(1) Establish and improve the overall guarantee mechanism for general outpatient expenses of employee medical insurance.
(2) The payment of benefits can be appropriately tilted towards retirees.
(3) Simultaneously improve the outpatient co-ordination of basic medical insurance for urban and rural residents.
(4) Gradually expand the scope of outpatient chronic diseases and special diseases paid by the overall fund; (5) Gradually transition from disease protection to cost protection.
2. Improve the personal account entry method (1), and scientifically and reasonably determine the personal account entry method and entry level. Personal accounts of employees are included in the basic medical insurance premiums paid by individuals, and the inclusion standard is controlled in principle at 2% of the base of my insured payment, and all the basic medical insurance premiums paid by the unit are included in the overall fund; In principle, the individual accounts of retirees are allocated by the overall fund according to the quota, and the allocated amount is gradually adjusted to about 2% of the average basic pension level in the year when the reform was implemented in the overall planning area according to this opinion.
(2) Improve the outpatient treatment of the insured. The specific proportion or standard of individual accounts shall be determined by the provincial medical insurance department in conjunction with the financial department in accordance with the above principles, guiding the overall planning area and combining local actual research. After adjusting the overall fund and personal account structure, the increased overall fund is mainly used for outpatient economic security and improving the outpatient treatment of insured persons.
3. Standardize the scope of personal accounts.
(1) Personal account is used for individual contributions of spouses, parents and children participating in the basic medical insurance for urban and rural residents. It can be used to pay the medical expenses incurred by the insured and their spouses, parents and children in designated medical institutions, as well as the expenses incurred by individuals in purchasing drugs, medical devices and medical consumables in designated retail pharmacies. Explore the personal accounts of spouses, parents and children participating in the basic medical insurance for urban and rural residents.
(2) Improve the management measures for the use of personal accounts and make statistics on revenue and expenditure information.
4. Strengthen supervision and management.
(1) Strictly implement the budget management system of medical insurance fund.
(2) Seriously investigate and deal with "hanging bed" hospitalization, induced hospitalization and other illegal acts.
(3) Guide designated medical institutions to provide standardized diagnosis and treatment services.
(4) standardize the diagnosis, treatment and referral of designated medical institutions at the grass-roots level.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.