The outpatient cost from the reimbursement to the reimbursement of more than 50%of Henan employee medical insurance reform and these changes

On July 5th, the Press Office of the Henan Provincial People's Government held a special press conference on "Establishing and Improvement of the Great Protection Mechanism of the Basic Medical Insurance Clinic in Henan Province" to introduce and interpret the province's province's establishment and improvement of the basic medical insurance clinic for the province's basic medical insurance clinic support mechanism. Happening.

"Transforming the original personal accumulation guarantee into a fund great -scale protection is the core content of this reform." Luo Wenge, deputy director of the Henan Provincial Medical Security Bureau, introduced the main changes in the reform in detail.

The guarantee mode is further optimized

For a long time, employee medical insurance has implemented a combination of security models of overall funds and personal accounts. However, because the original employee's personal account does not have a good job, there is a large gap between the accumulation of accumulation between insured personnel.

Through the adjustment of the unified account structure, this reform has changed personal accounts from accumulation to mutual aid, and co -planning of employees' outpatient clinics is used to protect the medical expenses of the people's outpatient clinics. In the general outpatient clinic, a full -chain medical expense guarantee system was formed, and the guarantee function was further enhanced.

Fund use efficiency will greatly improve

This reform adjusts the structure of the overall fund and personal account, and at the same time improves the method of personal accounts. On the basis of not changing the payment model of the unit and the individual, and not increasing the unit and individual payment items, about 9 billion yuan per person per year The account funds are turned into overall funds. The increased overall funds mainly strengthen the guarantee of outpatient help, improve the level of guarantee guarantee for outpatient treatment of employees' medical insurance, and allow medical insurance funds to better use them on those common diseases and chronic diseases, especially for retirement. Personal.

For example, in 2021, the province's employee medical insurance fund raised 56.63 billion yuan in that year, and the overall fund expenditure was 30.36 billion yuan. After the reform, the expected expected expenses were 39.36 billion yuan. The increased overall fund expenditure increased the utilization rate of the fund by more than 15 percentage points.

Grassroots medical resources will gradually activate

After the reform, the outpatient cost of the employee has never been reimbursed to more than 50%of the reimbursement. The people see a doctor at the grass -roots medical institutions. There is no reimbursement threshold. The reimbursement ratio is more than 60%.

Through the establishment of the outpatient help mechanism, the leverage role of the medical insurance fund is used to promote the reasonable allocation of medical resources, guide the hierarchical diagnosis and treatment, activate grass -roots medical resources, enhance the level of grass -roots medical services, and facilitate the masses to enjoy medical services nearby, so that the masses will spend less money and optimize sick.

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