From the practice of various places, the classification of medical assistance in my country mainly includes the following categories:
According to the types of diseases assisted, it can be divided into the following three categories: (1) Outpatient assistance: mainly For general diseases, which have the characteristics of large number of rescues and low average compensation level, relief is generally provided in the form of issuing medical assistance cards or policy reductions and exemptions. (2) Hospitalization assistance: mainly for major diseases. Since inpatient diseases are more complicated, have longer course, and have higher average cost per time, the compensation level for inpatient assistance is higher than that of outpatient assistance. Therefore, inpatient assistance is currently being explored as a pilot project for medical assistance. commonly used form. The Department of Minimum Living Security of the Ministry of Civil Affairs (2006 Urban Medical Assistance Pilot Work Annual Report) pointed out that the number of pilot counties (cities, districts) that carry out both outpatient and inpatient assistance only accounts for 65.8% of the total number of pilot areas, and only Hospitalization assistance (or critical illness assistance) accounts for 33.9% (of which the western region accounts for 76.8%). (3) Comprehensive assistance: Outpatient assistance and hospitalization assistance cover limited types of diseases, and neither can adequately solve the problem of medical accessibility for poor people. In addition, for some major diseases, such as mental illness and various infectious diseases (such as AIDS, schistosomiasis, tuberculosis, etc.), the establishment of special relief funds has also become the development direction of my country's medical assistance model. An important component of the comprehensive assistance model.
According to the form of assistance, it can be divided into direct assistance and indirect assistance. Direct assistance is targeted at the recipients through the distribution of cash, medical assistance cards, policy exemptions, etc. Allowing them to enjoy basic medical services. However, it is difficult to ensure the direction of the use of aid funds, which may lead to inefficient use of funds. At the same time, there is a lack of effective cost constraints for aid recipients. Indirect aid is provided by the medical aid department. The service agency calculates and allocates the relief funds to the medical institutions, and the medical institutions provide services to the recipients. Currently, many countries use the government to directly pay the relief funds to the medical institutions, forming a "third-party payment" model. Benefits are also divided into prepayment and postpayment, which are being actively explored by all countries.
According to the aid targets, my country currently mainly includes urban medical aid recipients and rural medical aid recipients. According to the Ministry of Civil Affairs, Ministry of Health, and Labor and Social Security. According to the "Opinions on the Pilot Work on Establishing an Urban Medical Assistance System" promulgated by the Ministry of Finance and the Ministry of Finance in 2005, the objects of urban medical assistance are mainly those who have not participated in the urban employee basic medical insurance among the urban residents' minimum living security recipients, and those who have participated in the urban employee basic medical insurance. According to the "Opinions on the Implementation of Rural Medical Assistance" jointly issued by the Ministry of Civil Affairs, the Ministry of Health and the Ministry of Finance in 2003, rural medical assistance targets rural households with five guarantees. Rural poor family members and other eligible rural poor farmers specified by local governments have gradually been added to other assistance recipients other than the two "Opinions", such as low-income elderly, pregnant women among the floating population, and mentally ill people. Patients, etc.
According to the time of assistance, it can be divided into pre-medical assistance, intra-medical assistance and post-medical assistance.
Pre-medical assistance. It mainly refers to providing certain compensation to the poor recipients before they need health services, so as to improve the utilization of health services by the poor recipients. The specific compensation forms include regular payment of medical assistance funds and funding for urban residents to participate in medical insurance. Assist rural residents in need to participate in the new rural cooperative medical care, etc. The assistance department issues medical assistance certificates to the assistance recipients, and the assistance funds are settled directly with the hospital. After the medical services are completed, the assistance recipients only need to pay the out-of-pocket portion without having to advance the assistance expenses.
The financial settlement procedures for pre-medical assistance are simpler than other types, which avoids the problem of assistance recipients being unable to receive medical services due to their inability to advance medical assistance expenses, and is conducive to improving the accessibility of health services for the poor. It is consistent with the original intention of the medical assistance system.
2. Medical assistance
Medical assistance refers to providing a certain amount or proportion of assistance to poor recipients based on their disease burden during the process of disease diagnosis and utilization of medical services. The assistance can be in the form of cash compensation from the medical assistance department (Ministry of Civil Affairs), or it can be that medical institutions advance a certain amount or proportion of medical service costs, and the civil affairs department will then calculate the compensation with the medical institution.
The compensation provided by the civil affairs department to medical institutions is a type of indirect assistance. Although the compensation time is usually after the completion of medical services (generally compensated on a monthly or quarterly basis), as far as the medical assistance recipients are concerned, they receive medical services directly after being exempted from part of the fee. Their compensation is realized during the implementation of medical services. With the continuous improvement of my country's various medical insurance systems, subsidizing poor residents to participate in corresponding medical insurance and providing secondary assistance during the insurance payment process has become the development trend of my country's medical assistance system in the future.
3． Post-medical assistance
Post-medical assistance means that the medical assistance recipients determined by the medical assistance department pay the medical expenses in advance when they receive medical services after falling ill, and then apply to the medical assistance management agency to obtain assistance funds. Compensation for upfront costs. This is currently the most common rescue method. According to statistics from the Ministry of Civil Affairs, as of 2006, among the pilot counties (cities and districts) for medical assistance that have determined rescue methods across the country, most still adopt post-medical assistance, and only a few counties (cities and districts) carry out or Appropriate pre-medical assistance or a combination of pre-medical assistance and post-medical assistance has been carried out. Post-operative assistance requires poor people to pay all medical expenses in advance when they see a doctor. This has led to a considerable number of assistance recipients giving up or delaying due to lack of ability to pay. treat. In addition, some pilot areas not only implement "post-medical assistance", but also delay the reimbursement time for too long, and some even only apply for it once a year or half a year. At present, there is a clear trend from post-medical assistance to pre-medical and intra-medical assistance.