in personal accounts in Shanghai employee medical insurance, far exceeding other provinces and cities -this is the direct manifestation of this structure, which also shows that Shanghai has the conditions to promote the good medical insurance family.

On the other hand, the need to update the medical insurance settlement system and settlement mechanism in a timely manner to realize the payment of family facilities, which is a test of local management level. Feng Jin believes that "the management level of Shanghai medical insurance reform is relatively high, and it has always been at the forefront of the country. This is also a favorable condition that policies can implement."

It's not bad for the insured

"A good news of the medical insurance family, and the cost of paying the family to see the medical treatment and the medicine through the fundraising of the good funds. Isn't the medical insurance treatment that the family can enjoy it?" Many citizens have such concerns.

Feng Jin said that this understanding is not correct. Because the regulations of Shanghai's medical insurance reimbursement are relatively complicated, the reimbursement ratio and the starting payment line are linked to the age. It is easy to be misunderstood as "After the formulating person is composed of the network, my reimbursement treatment must be consistent with him/her, so that he/she can use him/her The balance of funds in the years. "

However, in fact, the Shanghai Medical Insurance Family Fair follows the principle of "two constant changes", that is, the rules of medical treatment are unchanged. constant. Therefore, the citizens' concerns around the treatment are redundant. "The treatment is always unchanged, but the money you originally had to be at your own risk became a family to help you pay you with idle money."

"For the insured, the help of the medical insurance family is only good and there is no harm." By raising the efficiency of personal account protection, reduce the pressure of family cash payment, and enhance the ability of family resistance to disease risks. From this perspective, the New Deal is particularly good for those families who are "old and small".

The Municipal Medical Insurance Bureau stated that if the medical insurance overall fund reimbursing the outpatient or inpatient medical expenses for each patient is "a lot of good luck", the goal of "I am everyone, everyone for me" It is a new guarantee mechanism for "small communities" that will build "I am a family and family for me".

The scale of narrowing alone is a large direction

At the same time, some people have proposed that this is the signal of medical insurance payment methods from the city's overall planning to family -oriented and weakening the proportion of payment?

Feng Jin also denied this statement, "On the contrary, this conveys signals that weaken personal accounts and strengthen coordinated payment." She pointed out that the personal account of medical insurance is the product of the historical transition. In the past public medical phase, as long as a person in the family has public medical care, the whole family and even relatives and friends will enjoy it, which will lead to excessive medical expenditure and bring moral risks.

Personal account is born in a historical period of transformation from public expenses and labor insurance to employees. "With a personal account, the ownership of the money is the insurer. In case of death, the insured will consciously control the excessive consumption behavior." The restraint of over -medical consumption has played an important role.

However, the system of social insurance is the fundamental difference between mutual assistance, and personal accounts are essentially different. Looking at the medical insurance systems around the world, except for individual countries such as Singapore, the basic medical insurance system of most countries does not include personal accounts. More and more my personal accounts balance, which is obviously not conducive to giving full play to the help of basic medical insurance.

Therefore, how to deal with the transition product of personal account has become one of the focus of the current medical reform. "It is a way to widen the scope of personal accounts and allow family members to help." Measures under thinking. In this way, the money in personal accounts has become less, the social overall coordination has become more, and the health of healthy people to the patients can be enhanced. For healthy people, in the future, they can also get more help from members of society, thereby returning to the essence of mutual help and help of medical insurance.

Will the medical insurance account withdraw from the historical stage? In her opinion, "the big direction must be gradually narrowing the scale of personal accounts." However, since the establishment of a urban employee medical insurance system in 1998, the concept of personal accounts has become popular. Considering the issue of the people's acceptance, "it takes a long process to completely cancel personal accounts."

Pay attention to the cost of control in the future

Since July, more than 40,000 families have formed a family of factories in Shanghai, with a total of more than 110,000 family members. Beginning this month, these batch of insured personnel can use family airspace funds to pay for their own medical expenses in designated medical institutions and designated pharmacies.

Feng Jin pointed out that compared with the scale of more than 1,500 million employees 'medical insurance insured and more than 3 million urban and rural residents' medical insurance insured persons, there are currently fewer people participating in family favors. "It is normal for citizens to do not understand the new policies just launched or have doubts." She suggested that the medical insurance department increased publicity, enhance the citizens' awareness of the policy, and ensure the convenience of the operation level. The development space is definitely more than this number. "

In addition, the medical insurance families have also put forward new requirements for medical control fees. According to Feng Jin, in recent years, my country's implementation of paid or paid reforms (DIP) paid (DIP) paid reforms (DIP) in China has been implemented in China in recent years. However, the reform of the DRG/DIP payment method is mainly based on the expenditure of inpatient medical insurance funds, which has a relatively small impact on outpatient fees.

In Shanghai's overall medical insurance fund expenditure, outpatient expenses have already occupied the big head. After the implementation of the medical insurance family's good luck, the expenditure of outpatient medical insurance funds will inevitably increase. "For example, the medical insurance of the elderly and the elderly can only be reimbursed by 50%, and the rest must be paid for themselves. The patient or family members of the patient or the patient's family will definitely instruct the doctor to pay attention. In the case of paying for accounts over the years, in the case of more account balances, they may not pay much attention to how much it costs. "

In this regard, Feng Jin believes that the expenditure of outpatient funds should be tracked in time in a timely manner. For medical insurance funds, the balance of income and expenditure and the improvement of outpatient cost control policies must be further recorded to ensure the sustainability of the medical insurance fund.

Liberation Daily · Shangguan News Original manuscript, reprinting without permission

Author: Zhou Chengyi

WeChat editor: Antong

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