Medical insurance settlement to promote social integration

Holding a social security card can see a doctor in any district and county across the country, which can greatly reduce the obstacles of population flow and business tourism. There is still a certain gap between the goal of "willingness to fall" in many parts of China. At this time, basic medical insurance realizes direct settlement of cross -provincial medical treatment across provinces, and promotes integration of public services first, which is conducive to establishing a unified domestic market.

Author: Nie Riming

Figure: Tuwa Creative

Recently, the State Medical Insurance Bureau and the Ministry of Finance jointly issued the "Notice on Further Doing a Basic Medical Insurance Cross -Provincial Different Place Different Settlement Work" to comprehensively promote the direct settlement of cross -provincial medical treatment. From the first proposal of the Ministry of Human Resources and Social Security in 2009, documents were introduced in 2014 and 2016. Over the years, the policy goals have continued to progress. The direct settlement system for the introduction of the medical treatment has basically been formed.

After years of development and integration, China's basic medical insurance presents several characteristics: first, the types of insurance formation have formed two types: employee medical insurance (including institutions and enterprises) and urban and rural residents' medical insurance. Second , Integrate to be managed by the independent medical insurance bureau; third, the overall level of overall planning has been continuously improved. As of 2020, 70 % of the prefecture -level cities have achieved unified collection of employees and residents' medical insurance. Gold or unified collection.

The size of the region will directly affect the convenience of patients to see a doctor. If the medical insurance payment and expenditure are limited to a county, it is a county -level coordinating plan. Medical insurance is only used in the county. Residents of the coordinated district can only pay at their own expense, or go through the referral procedures, and pay the funds before reimbursing. At the expense, the patient's burden of seeing a doctor was increased. The procedures for reimbursement before the reimbursement were paid. In the actual implementation, because of the tight funds of the insurance place, there were high obstacles to referring and reimbursement.

If the population is not flowing, the overall level is low and the region is small, and it is not a big problem. However, China is a migrant country, and the large -scale residents in different places are huge, especially the migrant workers who have not participated in the medical insurance of employees and the elderly who live in the city with their children. Specifically, in 2021, there were about 180 million migrant workers in China, of which more than 130 million were migrant workers entering the city, about 60 million people flowing across provinces, and only about 60 million migrant workers participating in employee medical insurance nationwide.

If the migrant population does not have a fixed labor contract and does not participate in employee medical insurance, they can only participate in urban and rural residents' medical insurance in the household registration place. If the resident and household registration is not in the same coordinated area, then you can only return to the household registration place when you see a doctor and hospitalization. In addition, there are differences in medical levels between regions. Some major diseases and difficult diseases cannot be treated in the underdeveloped areas. Only high -level hospitals in developed areas may be cured. Very important.

According to Qipu data, the flow rate of the inter-provincial flow population is relatively rapidly decreased in about 45-50 years old. The inter-provincial mobile participation rate of elderly people over 60 years of age is about 2.2%(7.1 million). About 9.3%(26 million people), which is obviously lower than the labor force of young and middle -aged. One of the possible reasons is that most of these elderly people only participate in residents' medical insurance in the household registration place. The need for medical treatment for middle -aged and elderly people near retirement is strong.

Holding a social security card can see a doctor in any district and county across the country, which can greatly reduce the obstacles of population flow and business tourism. There is still a certain gap between the goal of "willingness to fall" in many parts of China. At this time, basic medical insurance realizes direct settlement of cross -provincial medical treatment across provinces, and promotes integration of public services first, which is conducive to establishing a unified domestic market.

However, to reach a social security card to settle in hospitals in all cities and counties across the country, after having a complete policy document, it must be compacted and implemented. China's region is vast, regional gap, and the needs of medical treatment in different places must be met. There are bound to be many negative effects, such as the risk of medical insurance for residents in the underdeveloped areas, and the full -scale hospitals in developed areas. When you come down, the workload is not small. The notice issued this time has relatively systematically integrating the requirements of direct settlement of cross -provincial medical treatment in different provinces, requiring measures to adjust and notifications in various regions in various places to ensure that the national unified cross -provincial medical treatment policy is achieved at the end of December 2022. The file goal is mainly to implement the existing policy requirements, so that the direct settlement system and system can be used and easy to use across provinces.

In the end, the establishment of a medical settlement system for inter -provincial and different places may have some derivative impacts. Due to the policy requirements for cross -provinces and different places, the provincial financial accounts are allocated to the provincial financial accounts of the provincial -level provincial fiscal -level financial accounts, which also means that some provinces and cities in the province are unable to allocate the medical insurance expenditure of their insured persons in the province. At the time, the provincial government has the responsibility of the bottom, which may accelerate the provincial coordination of the medical insurance fund. The popularization of medical settlement in different places will also strengthen the competition of medical resources between regions. Some hospitals in the underwriting areas can originally rely on medical insurance in the coordinated area. Now they will have to improve the potential pressure of medical insurance outflows.

(The author is a researcher at Shanghai Finance and Law Research Institute)

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