Experts believe that the establishment and improvement of outpatient economic security mechanism is a long-simmering reform direction. Under the premise of not increasing the burden on enterprises and employees, by adjusting the fund structure, improving the payment method and the outpatient system, we can further play the strategic purchase function of medical insurance value, guide the allocation of medical resources and the behavior of both doctors and patients, promote the adjustment of medical service structure, improve the efficiency of fund use and reduce the medical burden on patients.
Extended data
After the adjustment of the unit medical insurance payment, it will no longer enter the personal account.
The National Medical Insurance Bureau recently issued "Guiding Opinions on Establishing and Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients (Draft for Comment)", proposing that employees' personal accounts should be included in the basic medical insurance premiums paid by individuals, and all the basic medical insurance premiums paid by units should be included in the overall fund.
This regulation has made major adjustments to the personal account system of medical insurance. According to1Decision on Establishing the Basic Medical Insurance System for Urban Employees issued by the State Council in February, 1998, the basic medical insurance fund combines social pooling with individual accounts, and all the basic medical insurance premiums paid by individual employees are included in individual accounts. The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish the overall fund, and the other part is included in the personal account. The proportion of individual accounts is generally about 30% of the employer's contribution. This policy has been in use since its introduction.
In other words, before this adjustment, the money in the personal account of medical insurance was all 30% of the personal medical insurance payment and the unit medical insurance payment. After the "Opinions" were formally implemented, the personal accounts of employees were included in the basic medical insurance premiums paid by individuals, and all the basic medical insurance premiums paid by units were included in the overall fund.
The opinion clearly puts forward that personal accounts are mainly used to pay the out-of-pocket expenses of insured employees within the policy scope of designated medical institutions or designated retail pharmacies. It can be used to pay the medical expenses incurred by employees themselves, their spouses, parents and children in designated medical institutions with medical insurance, as well as the expenses incurred by individuals in purchasing drugs and medical consumables in designated retail pharmacies.
At the same time, it is worth mentioning that the opinion proposes to explore the establishment of personal accounts for individuals whose spouses, parents and children participate in the basic medical insurance for urban and rural residents.
The balance of China Economic Net-medical insurance personal account has exceeded 800 billion, and the unit medical insurance payment no longer enters the personal account.