20 16 0 10 the State Council issued "the State Council's opinions on integrating the basic medical insurance system for urban and rural residents", pointing out that the basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) and the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system) should be integrated to establish a unified basic medical insurance system for urban and rural residents (hereinafter referred to as urban and rural residents' medical insurance).
1, uniform coverage
The coverage of urban and rural residents' medical insurance system includes all the insured persons of the existing urban residents' medical insurance and the new rural cooperative medical system, that is, all urban and rural residents except those who should be insured in the basic medical insurance for employees. Migrant workers and flexible employees shall participate in the basic medical insurance for employees according to law, and may participate in the medical insurance for urban and rural residents in accordance with local regulations if they have difficulties.
2. Unified guarantee treatment.
The medical insurance fund for urban and rural residents is mainly used to pay the medical expenses incurred by the insured in hospitalization and outpatient service. Stabilize the level of hospitalization security, and maintain the proportion of hospitalization expenses within the policy range at around 75%. Further improve outpatient co-ordination and gradually improve the level of outpatient support. Gradually narrow the gap between the payment ratio within the scope of the policy and the actual payment ratio.
Extended data
Basic principles of integration
1. Overall planning and coordinated development. It is necessary to incorporate the medical insurance system for urban and rural residents into the overall situation of the development of universal medical insurance system and deepen medical reform, make overall arrangements and rational planning, highlight the linkage between medical insurance, medical care and medicine, strengthen the connection between basic medical insurance, serious illness insurance, medical assistance, emergency medical assistance and commercial health insurance, and enhance the system's systematicness, integrity and synergy.
2, based on the basic, to ensure fairness. According to the level of economic and social development, the burden of urban and rural residents and the ability to bear funds, we should accurately locate and scientifically design, fully consider and gradually narrow the gap between urban and rural areas and regional differences, ensure that urban and rural residents enjoy basic medical insurance benefits fairly, and realize the sustainable development of the medical insurance system for urban and rural residents.
3, according to local conditions, in an orderly manner. It is necessary to combine the actual situation, comprehensively analyze and judge, carefully formulate the implementation plan, strengthen the connection before and after integration, ensure the smooth continuation and orderly transition of work, ensure that the basic medical insurance benefits of the people are not affected, and ensure the safety of the medical insurance fund and the smooth operation of the system.
4. Innovate mechanisms to improve efficiency. It is necessary to adhere to the separation of management and operation, implement government responsibilities, improve the management and operation mechanism, further promote the reform of payment methods, and improve the efficiency of the use of medical insurance funds and the efficiency of management services. Give full play to the role of market mechanism and mobilize social forces to participate in basic medical insurance services.
Reference source People's Network-Urban residents' medical insurance and the new rural cooperative medical system will be integrated into urban and rural residents' medical insurance.
Reference Source People's Network-the State Council's Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents