New 2017 medical insurance policy
The State Council recently issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, proposing the integration of urban residents' medical insurance and the New Rural Cooperative, which will appropriately increase the proportion of individual contributions. Migrant workers and flexibly employed people will participate in the basic medical insurance for employees. What practical information is mentioned in this opinion? I sorted out many dry goods for you, hurry up and take a look!
1, which people are covered?
The scope of coverage of the urban and rural residents' health insurance system includes the existing urban residents' health insurance and the new rural cooperative all should be insured (co-operation) personnel, that is, covering all urban and rural residents in addition to the employees' basic medical insurance should be insured personnel. Rural migrant workers and flexibly employed persons shall participate in the basic medical insurance for employees in accordance with the law, and those who have difficulties may participate in the urban and rural residents' medical insurance in accordance with local regulations.
2. The proportion of individual contributions will be raised.
Regions with a large gap between the individual contribution standards of the existing urban residents' medical insurance and the New Rural Cooperative Medical Insurance can adopt the method of differential contribution, and utilize 2-3 years for gradual transition. The actual per capita financing and individual contributions after integration shall not be lower than the existing level.
Gradually establishing a mechanism to link individual contribution standards with the per capita disposable income of urban and rural residents. Reasonable division of responsibility for financing between the government and individuals, while raising the standard of government subsidies, appropriately increasing the proportion of individual contributions.
3, how to raise funds?
Adhering to multi-channel financing, continue to implement the combination of individual contributions and government subsidies as the main mode of financing, and encourage collective, unit or other social and economic organizations to give support or funding. Reasonable division of responsibility for financing the government and individuals, in raising the standard of government subsidies, while appropriately increasing the proportion of individual contributions.
4, how to determine the financing standards?
Everywhere to take into account the urban and rural residents' health insurance and major medical insurance protection needs, in accordance with the principle of balancing fund income and expenditure, and reasonably determine the urban and rural unified financing standards. Existing urban residents' medical insurance and new rural cooperative individual contribution standard gap is large in the region, can take the approach of differential contribution, using 2-3 years of time for gradual transition. The actual per capita financing and individual contributions after integration shall not be lower than the existing level.
5. How is the protection treatment equalized?
Following the principle of moderate protection and balance of income and expenditure, the protection of urban and rural areas is balanced, and the scope of protection and payment standards are gradually unified. Urban and rural residents health insurance fund is mainly used to pay for hospitalization and outpatient medical expenses incurred by insured persons. The level of inpatient coverage has been stabilized, with the proportion of inpatient costs paid within the scope of the policy remaining at around 75 per cent. Outpatient coordination is further improved, and the level of outpatient coverage is gradually raised. Gradually narrowing the gap between the proportion of payment within the scope of the policy and the actual proportion of payment.
6. How much can the medical insurance pay after hospitalization?
The urban and rural residents' medical insurance fund is mainly used to pay for the hospitalization and outpatient medical expenses incurred by the insured. Stabilize the level of hospitalization protection, and keep the proportion of hospitalization expenses paid within the scope of the policy at about 75%. It further improves outpatient coordination and gradually raises the level of outpatient coverage. Gradually narrowing the gap between the proportion of payment within the scope of policy and the actual proportion of payment.
7. How is the medical insurance fund managed?
The urban and rural residents' health insurance to implement the national unified fund financial system, accounting system and fund budget management system. Urban and rural residents health insurance fund into the financial account, the implementation of "two lines of income and expenditure" management. Fund independent accounting, special account management, any unit or individual shall not be squeezed and misappropriated.
Combined with the fund budget management to promote total payment control. The use of the fund to follow the principle of income and expenditure, balance of income and expenditure, a slight surplus, to ensure that the fees payable in full and timely disbursement, and reasonable control of the fund balance rate and cumulative balance rate of the year. A sound early warning mechanism for the operation of the fund has been established to guard against the risks of the fund and improve the efficiency of its use.
8. Clearly define the scope of payment for medicines and medical services.
Following the principles of clinical necessity, safety and efficacy, reasonable price, appropriate technology, and affordability of the fund, on the basis of the existing urban residents' medical insurance and the New Rural Cooperative Medical Insurance Catalog, adjustments are made with due consideration to the changes in the needs of the insured, with additions and deletions, controls and expansions, so as to achieve a basically complete range of types and a reasonable structure in general. At the same time, improve the medical insurance catalog management methods, the implementation of hierarchical management, dynamic adjustment.
9. What are the payment methods of medical insurance
Systematically promoting the reform of composite payment methods combining multiple payment methods such as capitation, per-patient, per-bed-day, and total pre-payment, establishing and improving the negotiation and negotiation mechanism and risk-sharing mechanism between medical insurance operators, medical institutions and drug suppliers, promoting the formation of reasonable payment standards of medical insurance and guiding designated medical institutions to standardize service behaviors and control unreasonable medical costs. It will also guide designated medical institutions to standardize their service behaviors and control unreasonable increases in medical costs.
Promoting the construction of a graded diagnosis and treatment system through measures such as supporting the contracting of services between insured residents and primary medical institutions and general practitioners, and formulating differentiated payment policies, so as to gradually form a new order of medical treatment in which the first diagnosis is made at the grass-roots level, two-way referrals are made, emergencies and slowdowns are divided into different treatments, and the upper and lower levels are linked.
10, when to start implementation
Provinces (autonomous regions and municipalities) should plan and deploy the integration of urban and rural residents' medical insurance work by the end of June 2017, with a clear timetable and roadmap, to ensure that all policies and measures are put in place. The integrated regions should introduce specific implementation programs by the end of December 2017.
Seventeen provinces to realize universal health insurance unified management of human society
Since the issuance of the State Council's Opinions on the Integration of the Basic Medical Insurance System for Urban and Rural Residents, eight provinces (autonomous regions and municipalities directly under the Central Government) such as Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan, Guangxi and other provinces (autonomous regions and municipalities directly under the Central Government) have formally issued a document on the integration of the urban and rural residents of this province to make planning and deployment of the system of medical insurance, as scheduled. The State Council on the integration of the system work in the first half of the task requirements.
The above eight provinces have made plans and deployments for the comprehensive advancement of the integrated system from the overall consideration of rationalizing the system, integrating the system, and enhancing the effectiveness of the "trinity". First, it is clearly proposed that the health and family planning departments to assume the management functions of the new rural cooperative and the management functions of the humanities and social services departments of the management of urban residents' health insurance merged, unified by the humanities and social services departments management. Second, in accordance with the State Council's "Six Uniformities", the requirements for the comprehensive establishment of a unified basic medical insurance system for urban and rural residents through the integration of the two systems of urban residents' medical insurance and the New Rural Cooperative Medical Insurance were set forth. The third is to clarify the division of tasks for the integration work as well as the timetable and roadmap for the promotion, and also to ensure the smooth and orderly progress of the integration work, put forward specific requirements.
Up to now, the country's 32 provinces, autonomous regions and municipalities (including the Corps), Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan, Guangxi, 8 provinces have introduced the integration program, Tianjin, Shanghai, Zhejiang, Shandong, Guangdong, Chongqing, Ningxia, Qinghai, the Corps of the State Council before the release of the document has been fully realized the integration of the system in the above 17 provinces have broken through the system and mechanism of the division of urban and rural areas of health insurance Obstacles, the integration of the unified urban and rural residents of the basic medical insurance system is clearly assigned to the management of the human resources and social welfare departments, the realization of the basic medical insurance system for the whole population and even the unified management of the entire social insurance system, which fully illustrates the local party committee and government of the unified medical insurance management system of a high degree of **** knowledge of the social security system with Chinese characteristics of the profound understanding of the social security system.
From the viewpoint of local practice, the integration of the system has achieved remarkable results: first, the masses generally benefit from the reform, and the sense of access is enhanced. In practice, localities have adopted the idea of "lower contributions rather than higher, higher treatment rather than lower, and wider directories rather than narrower", and the fairness of the residents' health insurance system has been significantly enhanced, especially in rural areas, where the level of utilization of medical services and the level of protection have been generally improved. Secondly, it has enhanced the effectiveness of public **** services and reduced administrative costs. Relying on the social insurance public **** service system, integrated management services such as enrolment registration, fund collection, rights and interests recording and treatment payment have been realized, avoiding duplication of inputs and multiple constructions, and reducing duplication of enrolment and subsidies. The integration of Shandong Province alone eliminated 2.5 million people from duplicated participation, saving more than 800 million yuan of duplicated financial subsidies in the same year. Thirdly, it enhances the mutual assistance *** relief capacity of the medical insurance fund, which is conducive to the basic role of medical insurance on health care reform. Localities have focused on playing the law of social medical insurance system, promoting the external incentive constraints of medical insurance on medical services, and providing a solid foundation for the three medical reform.
China's current basic medical insurance system
(1) Basic medical insurance for urban workers. It is a social medical insurance system that protects the basic medical needs of workers according to the affordability of finances, enterprises and individuals, and is managed on a territorial basis, with the basic medical insurance premiums being borne by both the employer and the worker***, and the basic medical insurance combining social coordination and individual accounts.
(2)Basic medical insurance for urban residents. Is not participating in the urban workers health insurance urban minors and unemployed urban residents as the main object of medical insurance system; urban residents basic medical insurance to family contributions, the government to give appropriate subsidies;
(3) the new rural cooperative medical care. Is organized, guided and supported by the government, farmers participate voluntarily, individual, collective and government financing, to the main medical co-ordination of farmers' medical mutual **** relief system.
The State Council explained the integration of urban and rural residents of basic medical insurance
I, why integrate the basic medical insurance system for urban residents and the new rural cooperative medical system?
In 2003 and 2007, China established the New Rural Cooperative Medical Care (hereinafter referred to as the New Rural Cooperative Medical Care) and the Urban Residents' Basic Medical Insurance (hereinafter referred to as the Urban Residents' Medical Care) systems for the rural population and the urban non-employed population, respectively. Since the establishment of these systems, the scope of coverage has continued to expand, the level of protection has steadily risen, and the operation of the systems has continued to be smooth, playing an important role in improving the basic medical insurance system for the entire population, meeting the public's needs for basic medical protection, and raising the people's health standards.
In recent years, with the rapid economic and social development, the two systems of urban and rural division of the negative effects began to appear, there are duplication of insurance, duplication of investment, treatment is not enough and other problems. On the basis of summarizing the operation of the urban residents' health insurance and the New Rural Cooperative, as well as local experience in exploring and practicing, the CPC Central Committee and the State Council explicitly proposed the integration of the two systems of the urban residents' health insurance and the New Rural Cooperative, and the establishment of a unified basic medical insurance for urban and rural residents (hereinafter referred to as the urban and rural residents' health insurance) system.
Secondly, what is the progress of the work of integrating the urban and rural residents' medical insurance system at present? What are the effects of implementation?
At present, some provinces, cities and counties have realized the integration of the urban and rural residents' health insurance system. In general, the localities follow the path of "first under one roof, then integrated" to straighten out the administrative management system, unify the policies in accordance with the principle of "financing is low, not high, treatment is high, not low, and directory is wide, not narrow", and adopt the "system of multiple grades, The basic medical insurance system for residents in urban and rural areas will be unified by means of a gradual transition to "one system with multiple grades and a system that connects financing and treatment". Integration of management resources and implementation of integrated management services. Improve the information management system of medical insurance and raise the level of informationized management. Properly handle special issues, do a good job of integrating the system and realize a smooth transition.
Overall, the local explorations have provided useful reference for the nationwide integration of urban and rural residents' medical insurance systems. The integration in some areas has achieved initial results, expanded the fund's risk-resistant capacity, and to a certain extent avoided duplication of enrollment, duplication of subsidies, and duplication of construction. However, due to the lack of top-level design and systematic promotion, the synergistic development of the health insurance system and the medical service system needs to be further strengthened, and the fairness of the financing of the health insurance system needs to be further improved.
Three, at present, the central government decided to comprehensively promote the integration of urban and rural residents' medical insurance system of great significance?
Integration of the two systems of urban residents' health insurance and new rural cooperative, the establishment of a unified urban and rural residents' health insurance system, is to promote the reform of the medical and health system, the realization of urban and rural residents to enjoy the rights and interests of the basic medical insurance, to promote social justice, and promote the well-being of the people's major initiatives, urban and rural economic and social coordinated development, and the building of a moderately prosperous society in an all-round way has great significance. The establishment of a medical insurance system for urban and rural residents is conducive to the promotion of fairer protection, more standardized management services, more effective use of medical resources, and the promotion of the sustainable and healthy development of the universal health insurance system.
Four, comprehensively promote the integration of urban and rural residents health insurance system of the general idea is what? How to grasp the basic principles?
The general idea is to start from the policy, the first easy and then difficult, step by step, "unified system, integrated policy, balanced level, improve the mechanism, improve the service". Highlighting the integration of the system policy, the implementation of the "six unified"; highlighting the rationalization of the management system, the integration of agencies, to provide urban and rural integration of services; highlighting the enhancement of the effectiveness of the service, to achieve a gradual transition and smooth integration, the establishment of urban and rural residents of a unified basic medical insurance system.
Basic principles: First, integrated planning, coordinated development. The integration of urban and rural residents' health insurance system into the development of universal health insurance system and deepen the overall situation of health care reform, highlighting the "health insurance, medical care, medicine" three medical linkage, and strengthen the system convergence. Second, based on the basic, to ensure fairness. Based on the level of economic and social development, the burden on urban and rural residents and the fund's affordability, the urban-rural gap and regional differences are fully taken into account and gradually narrowed, so as to ensure that urban and rural residents have fair access to basic health insurance treatment. Thirdly, the system will be promoted in an orderly manner, taking into account local conditions. Strengthen the connection before and after the integration, ensure smooth succession and orderly transition, ensure that the basic medical insurance treatment of the masses will not be affected, and ensure the safety of the fund and the smooth operation of the system. Fourth, innovate the mechanism and enhance the effectiveness. Adhere to the separation of management and operation, improve the management and operation mechanism, and further promote the reform of payment methods. Give full play to the role of the market mechanism, mobilize social forces to participate in the basic medical insurance services.
Fifth, in the integration of urban and rural residents in the process of how to implement the "six unified" health insurance system?
The integration of the urban and rural residents' health insurance system from a policy perspective focuses on integrating its financing and treatment guarantee policies. On the basis of studying and comparing the differences between the two original systems and summarizing the practical experience of various regions, the "six unified" policy integration requirements have been put forward.
One to unify the scope of coverage. The urban and rural residents' health insurance covers all urban and rural residents except those employed in cities and towns. Rural migrant workers and flexibly employed people who have difficulty participating in employee health insurance are allowed to choose to participate in urban and rural residents' health insurance.
The second is to unify the financing policy. Adhere to multi-channel financing, reasonably determine the urban and rural unified financing standards, improve the financing dynamic adjustment mechanism, and improve the financing sharing structure. Urban residents' medical insurance and the new rural cooperative individual contribution standard gap area can take the method of differential contribution gradual transition. Gradually establish the individual contribution standard and urban and rural residents per capita disposable income convergence mechanism.
Third, to unify the protection treatment. Gradually unify the scope of protection and payment standards, the proportion of hospitalization expenses paid within the scope of the policy is maintained at about 75%, and the level of outpatient protection is gradually increased. Properly handle the integration of special protection policies before and after the integration, and gradually reduce the gap between the proportion of payment within the scope of the policy and the actual proportion of payment.
Fourth, to unify the medical insurance catalog. Each province, in accordance with the relevant provisions of the State, following the principles of clinical necessity, safety and effectiveness, reasonable price, appropriate technology, and affordability of the fund, on the basis of the existing urban residents' medical insurance and the new rural cooperative directory, with due consideration to changes in the needs of the insured, to formulate a unified directory of medical insurance medicines and medical service items.
Fifth, the fixed-point management should be unified. Unify the management of fixed-point institutions, strengthen the management of fixed-point service agreements, improve the evaluation mechanism, and implement dynamic access and withdrawal. Adopt a policy of equal treatment for social medical organizations.
Sixth to unify fund management. The implementation of a unified fund financial system, accounting system and fund budget management system, strengthen the internal control management, external supervision system, promote the total payment control, improve the fund operation risk early warning mechanism, reasonable control of the fund balance, to prevent the fund risk, improve the efficiency of use.
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