On Thursday, Ms. Zheng from Shanghai took her son to the Children's Hospital. My son is covered by medical insurance for urban and rural residents in Shanghai. Compared with her own employee medical insurance, the proportion of medical insurance reimbursement for urban and rural residents is small and the proportion of out-of-pocket payment is high.
This time, the payment will change greatly. Since August, Shanghai has officially launched the "family economy" function of employee medical insurance, which means that the remaining money in Ms. Zheng's employee medical insurance personal account can be used not only for her own use, but also for her spouse, parents and children.
After binding the son information, the medical insurance account has taken effect. Her son's medical expenses this time are 895 yuan, and his own medical insurance can be reimbursed for 307 yuan, and the remaining 588 yuan is all paid by the balance in the * * * economic account, that is, Ms. Zheng's personal medical insurance account.
In fact, the rules of family medical insurance are not complicated. After my family formed the * * * economic network, my original medical insurance benefits remained unchanged, but the money I originally needed to pay by myself added a channel for my family to pay for medical insurance.
Jin Feng, Director of the Department of Public Economics, School of Economics, Fudan University: Even if the insured participates in the * * * economic network of the family founder, his original applicable treatment rules remain unchanged. It just gives him an extra convenience, and using the personal account of the insured person with family members' medical insurance will not affect his applicable reimbursement rules and other benefits.
At present, more than 40,000 families in Shanghai have established a family economic network, which is still very low compared with Shanghai150,000 employees. However, in pediatrics and children's hospitals, the proportion of using medical insurance accounts is significantly higher.
Zhang Kun, Director of Finance Department of Shanghai Children's Hospital: As of August 24th, there were over 9,000 transactions settled and paid through the medical insurance account in our hospital, involving 3 157 households, accounting for 6% of our entire medical insurance account, and showing an upward trend.
In April last year, the General Office of the State Council issued a document, requiring all provinces to introduce measures for the implementation of financial assistance for medical insurance families before the end of February last year. Although the progress is different, family medical insurance has been fully promoted nationwide. The background of this reform is that the personal account balance of employee medical insurance in China is relatively large. At the end of last year, the accumulated balance was 1. 1 trillion yuan, and the accumulated balance of Shanghai employees' medical insurance personal accounts was as high as more than 300 billion yuan. Excessive and idle personal account balances are not conducive to the medical insurance fund's function of sharing medical risks among different groups of people.
In the expert's opinion, if the medical insurance fund reimburses medical expenses for each patient, it is a kind of "big * * * assistance" to achieve the goal of "I am for everyone and everyone is for me", then the family * * * assistance of employee medical insurance personal account is a kind of "small * * * assistance" within the family, in order to construct "I am for my family and my family is for me".
After the implementation of medical insurance family assistance in Shanghai, some experts used one sentence to reassure everyone that this reform is not bad for everyone. But after all, it has just been implemented, and many things have not been understood, and there are many question marks. Looking back at Beijing recently, the news that Beijing employees' personal medical insurance accounts will no longer be freely withdrawn from September has been searched several times. Why? Where will the policy go next?
Mr. Meng worked in a state-owned enterprise and paid employee medical insurance in Beijing for nearly ten years. Recently, a series of news about Beijing medical insurance caught his attention. Unlike his wife who works in her hometown of Shenyang, the personal account of medical insurance can only be used for special purposes; In addition to the social security card that can be reimbursed, Mr. Meng also has a bank account in Beijing, where he can freely withdraw funds from his personal account, which makes him feel the difference in Beijing's employee medical insurance.
The news that "Beijing employees' personal medical insurance accounts will no longer be withdrawn free of charge from September this year" has caused many insured people to queue up at the Bank of Beijing, which can withdraw funds from personal accounts.
Although the official clarified the personal account funds that had been transferred out before September, they can still be withdrawn at any time afterwards. Personal accounts after September are limited to medical fields such as seeing a doctor and buying medicines, and the funds are special. But it still makes many people pay attention to what is a personal account for the first time. The so-called employee medical insurance personal account is equivalent to the "medical savings" accumulated by oneself. If the personal account is used in the non-medical field, its function of "saving in peacetime and saving in illness" will not be reflected.
Jin Feng, Director of the Department of Public Economics, School of Economics, Fudan University: Personal accounts can be withdrawn from bank accounts, which is indeed a very special practice. This practice is actually not in line with the original intention of medical insurance personal accounts. The supervision of personal accounts is still very important. Before, we also saw some irregular behaviors, such as using money from personal accounts to buy some daily necessities, which have no direct relationship with health, thus losing the original intention of our personal accounts.
The medical insurance system for employees in China was established in 1998, which consists of two parts: overall account and individual account. The pool of funds in the overall account belongs to all insured persons, and the funds are not controlled by individuals, thus ensuring the overall reimbursement treatment of the insured persons; Personal accounts are accumulated, and funds are used by individuals to deal with their possible medical risks in the future.
Jin Feng, head of the Department of Economics, School of Economics, Fudan University: The original intention of launching personal accounts is to encourage more people to participate in insurance. Part of the money I paid is in my account, and the ownership of this account is relatively clear. The second is to control moral hazard. The so-called moral hazard is the risk of overtreatment. The ownership of the money in your account is yours. If you spend too much, spend your own money, so as to control over-medical treatment.
Although the early personal account played a certain role in promoting the enthusiasm of participating in insurance and preventing excessive medical care, it also produced practical problems in the operation of employee medical insurance for more than 20 years. In recent years, people's expectations for improving reimbursement have gradually increased, and improving medical insurance benefits depends on whether the pool of funds in the overall account is sufficient. Coupled with the increase in the number of retirees in the future, the expenditure of the overall account will also increase accordingly, which will also increase the expenditure pressure of the overall account in many aspects.
Jin Feng, Director of the Department of Public Economics, School of Economics, Fudan University: If we put too much money into personal accounts, we can't actually give full play to the economic function of medical insurance. It is very difficult for some individuals, especially the elderly groups with frequent occurrences, to improve medical insurance benefits. Therefore, reducing the number of personal accounts and giving full play to economic functions should be an effective measure.
Increasing the financial strength of the overall account and revitalizing the personal account is not only the reform direction in recent years, but also in line with the expectations of the insured. For example, how to avoid "lying on the account" and how to better meet the demand for medical expenses after the personal account of Beijing employees' medical insurance cannot be freely withdrawn from September is also a concern of the insured.
When people pay attention to the policy of family assistance with medical insurance, many people may overlook that the Guiding Opinions on Establishing and Perfecting the Outpatient Security Mechanism for Employees' Basic Medical Insurance issued by the General Office of the State Council in April last year mentioned that provincial governments should introduce the implementation measures of family assistance with medical insurance before the end of last year, and a transition period of about three years can be set, that is to say, all of us who participate in medical insurance, no matter where you are? Will have something to do with this. Therefore, in today's highly frequent turnover of personnel, some people will directly ask whether family members can also support medical treatment in different places.
Zhou Jun, 46, is a rural primary school teacher in Jinyun, Zhejiang. Teach students mathematics, science, physical education and other subjects. He can spend more time at home with his parents before the new semester begins. My father has suffered from heart disease for nearly 20 years. After installing a pacemaker, he used Zhou Jun's family account to buy medicine every month.
Zhou Jun and his father's medical insurance payment places are in Jinyun. My father's first two operations were completed in a local hospital, and the related medical expenses were also settled directly in the local area. Usually, I seldom use the medical insurance account, so my family helped Zhou Jun spend the money in his account on my dad. Recently, this operation is more complicated than in the past, and he needs to take his father to a hospital in Hangzhou for treatment. This is also his first settlement in different places, using family account.
At present, when families in Zhejiang Province set up * * * economic accounts, all members need to pay medical insurance in the same place. This is a letter selected by the People's Government of Zhejiang Province in comments from netizens in May this year. The author said that he and his mother were insured in two places in the province, and they wanted to give their mother the balance over the years. The medical insurance department clearly replied that the insured in different places can't enjoy the economic benefits of family account, so the account balance can't be used. Zhou Jun's daughter is going to go to school in other places soon. He also hopes that the future policy will allow his account balance to be shared with his daughter.
Wang Lin, director of Jinyun Medical Insurance Service Center: I think families can recognize each other in this way, and the trend of mutual communication is quite obvious. Because many of our young children now go out to work across cities and provinces, it is still relatively common. Then their medical insurance places are generally cross-city or cross-province, and this piece may need specific deployment by provincial or national medical insurance departments. In this case, the scope of family assistance will be wider.
In fact, in recent years, many places in China are exploring and introducing policies related to medical insurance family economy. Two years ago, Fujian Province implemented * * * family assistance. As of July 3rd, this year, * * * has established more than 848,000 economic accounts for family * * and spent more than 4.6 million transactions, covering hospitalization, general outpatient service, outpatient service for special diseases, and drug purchase. At the beginning of this month, Xiamen took the lead in implementing the new regulations of national medical insurance for medical treatment in different places, and further optimized and improved the inter-provincial medical treatment services for insured persons. At the same time, people also expect family accounts to play a role in the settlement in different places.
Xiamen citizen Yu Na: My family (registered permanent residence) includes me, my husband and my children. I hope more relatives can join me, such as my parents (in Liaoning). It would be better if you could appreciate it.
Lin Dai, Chief Representative of Administrative Service Center of Xiamen Medical Insurance Bureau: At present, nearly 500,000 families in Xiamen have established family account. Now many young people are working in our provincial capital, and his parents may be in their hometown, so as long as he is bound to the economic account of Fujian Province, his parents can use the funds of this young man's economic account.
How big is the demand for medical treatment in different places? According to the Statistical Bulletin on the Development of National Basic Medical Security in 20021year issued by the National Medical Insurance Bureau, last year, 64.34 million employees participated in medical insurance and the medical expenses in different places were 65.438+0663 billion yuan. There were 4310.8 million residents' medical insurance participants in different places, and the medical expenses in different places were 298.5 billion yuan. Faced with such a huge mobile reality, it is normal for family members to work and live across provinces. Let the family economy play a wider role, which not only meets people's expectations, but also puts forward a test for policy making.
Jin Feng, Director of the Department of Public Economics, School of Economics, Fudan University: In order to break through the cross-regional establishment of family economic network, the existing obstacle is essentially to improve the overall planning level. If my parents are not in a co-ordination area with me now, and I add him to my economic network, he will use this fund across co-ordination areas. In this case, it will cause many difficulties in the overall planning and use of medical insurance. To break through this obstacle in the future is to improve the level of overall planning. It is the general trend to use this * * * economic account across provinces and cities. I believe that there will be no major problems in the technical level, but the key lies in the system design level.
In every country, as long as it involves education and medical care, it is a big move that the whole people pay attention to, because it concerns the whole people, especially in a populous country like China. The family-oriented economic policy of medical insurance is certainly 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 without bringing waste risks? But also convenient and practical, which is a challenge in operation. But shouldn't anything in China be faced, solved and promoted in the reform?