Medicare fund balance to fund Beijing's 11 major diseases to be reimbursed twice next year
2012-08-3116:52Beijing Evening NewsNew policy on medical insurance
What to do if you are still burdened by medical insurance reimbursement? You can be reimbursed again through the medical insurance for major illnesses! Yesterday, the National Development and Reform Commission (NDRC), the Ministry of Health and other departments issued the "Guiding Opinions on Carrying Out Major Disease Insurance for Urban and Rural Residents". Sun Zhigang, deputy director of the National Development and Reform Commission and director of the State Council's Office of Health Care Reform, said that the major illness insurance will reimburse a small group of people for their personal expenses on the basis of the basic medical insurance has been reimbursed again, the actual reimbursement rate of not less than 50%, as far as possible, to avoid "a person with a serious illness, the whole family in trouble".
Purpose of assistance
Solving the problem of "poverty caused by illness and returning to poverty due to illness"
The "Guiding Opinions on Carrying Out Major Disease Insurance for Urban and Rural Residents" shows that major disease insurance for urban and rural residents is a systematic arrangement to provide further protection for the high medical expenses incurred by patients with major illnesses, on top of the basic medical insurance. a systematic arrangement.
Sun said that in recent years, with the continued promotion of the new healthcare reform, the universal healthcare insurance system has been initially established, with the number of urban residents enrolled in the urban residents' healthcare insurance and the New Rural Cooperative Insurance reaching 1.032 billion, and the reimbursement ratio within the scope of the policy reaching about 70 percent. "But we also see that at present, China's urban residents health insurance, new rural cooperative protection level is still relatively low, the system is not sound enough, the more prominent problem is that people suffering from serious illnesses incurring high medical expenses after the personal burden is still relatively heavy, there is 'a person gets sick, the whole family in trouble' phenomenon. It is necessary to design an insurance system specifically for major illnesses to solve the practical difficulties of the masses, so that everyone in urban and rural areas can enjoy protection against major illnesses."
Relief standards
Actual reimbursement ratio of not less than 50%
It is reported that the object of protection of major disease insurance is the urban residents of the medical insurance, the new rural cooperative participants. As the basic medical insurance fund has a lot of balance, the accumulated balance of a large scale, the funds needed for the insurance of major diseases from the urban residents medical insurance fund, the new rural cooperative fund, no additional increase in the burden of the masses of individual contributions.
It is reported that the scope and goal of the coverage of the major disease insurance is at the average level, so that individuals have to spend less on medical expenses than the family catastrophic medical expenditures. It has been estimated that the annual per capita disposable income of urban residents or the annual per capita net income of farmers in various places can be used as the standard of catastrophic medical expenditure of local families. When the medical expenses borne personally by insured patients exceed this standard, it is likely that the family will fall into financial difficulties. Catastrophic insurance reimburses this small group of people for their personal burden of compliant medical expenses on top of what has already been reimbursed by the basic medical insurance, requiring the actual reimbursement rate to be no less than 50 percent. In addition, a very small number of people with low incomes or incurring huge medical expenses can be solved by means of assistance.
Coverage organizations
Balancing income and expenditure to maintain a small profit
Urban and rural residents' major disease insurance has adopted a government-led approach, with commercial insurance organizations undertaking the work. Sun said commercial insurance organizations will provide major disease insurance coverage for insured people in accordance with the government's requirements.
According to the report, commercial insurance organizations undertaking major disease insurance for urban and rural residents must meet certain conditions. The relevant agencies will also standardize the bidding and contract management of major disease insurance, requiring that the principle of balancing income and expenditure, preserving capital and making a small profit be followed, and that the profit rate of commercial insurance institutions be reasonably controlled. In addition, commercial insurance institutions to provide "one-stop" instant settlement services to ensure that the public convenient and timely enjoyment of the benefits of major disease insurance, the commercial insurance institutions to play the national network and other advantages, for the insured to provide foreign settlement and other services.J159J205
Interviewed
The reporter from the Beijing Municipal Bureau of Human Resources and Social Security was informed that the city is currently in a state of emergency. Social Security Bureau was informed that the city is currently conducting research, plans to improve the medical insurance system for major illnesses, the establishment of a supplementary medical approach to major illnesses, focusing on solving the problem of malignant tumors, leukemia, organ transplantation and other major diseases of a number of insured persons in the basic medical insurance system of the burden of the heavy burden of medical costs.
According to 2011 statistics, the average cost of hospitalization for insured persons in Beijing's tertiary hospitals was nearly 18,000 yuan, of which about 75 percent was reimbursed by the medical insurance system, with the individual needing to bear only 25 percent. Although the personal burden has been greatly reduced, for those unfortunate patients suffering from serious illnesses, due to the huge total number, 25% of the out-of-pocket payment is still a considerable amount, coupled with many expensive examination items and imported and high-priced drugs are not included in the medical insurance catalog, and cannot be reimbursed, the medical burden is still their "unbearable weight".
Zhang Xinqing, director of the city's Human Resources and Social Security Bureau, revealed that the initial idea of the policy is to take out some of the money from the social insurance fund that participants have already deposited to form a fund, which will then be used to buy commercial medical insurance from insurance companies. Participants suffering from major diseases after medical expenses exceed the starting line, first enjoy the basic medical insurance reimbursement, to alleviate some of the burden, and then through the commercial medical insurance for a "second reimbursement", which can also alleviate some of the burden. The major diseases currently under investigation include malignant tumors, kidney dialysis, leukemia, hemophilia and 11 other special diseases. The policy is expected to be introduced next year.
After the introduction of the supplemental medical policy for major diseases, it will become the fourth "umbrella" that the municipal party committee and the municipal government will support for the insured after the universal reimbursement of the medical insurance, the reimbursement of the supplemental insurance, and the medical aid from the civil affairs departments.
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