First, improve the treatment of medical staff.

1, combined with the characteristics of the medical industry, establish the salary system of public hospitals, improve the incentive and restraint mechanism of income distribution, gradually improve the treatment of medical staff and widen the income gap reasonably. According to the results of performance appraisal, focusing on clinical frontline, key positions, business backbones and people who have made outstanding contributions, we will implement more pay for more work, excellent grades and equal pay for equal work. It is strictly forbidden to set income targets for medical staff, and it is strictly forbidden to link the income of medical staff with the income of drugs, inspection and treatment in hospitals. Formulate scientific grading diagnosis and treatment methods. Comprehensive use of medical care, medical insurance, price and other means to guide patients to the grassroots for the first time, and promote the formation of a medical order of graded diagnosis and treatment and two-way referral. Through technical cooperation, talent flow and management support, we will promote the establishment of a division of labor and cooperation mechanism among grassroots medical and health institutions, county-level hospitals and large urban hospitals.

2. The key opinions of medical reform put forward that the bidding and purchasing methods of essential drugs and commonly used drugs will be further improved, the supply of drugs will be guaranteed, and the integrity record of centralized drug procurement and the market clearance system will be established. To study and formulate policies conducive to giving full play to the role of traditional Chinese medicine and supporting the development of traditional Chinese medicine. Implement financial compensation and the government's preferential policies for Chinese medicine hospitals. Improve the medical insurance payment policy, encourage the use of Chinese medicine services, and promote the development of Chinese medicine. On the basis of carrying out the pilot reform of charging methods for dominant diseases of traditional Chinese medicine, we will expand the scope of the pilot, increase the number of pilot diseases, implement single-disease payment for dominant diseases of traditional Chinese medicine, and reasonably determine the payment standard.

Second, medical insurance payment is tilted to the grassroots level.

1, accelerate the practice of doctors. Suggestions are put forward to promote doctors' multi-point practice, further simplify procedures, promote socialized management of medical personnel security, improve policies and measures to encourage multi-point practice, and promote the orderly flow and rational allocation of medical and health personnel. We will implement policies and measures such as purchasing and distribution of essential drugs, compensation mechanism, clinical application, personnel distribution, and performance appraisal, and promote reform. Establish a guarantee mechanism for the supply of medicines in short supply. For drugs that are necessary for clinical use, but the dosage is small and the market is in short supply, the supply is guaranteed by means of bidding and fixed-point production. We will improve the shortage drug reserve system and focus on ensuring the supply of basic drugs such as infectious disease prevention drugs and first-aid drugs.

2. Implement the service orientation of primary health care institutions. We will implement the policy of tilting medical insurance payment to the grassroots level, guide the masses to seek medical treatment in primary medical and health institutions for minor illnesses, and promote the formation of a graded diagnosis and treatment system. Gradually implement family doctor service, so that primary medical and health institutions become the first choice for urban and rural residents to see a doctor. Implement the policy of providing for the aged for rural doctors, and adopt various ways to properly solve the problems of providing for the aged rural doctors' old-age security and life difficulties. Grassroots medical and health institutions can give priority to rural doctors who have obtained the qualification of practicing (assistant) doctors under the same conditions.

The third is to integrate urban medical insurance and the new rural cooperative medical system.

Formulate policies and measures to promote telemedicine services. The pilot areas for comprehensive reform of county-level public hospitals should speed up information construction.

Fourth, medical insurance.

Medical risks are mainly outpatient medical risks and hospitalization medical risks, the most important of which is hospitalization medical risks. Therefore, the most practical thing is to consider buying hospitalization insurance first. What matters needing attention in medical insurance are as follows:

First of all, it must have the function of ensuring updates.

Hospitalization medical insurance is generally one year, that is, the insurance period is one year, and it needs to be re-insured after one year (called renewal insurance). Many inpatient medical insurance products are not guaranteed to be renewed, that is to say, customers can renew their insurance every year when they are young and healthy, but no matter how many years they have renewed their insurance, even if it is 30 to 30 years, once they are sick, the insurance company may ask for additional premiums when they renew their insurance next year, or exclude illness or even refuse to insure. Refusal of insurance is legal. Because this is a one-year insurance. The insurance contract is terminated at the expiration of one year. If you want to continue to insure next year, you must start a new contract. Insurance companies and policyholders can choose from each other. Both parties can discuss the terms, what kind of price and what kind of guarantee to continue the contract. If no agreement can be reached, you can choose not to renew the insurance. Therefore, before starting a new contract, it is understandable for the insurance company to evaluate the risks of the insured. Insurance covers all uncertain risks. If it is confirmed, it is not insurance, but relief.

If the purchased product has the guarantee renewal function, after entering the guarantee renewal, even if the claim is several hundred thousand yuan, the insurance can still be renewed next year. That is to say, once the insurance company agrees that the insured enters the state of guarantee renewal, the insurance company loses the right to choose the insured, and the insured still has the right to choose the insurance company. As long as the insured requests renewal, the insurance company can only accept it and has no choice.

Second, it is best to pay a fixed fee. The so-called "fixed payment type" is relative to the expense type.

The basis of expense insurance compensation is invoice. The compensation amount can only be lower than the actual cost. Fixed payment means paying according to the insurance amount agreed in advance, no matter how much it actually costs. So the insurance company's claim amount may be higher than the actual expenditure (of course, it may be lower). The higher part can be used for nutrition expenses, lost time expenses, travel expenses, companion expenses, nursing expenses, and higher-level and higher-quality medical services such as single ward and expert diagnosis and treatment. In addition, it is often unnecessary to provide the original invoice when paying the fixed amount of hospitalization medical insurance claims, and the procedure is simple and it is not easy to cause claims disputes. Moreover, it does not conflict with whether you have social medical insurance or medical insurance from other insurance companies, and can be used as an additional guarantee. Most insurance companies stipulate that fee-based medical insurance only pays the medical expenses within the scope stipulated by social security. According to the principle of cost compensation, if the customer has been reimbursed through social security or other institutions, the insurance company only reimburses the rest.

Therefore, when purchasing hospitalization medical insurance, we must find out whether it is necessary to provide the original invoice of the hospital when making claims. It is best to have a fixed hospitalization medical insurance, not invoices, especially those who already have social medical insurance or medical insurance from other insurance companies.

Third, it is best to be the main insurance.

If the medical insurance we buy is additional insurance, we often have to spend very expensive money to buy an additional "main insurance" that we may not need at all. Even if we are not refused insurance halfway, the main insurance may expire or fail for other reasons, and the protection of additional insurance will no longer exist.

Fourth, it is best to protect against accidents and diseases.

In-patient medical insurance products in the market only bear the liability for insurance compensation caused by accidents, some only bear the liability for insurance compensation caused by illness, and some both bear the liability for insurance compensation. Therefore, you must read the insurance clauses carefully when purchasing, and it is best to guarantee accidental hospitalization and illness hospitalization.

Five, try to buy the most upscale.

If you choose a lower grade, it seems that you have saved a little money, but in fact you have suffered a big loss.

Six, buy all insurance liability

If we cover less insurance liability, the insurance premium will actually be much less, but the compensation will also be much less. Therefore, we should choose the five insurance liabilities of hospitalization, hospitalization for major diseases, surgery, organ transplantation and intensive care unit as far as possible, which are the most worrying, fearful and likely to lead to poverty or return to poverty.

Seven, adhere to the update.

We must change the concept of "no hospitalization and no compensation is not cost-effective" and make the purpose of buying insurance very clear. "In order to get hundreds of thousands of yuan in compensation? What will happen to us if we get compensation of several hundred thousand yuan? Maybe I lost my leg, my arm and my kidney. Are we willing to do this? Of course not. We hope that once we buy insurance, we will not get sick, and we hope that all the insurance premiums we pay will be contributed to others.

Eight, if one thousand local can only buy the cost of hospitalization medical insurance, it is best to choose the total amount limit, not the project limit.

Extended reading of related knowledge: What does medical insurance mean?

Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth. For example, free medical care and labor insurance medical care in China. The medical expenses of employees in China are shared by the state, units and individuals to reduce the burden on enterprises and avoid waste.

Shandong Medical Insurance Reimbursement Proportion and Process

Medical insurance for urban and rural residents in Shandong will reimburse serious illness at a rate of not less than 50%.

It was learned from the provincial government that our province issued "Opinions on Establishing the Basic Medical Insurance System for Residents", which made it clear that the basic medical insurance for urban residents and the new rural cooperative medical system will be integrated from this year, and a unified basic medical insurance system for urban and rural residents will be established, so that urban and rural residents can enjoy basic medical insurance benefits fairly. Urban and rural residents (including rural residents and urban non-employed residents) who are not covered by the basic medical insurance for employees within the administrative area of this province can participate in the basic medical insurance for residents.

Time node

Basically realize municipal overall planning.

In terms of the goal of integrating urban and rural medical insurance, our province will integrate the basic medical insurance for urban residents and the new rural cooperative medical system, realize the organic unity of "basic system, management system, policy standards, payment and settlement, information system and handling services", and establish a "practical, coordinated urban and rural areas, benefiting the people, efficient, fair and accessible" basic medical insurance system for residents to maximize the protection of the interests of insured residents.

At a specific time node, the integration work will be fully completed; In 20 15 years, municipal overall planning will be basically realized. It is understood that urban and rural residents who are not covered by the basic medical insurance for employees in the administrative area of our province, including rural residents, urban non-employed residents, and other personnel stipulated by the state and our province, can participate in the basic medical insurance for residents. Moreover, the basic medical insurance fund for residents will be established in our province, and the fund will be co-ordinated at the municipal level, which will be managed by all cities (cities that do not have the conditions for unified fund collection and expenditure can first establish a municipal-level adjustment fund system), and all funds will be managed at the municipal level by the end of 20 17.

Payment limit

More than eight times the per capita disposable income.

It is understood that after the establishment of the basic medical insurance fund for residents in our province, cities will raise funds by means of "individual contributions and government subsidies", and break the restrictions on urban and rural residents' status, allowing residents to voluntarily choose the payment grade. The minimum funding standard of basic medical insurance for residents in each city is not lower than that of 400 yuan, and the government subsidy is not lower than that of 320 yuan. In terms of medical insurance benefits, the average payment ratio of hospitalization expenses fund within the policy scope is not less than 70%.

Our province also proposed that the maximum payment limit of hospitalization expenses fund within the scope of municipal policies should reach more than 8 times of the per capita disposable income of urban and rural residents. Moreover, it is necessary to appropriately widen the gap in the proportion of funds paid by different levels of medical institutions, and the difference is not less than 10%. Within the scope of the policy, the average payment ratio of hospitalization expenses fund is not less than 70%, and the payment ratio of outpatient expenses fund is not less than 50%.

Convenient for medical treatment

The medical insurance relationship is transferred from different places.

It is clear in our province that residents who participate in the basic medical insurance for residents are provided with medical services and management by their cities. In addition, the human and social departments of our province will formulate measures for the transfer and connection of the basic medical insurance relationship of residents in the province and establish a co-management mechanism in different places. Cumulative calculation of the insured years of the insured residents in each city, so as to realize the transfer of rights and interests with the insured residents. Moreover, our province will also promote online settlement of medical treatment in different places in the province, establish an inter-provincial instant settlement cooperation mechanism for medical treatment in different places, explore the establishment of a conversion mechanism between basic medical insurance for residents and basic medical insurance for employees, and realize the convergence of different insurance systems in terms of payment years and treatment enjoyment. The reporter learned that the basic medical insurance for residents will implement a unified catalogue of drugs, diagnosis and treatment items, high-value medical consumables and medical service facilities in the province.

Reimbursement ratio

Serious illness reimbursement is not less than 50%

In terms of serious illness insurance and medical assistance, our province will carry out serious illness insurance to compensate for high medical expenses and explore the establishment of multi-level supplementary insurance for serious illness. In addition, we should do a good job in connecting the basic medical insurance for residents with the medical assistance system, and establish and improve the information sharing mechanism of the basic medical insurance for residents, medical assistance and designated medical institutions.

It is understood that the funds for serious illness insurance will be allocated from the residents' basic medical insurance fund according to a certain proportion or amount. In principle, the annual financing standard is controlled at about 10% of the basic medical insurance financing standard for residents, and it will be adjusted in time with the changes of financing standard and medical expenses. In addition, the residents' serious illness insurance fund implements special account management and independent accounting. The actual payment ratio of the serious illness insurance fund to the insured residents' compliance medical expenses is not less than 50%. In principle, the higher the medical expenses, the higher the payment ratio.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.