Medical insurance co-ordination payment refers to the part paid by the medical insurance co-ordination fund when the insured has medical expenses. Specifically, medical insurance is divided into two parts: individual account and overall account. Personal account is mainly used for daily outpatient expenses and medicine purchase, and overall account is used for reimbursement of hospitalization and special outpatient expenses. When the insured has a large amount of medical expenses, the part that exceeds the payment capacity of the individual account shall be paid by the fund in the overall account. These funds come from the medical insurance premiums paid by all insured units and employees, except those included in personal accounts. The overall fund is earmarked for special purposes and can only be used for reimbursement of medical expenses and cannot be used for other purposes. In practice, the overall payment of medical insurance is also limited by policies such as deductible and reimbursement ratio.

Social security fund management:

1. Sources of funds: including social insurance premiums paid by units and individuals, government subsidies, fund investment income, etc.

2. Fund classification: it is usually divided into endowment insurance fund, medical insurance fund, unemployment insurance fund, work injury insurance fund and maternity insurance fund;

3. Fund operation: manage and use the fund as a whole through social insurance agencies to ensure the rational distribution and effective use of the fund;

4. Fund supervision: relevant government departments are responsible for supervision and management to ensure the safe and compliant operation of funds;

5. Fund payment: The fund is mainly used to pay various social insurance benefits of the insured, such as pension, medical expenses and unemployment benefits.

To sum up, the medical insurance co-ordination payment mechanism will transfer part of the expenses paid by all insured units and employees to the co-ordination account for the reimbursement of large medical expenses incurred by the insured, and the expenses beyond the affordability of the individual account will be paid by the co-ordination fund to ensure that the funds are earmarked, subject to the deductible and reimbursement ratio policies, and effectively share the personal medical burden.

Legal basis:

People's Republic of China (PRC) Basic Medical Care and Health Promotion Law

Article 30

The state promotes the implementation of the graded diagnosis and treatment system for basic medical services, guides non-emergency patients to see doctors at primary medical and health institutions first, implements the responsibility system of first diagnosis and referral review, and gradually establishes a mechanism of first diagnosis, two-way referral, fast and slow division of labor and linkage up and down at the primary level, which is connected with the basic medical insurance system. The local people's governments at or above the county level shall, according to the medical and health needs of their respective administrative areas, integrate the medical and health resources organized by the local government, and establish cooperative medical service cooperation mechanisms such as medical consortia according to local conditions. Encourage medical and health institutions organized by social forces to participate in the medical service cooperation mechanism.