Overall payment refers to the use of funds in the overall medical insurance account to pay the relevant medical expenses of the insured. The funds involved in this payment method come from the medical insurance premiums paid by all insured units and individuals, excluding the part transferred to personal accounts. This part of the funds is centrally managed by the social insurance agency, which is used for the medical expenses of all insured persons to realize risk sharing and resource sharing. In short, overall payment is a socialized medical cost sharing mechanism, which aims to provide medical security for the insured through the centralized management and use of medical insurance funds.

Basic principles of overall payment:

1. Unified management: all the insurance premiums of the insured are included in the same fund management to realize centralized fund management;

2. Risk * * * burden: All insured persons bear insurance risks and share the high medical expenses incurred by individuals due to illness or other reasons;

3. Balance of payments: ensure the balance of payments of the fund, and ensure the long-term stability of the fund by setting the payment rate and treatment standard reasonably;

4. Mutual assistance: It embodies the spirit of social mutual assistance. By coordinating the operation of the fund, the insured can get necessary financial help when encountering difficulties.

To sum up, overall payment is a kind of social medical insurance mechanism, which is managed by social insurance agencies through centralized use of medical insurance funds other than personal accounts to pay the medical expenses of all insured persons, so as to realize risk sharing and resource sharing, thus providing more balanced and sustainable medical insurance for insured persons.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.