What exactly does the new "good help" of medical insurance mean?

In the life of a person, the ancestors used four words to make accurate summary, which is "birth and death and death." In this process, it is inseparable from hospitals, doctors and health attention. Because of this, all news related to medical and health can easily attract people's attention because it is related to everyone. No. In August this year, the miles of employees' medical insurance families were officially opened in Shanghai, and in Tianjin, it was implemented in July. Looking at the whole country, this reform is also being fully explored and promoted. What is the employee's medical insurance family, which is simply for those who participate in the employee medical insurance. In the past, the money in the personal account of medical insurance could only be used when I saw a doctor. What do parents and children use family members such as family members? Are we earning, or can we suffer? convenient? Is it fair and reasonable?

On Thursday, Ms. Ms. Zheng took her son to the Children's Hospital for treatment. The son's participation in the urban and rural residents' medical insurance in Shanghai. Compared with the medical insurance of her own employees, the proportion of medical insurance reimbursement in urban and rural residents is small and the proportion of self -payment is higher.

And this time to see a doctor, there will be a big change when paying. Beginning in August, Shanghai has officially opened the function of "family support" of employee medical insurance, which means that the remaining money in the personal account of women's medical insurance can not only be used by themselves, but also can be used by family members such as spouses, parents and children.

After the son's information is bound, the medical insurance account account has taken effect. Her son's medical expenses this time were 895 yuan, and her son's own medical insurance could be reimbursed for 307 yuan, and the remaining 588 yuan were all paid by the balance of the aided account, that is, the personal account of Zheng Zheng's medical insurance.

In fact, the rules of the medical insurance family are not complicated. After the family members have set up a good network, my original medical insurance treatment remains unchanged, but the money that originally needed to pay was added. Essence

Feng Jin, director of the Department of Public Economics at the School of Economics of Fudan University: Even if the insured participated in the Fairwrling Network of the Family, his original application rules were unchanged. It just allows him to have one more convenient to use the personal account of family members and employees, and will not affect his applicable reimbursement rules and other treatment.

At present, more than 40,000 families in Shanghai have formed a family of factories. Compared with more than 1,500 million employees in Shanghai, this proportion is still very low. However, in pediatrics and children's hospitals, the proportion of use of medical insurance accounts is significantly higher.

Zhang Yan, Director of the Finance Department of Shanghai Children's Hospital: As of the 24th of our hospital (August), a total of more than 9,000 pens were settled through the medical insurance appointment account. The proportion of the account is 6%, and it presents a rising trend.

In April last year, the General Office of the State Council issued a document requesting that the provinces issued the implementation of medical insurance families by the end of December last year. Although the progress is different, the medical insurance families are fully pushed away nationwide. The big background of this reform is that there are many balances of personal accounts for employees in my country. At the end of last year, a total of 1.1 trillion yuan was deposited. The cumulative deposit of Shanghai employee medical insurance accounts for more than 300 billion yuan. Excessive balance of personal accounts and idleness, which is not conducive to the function of medical insurance funds to share the function of sharing medical risks among different groups.

From the perspective of experts, if the medical insurance fund is reimbursed for medical expenses for each patient, it is a "great help" in order to achieve the goal of "I am everyone, everyone for me" Family support is a kind of "small agent" in the family scope, in order to build a new guarantee mechanism of "I am a family, family for me".

After the implementation of medical insurance families began to implement in Shanghai, some experts used a word to let everyone eat peace pills, that is: this reform is not bad for everyone. But after all, at the beginning of the implementation, many things have not understood yet, and there are many question marks. Looking back at Beijing recently, the news of Beijing's employee medical insurance account has been on the hot search several times since September. Why? Where can I go next?

Mr. Meng, who worked for state -owned enterprises, paid the medical insurance for almost ten years in Beijing. Recently, a series of news in Beijing's medical insurance has attracted his attention. Unlike his wife who works in Shenyang in his hometown, medical insurance personal accounts can only be specially used for special funds; in addition to the social security card for reimbursement, Mr. Meng also has a Beijing bank account that can freely extract personal account funds, which makes him feel that Beijing employee medical insurance The difference.

The news that the Beijing employee's medical insurance account will no longer be freely withdrawn from September this year, so that many insureds go to the Bank of Beijing, which can withdraw money to withdraw money, and have a queue.

Although the official clarification of the personal account funds that have been entered before September, it can still be used at any time. After September, the personal account is only limited to the medical field such as seeking medical treatment and buying medicine. But still let many people pay attention to what is personal account for the first time? The so -called employee medical insurance personal account is equivalent to the "medical savings" that you accumulate. If you use personal accounts for non -medical fields, the role of "accumulation and emergency treatment" will not be reflected.

Director of the Department of Public Economic Department of the School of Economics of Fudan University: Beijing's personal account can be taken out of the bank account. This is indeed a very special approach. In fact, this approach is also inconsistent with the original intention of medical insurance personal accounts. Essence It is still very important for the supervision of personal accounts. Before we saw some unsatisfactory behaviors, such as using personal account money to buy some daily necessities, which is not directly related to health. This loses our personal account itself. The original intention. The Chinese employee medical insurance system has been composed of two parts: a coordinated account and a personal account since its establishment in 1998. The overall account fund pool belongs to all the insureds to coordinate and appreciate it, and the funds are not dominated by the individual, ensuring the overall reimbursement treatment of the insured;

Director of the Department of Public Economic Department of the School of Economics of Fudan University: The original intention of launching a personal account was the first to encourage more people to have enthusiasm for insurance. Some of the money I paid was in my account. The ownership of this account was relatively clear Essence The second one to control moral risks. The so -called moral risk is the risk of excessive medical care. The ownership of the money in your account itself is yours. If you spend more, you can spend your own money, so that you can control excessive medical care.

Although the early personal accounts played a certain role in improving the enthusiasm of insurance participation and preventing excessive medical care, in the operation of employees' medical insurance for more than 20 years, real problems also occurred. In recent years, people's expectations for improving reimbursement have gradually increased, and the improvement of medical insurance treatment depends on whether the funds pool of the overall account is sufficient. In addition, the number of retirees in the future increases, and the corresponding increase in the expenditure of overall accounting accounts has also exacerbated the pressure of overall account expenditure in many regions.

Director of the Department of Public Economic Department of the School of Economics of Fudan University: If we put too much money in personal accounts, in fact, we cannot play the airspace function of medical insurance. For some individuals, especially the elderly groups with multiple diseases, come to the elderly It is said that it is very difficult to improve medical insurance benefits, so we now reduce the plate of personal accounts and exert a common function, which should be an effective measure to improve medical insurance treatment.

Increasing the capital strength of the overall account and revitalizing personal accounts is not only the direction of reform in recent years, but also in line with the expectations of the insured. For example, after September, the Beijing employee medical insurance personal account cannot be freely withdrawn, how to avoid the funds from "lying on the account" How to better meet the needs of medical expenditures is also the issue that the insured pays attention.

When everyone is paying attention to the policy of miracle in medical insurance, many people may ignore the "Guidance Opinions on Establishing and Improve the Affairs Protection Mechanism on Establishing and Immediate Medical Insurance Clinic" issued by the General Office of the State Council released in April last year. The provincial governments should introduce the implementation of medical insurance families by the end of last year to set up a transition period of about three years, which means that all of us who are involved in medical insurance, no matter where you are? It will be related to this. As a result, today, when the personnel flow is very frequent, for this policy, some people will directly ask the good luck between the family. Can they also support the medical treatment at different places?

46 -year -old Zhou Jun is a rural primary school teacher in Yunyun, Zhejiang. Teach students to mathematics, science, sports and other disciplines at school. Taking advantage of the new semester, he can accompany Er Lao at home. His father suffered from a heart disease of nearly 20 years. After installing the pacemaker, he used a family of good luck under the name of Zhou Jun to buy medicines every month.

Zhou Jun and his father's medical insurance were paid in the same place. The first two operations of his father were completed in the local hospital. The relevant medical expenses were also settled directly in the local area. I usually use the medical insurance account less, and the family facilitation allows the money in Zhou Jun's account to use it on his father. Recently, the complexity of this operation is greater than the past, and he needs to take his father to the hospital in Hangzhou for treatment. This is also the first time that he has used a family forewatement account when settlement in different places.

At present, when a family of Zhejiang Province is setting up an appointment account, members need to pay medical insurance in the same place. This is a letter selected by the Zhejiang Provincial People's Government in the message of the netizen in May this year. The believer stated that the mother was insured with the mother in the province, and wanted to use her balance over the years. The medical insurance department clearly responded that different participating places could not enjoy family accounts, so the balance of accounts could not be used. Zhou Jun's daughter is about to go to school soon. He also hopes that the future policy can allow his account balance to share with his daughter.

Wang Qin, director of the Pu Yun County Medical Insurance Service Center: Family support can recognize and interconnect in this way. I think this (demand) trend is still more obvious. Because many young children are now, they are more common to go out of the city and work across the province. Then the place of insurance in their medical insurance must generally be across cities or across provinces. This one may require a provincial -level or national medical insurance department to make another specific deployment. In this case, the scope of the use of the family is wider.

In fact, in recent years, my country has been exploring many places in recent years to introduce policies related to good protection from medical insurance families. Two years ago, Fujian Province promoted a family of credit. As of July 31 of this year, more than 848,000 families have been established with a total of 848,000 families, consumption of more than 4.6 million strokes, covering a number of businesses such as hospitalization, ordinary outpatient clinics, outpatient special diseases, and drug purchase. Earlier this month, Xiamen City took the lead in the new regulations for medical insurance for medical insurance in different places, and further optimized and improved the insured's cross -provincial medical treatment services. At the same time, people can also play a role in the family foremoon account when settlement in different places. Xiamen citizen Yu Na: My family support (account) includes me, my husband and my child. I hope that more relatives can join in, such as my parents (in Liaoning), if we can share it, we will be more. it is good.

Dai Lin, chief representative of the Municipal Administrative Service Center of the Xiamen Medical Insurance Bureau: At present, nearly 500,000 families in Xiamen have established a family of good luck. Many young people now go to our provincial capital to work. His parents may be in the (province) hometown. As long as he binds the airspace account in Fujian Province, his parents can use the funds of this young man's foresmark account. Essence

How much is the need for medical treatment in different places? According to the Statistics of the National Medical Insurance Development Statistics of the National Medical Insurance Bureau in 2021, last year, 64.34 million person -times of employee medical insurance insured persons, 166.3 billion yuan for medical treatment costs; The cost of medical treatment was 298.5 billion yuan. Faced with such a huge flowing reality, it is normal for family members to work across provinces. Making the good luck of the family can play a more extensive role, that is, to satisfy people's expectations, and also a test of policy formulation.

Director of the Department of Public Economic Department of the School of Economics of Fudan University: We must be able to break through the establishment of a family of Family Fair Cross -region. The current obstacles are essentially to improve the level of overall planning. If my parents are not in the same coordinated area with me now, if I put him into my Wash.com, he will use the funds across the overall planning zone. In this case, it will cause many difficulties in the overall planning and use of medical insurance. In the future, it is necessary to break through this obstacle, which is to break through the overall level. It is the general trend to use this foremoth account across provinces and cities. I believe that there will be no major problems at the technical level. The key is the system design.

In every country, as long as it involves education and medical care, it is a big move for the whole people, because it is related to the whole people, especially in China. Of course, the family favorable policy of medical insurance is a kind of progress, but it also puts forward high requirements for the management level of governments at all levels. How to pay more attention to efficiency and let everyone have a sense of gain, while not bringing a waste of risk Intersection And it is convenient and practical, it is a challenge in operation. However, should nothing in China be faced in reform, solve, and promote progress?

(CCTV reporter Li Ang and Xu Xin Guo Jialing)

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