First of all, medical insurance refers to the establishment of a * * * medical security fund to pay the medical expenses of the insured through the contributions of individuals and units. The advantage of this system is that it can make full use of the collective strength to realize the risk burden and dispersion, so that the insured can get corresponding protection in the face of high medical expenses. In addition, medical insurance can also provide a wider range of medical services, including basic medical care and serious illness assistance, to meet the different needs of the insured.
Secondly, the overall planning system refers to integrating different medical insurance systems and establishing a unified medical security system. The advantage of this system is that it can avoid repeated payment and insurance overlap and improve the utilization efficiency of insurance resources. Through the overall planning system, the complementarity and coordination between different insurance systems can be realized, so that the insured can enjoy medical security and reduce the economic burden.
The difference between outpatient co-ordination and outpatient assistance is as follows:
1. Scope of protection: The outpatient department shall co-ordinate the medical expenses of the insured for common diseases, such as headache, fever, cold, diarrhea, etc., except for specific outpatient diseases. Outpatient service greatly enhances the support ability of general outpatient service, improves the support level of specific diseases in employee medical insurance outpatient service, and also expands the use scope of personal account and optimizes the payment guarantee of outpatient service.
2. Medical institutions: the designated institutions for outpatient co-ordination are township hospitals or community medical insurance designated clinics; The designated institutions of outpatient service are secondary and tertiary hospitals.
3. Reimbursement ratio: the overall reimbursement ratio of outpatient department is high, and the scope of protection is wide; Outpatient medical insurance premium is low, and the reimbursement ratio may be limited.
The benefits of paying medical insurance are as follows:
1 is conducive to improving labor productivity and promoting the development of production. Medical insurance is the inevitable result of social progress and production development. Conversely, the establishment and improvement of medical insurance system will further promote social progress and production development. On the one hand, medical insurance relieves the worries of workers, makes them work with peace of mind, can improve labor productivity and promote the development of production; On the other hand, it also ensures the physical and mental health of workers and the normal reproduction of labor;
2. Adjust income differences and reflect social equity. Medical insurance is an important means for the government to redistribute income by collecting medical insurance premiums and paying medical insurance service fees.
3. An important guarantee for maintaining social stability. Medical insurance helps sick workers economically, helps to eliminate social instability caused by diseases, and is an important social mechanism to adjust social relations and social contradictions;
4. An important means to promote social civilization and progress. The social system of medical insurance and social mutual assistance embodies a new social relationship of "one party is in trouble and all parties support" by the insured sharing the risk of disease costs, which is conducive to promoting social civilization and progress;
5. An important guarantee for promoting economic system reform, especially the reform of state-owned enterprises.
To sum up, medical insurance and overall planning have their own advantages and characteristics, and which one is better depends on the specific situation. When formulating medical insurance policies, we should comprehensively consider the needs of the insured, the actual situation in the region and the utilization efficiency of insurance resources in order to achieve a better medical security system.
Legal basis:
People's Republic of China (PRC) social insurance law
second
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 when they are old, sick, injured, unemployed and have children.