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New medical insurance policy in p>217

the State Council recently issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, proposing that integrating the medical insurance for urban residents and the new rural cooperative medical system will appropriately increase the proportion of individual contributions. Migrant workers and flexible employees will participate in the basic medical insurance for employees. What practical information is mentioned in this opinion? Xiaobian has combed a lot of dry goods for you, so come and have a look!

1. which groups are covered?

the coverage of urban and rural residents' medical insurance system includes all insured persons of the existing urban residents' medical insurance and the new rural cooperative medical system, that is, it covers all urban and rural residents except those who should be insured in the basic medical insurance for employees. Migrant workers and flexible employees shall participate in the basic medical insurance for employees according to law, and those who have difficulties may participate in the medical insurance for urban and rural residents in accordance with local regulations.

2. The proportion of individual contributions will be increased.

in areas where there is a big gap between the existing medical insurance for urban residents and the individual payment standards of the new rural cooperative medical system, we can adopt the method of differential payment and make a gradual transition in 2-3 years. The actual per capita financing and individual contributions after integration shall not be lower than the existing level.

gradually establish a mechanism linking the individual payment standard with the per capita disposable income of urban and rural residents. Reasonably divide the financing responsibilities between the government and individuals, and appropriately increase the proportion of individual contributions while raising the government subsidy standard.

3. How to raise funds?

Adhere to multi-channel fund-raising, continue to combine individual contributions with government subsidies, and encourage collectives, units or other social and economic organizations to give support or funding. Reasonably divide the financing responsibilities between the government and individuals, and appropriately increase the proportion of individual contributions while raising the government subsidy standard.

4. how to determine the financing standard?

all localities should consider the needs of urban and rural residents for medical insurance and serious illness insurance, and reasonably determine the unified financing standards for urban and rural areas according to the principle of fund balance. In areas where there is a big gap between the existing medical insurance for urban residents and the individual payment standard of the new rural cooperative medical system, we can adopt the method of differential payment and make a gradual transition in 2-3 years. The actual per capita financing and individual contributions after integration shall not be lower than the existing level.

5. how to balance the security benefits?

follow the principle of moderate security and balance of payments, balance urban and rural security benefits, and gradually unify the scope of security and payment standards. The urban and rural residents' medical insurance fund is mainly used to pay the medical expenses incurred by the insured for hospitalization and outpatient service. Stabilize the level of hospitalization security, and maintain the proportion of hospitalization expenses within the policy range at around 75%. Further improve outpatient co-ordination and gradually improve the level of outpatient support. Gradually narrow the gap between the payment ratio within the policy scope and the actual payment ratio.

6. how much can medical insurance pay after hospitalization?

the urban and rural residents' medical insurance fund is mainly used to pay the medical expenses incurred by the insured persons for hospitalization and outpatient service. Stabilize the level of hospitalization security, and maintain the proportion of hospitalization expenses within the policy range at around 75%. Further improve outpatient co-ordination and gradually improve the level of outpatient support. Gradually narrow the gap between the payment ratio within the policy scope and the actual payment ratio.

7. how to manage the medical insurance fund?

the medical insurance for urban and rural residents shall implement the unified national fund financial system, accounting system and fund budget and final accounts management system. The medical insurance fund for urban and rural residents shall be included in the financial special account, and the management of "two lines of revenue and expenditure" shall be implemented. Fund independent accounting, account management, no unit or individual may misappropriate.

comprehensively promote the total payment control in combination with fund budget management. The use of the fund follows the principle of fixed income and expenditure, balance of payments and slight balance, ensuring that the payable expenses are fully paid in time, and reasonably controlling the current year balance rate and accumulated balance rate of the fund. Establish and improve the early warning mechanism of fund operation risk, prevent fund risks and improve the efficiency of use.

8. define the payment scope of medical insurance drugs and medical services.

following the principles of clinical necessity, safety, effectiveness, reasonable price, appropriate technology and affordable fund, on the basis of the existing urban residents' medical insurance and the new rural cooperative medical system catalogue, the changes in the needs of the insured personnel are appropriately considered for adjustment, and the increase or decrease, control and expansion are achieved, so that the types are basically complete and the structure is generally reasonable. At the same time, improve the management methods of medical insurance catalogue, and implement hierarchical management and dynamic adjustment.

9. What are the payment methods for medical insurance?

The system promotes the reform of compound payment methods that combine various payment methods, such as paying by head, paying by disease type, paying by bed day, and prepaying the total amount, establishes and improves the negotiation mechanism and risk sharing mechanism between medical insurance agencies, medical institutions and drug suppliers, promotes the formation of reasonable medical insurance payment standards, guides designated medical institutions to standardize their service behaviors, and controls the unreasonable growth of medical expenses.

by supporting the insured residents to carry out contract services with primary medical institutions and general practitioners, and formulating differentiated payment policies, we will promote the construction of graded diagnosis and treatment system, and gradually form a new medical order of primary diagnosis, two-way referral, rapid and slow division, and up-and-down linkage.

1. When will it be implemented

All provinces (autonomous regions and municipalities) should make plans and arrangements for the integration of medical insurance for urban and rural residents before the end of June 217, make clear the timetable and road map, and ensure that all policies and measures are put in place. All overall planning areas should introduce specific implementation plans before the end of December 217.

17 provinces realize the unified management of people and society with universal medical insurance

Since the issuance of "Opinions of the State Council on Integrating the Basic Medical Insurance System for Urban and Rural Residents", eight provinces (autonomous regions and municipalities directly under the Central Government) including Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan and Guangxi have successively issued documents to make plans and arrangements for integrating the medical insurance system for urban and rural residents in this province, and fulfilled the task requirements for the first half of the year put forward by the State Council on schedule.

the above eight provinces have made plans and arrangements for the comprehensive promotion of the integration system from the overall consideration of the trinity of straightening out the system, integrating the system and improving the efficiency. First, it is clearly put forward that the management functions of the new rural cooperative medical system undertaken by the health and family planning department and the medical insurance management functions of urban residents managed by the human and social departments should be merged and unified by the human and social departments. Second, according to the "six unifications" requirements of the State Council document, it is required to comprehensively establish a unified basic medical insurance system for urban and rural residents by integrating the two systems of urban residents' medical insurance and the new rural cooperative medical system. The third is to clarify the division of tasks and the timetable and road map for the integration work, and at the same time put forward specific requirements for ensuring the smooth and orderly progress of the integration work.

Up to now, among the 32 provinces, autonomous regions and municipalities (including Corps) in China, eight provinces (Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan and Guangxi) have issued integration plans, and nine provinces (Tianjin, Shanghai, Zhejiang, Shandong, Guangdong, Chongqing, Ningxia, Qinghai and Corps) have fully realized the system integration before the release of the the State Council document, and all the above 17 provinces have broken through the urban-rural division of medical insurance. Clearly put the integrated unified basic medical insurance system for urban and rural residents under the management of human and social departments, realizing the unified management of the universal basic medical insurance system and even the whole social insurance system, which fully shows that the local party committees and governments have a high degree of knowledge of the unified medical insurance management system and a profound understanding of the social security system with China characteristics.

From the perspective of local practice, the system integration has achieved remarkable results: First, the masses have generally benefited, and the sense of reform has been enhanced. In practice, all localities have adopted the idea of "low payment is not high, high treatment is not low, wide catalogue is not narrow", and the fairness of residents' medical insurance system has been significantly enhanced, especially the utilization level and security level of rural residents' medical services have been generally improved. The second is to improve the efficiency of public services and reduce administrative costs. Relying on the social insurance public service system, the integrated management services such as enrollment registration, fund collection, rights and interests record and treatment payment have been realized, avoiding repeated investment and multi-head construction and reducing repeated enrollment and subsidies. Only the integration of Shandong Province eliminated 2.5 million people who participated in repeated insurance, saving more than 8 million yuan in financial repeated subsidies that year. Third, it has enhanced the mutual aid ability of the medical insurance fund, which is conducive to giving play to the basic role of medical insurance in medical reform. All localities pay attention to the law of social medical insurance system, promote the external incentive and restriction of medical insurance on medical services, and provide a solid foundation for the linkage reform of three medical services.

The current basic medical insurance system in China

(1) Basic medical insurance for urban workers. It is a social medical insurance system that guarantees the basic medical needs of employees according to the affordability of finance, enterprises and individuals, and implements territorial management. The basic medical insurance premium is borne by both employers and employees, and the basic medical insurance is combined with social pooling and personal accounts.

(2) Basic medical insurance for urban residents. It is a medical insurance system with urban minors and unemployed urban residents who have not participated in medical insurance for urban workers as the main participants; The basic medical insurance for urban residents is mainly based on family contributions, and the government gives appropriate subsidies;

(3) New rural cooperative medical system. Is organized, guided and supported by the government, farmers voluntarily participate, individuals, collectives and the government to raise funds in many ways, mainly to co-ordinate the serious illness of farmers medical mutual aid system.

the State Council interprets and integrates the basic medical insurance for urban and rural residents

1. Why should the basic medical insurance system for urban residents be integrated with the new rural cooperative medical system?

in p>23 and 27, China established the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system) and the basic medical insurance system for urban residents (hereinafter referred to as the urban residents' medical insurance system) respectively for rural population and urban unemployed population. Since the establishment of the system, the coverage has been continuously expanded, the level of security has been steadily improved, and the system has been running steadily, which has played an important role in improving the basic medical insurance system for all, meeting the basic medical insurance needs of the people and improving the health level of the people.

in recent years, with the rapid development of economy and society, the negative effects of the urban-rural division of the two systems have begun to appear, and there are problems such as repeated participation in insurance, repeated investment and insufficient treatment. On the basis of summarizing the operation of urban residents' medical insurance and the new rural cooperative medical system, as well as the practical experience of local exploration, the CPC Central Committee and the State Council clearly put forward to integrate the two systems of urban residents' medical insurance and the new rural cooperative medical system, and establish a unified basic medical insurance system for urban and rural residents.

second, how is the local exploration and integration of urban and rural residents' medical insurance system progressing? What is the implementation effect?

At present, some provinces, cities and counties have integrated the medical insurance system for urban and rural residents. All localities generally straighten out the administrative system according to the path of "centralized management first, then integration", unify policies according to the principle of "low financing is not high, high treatment is not low, and the catalogue is not narrow", and adopt the way of "one system with multiple files, linking financing and treatment" to gradually transition and establish a unified basic medical insurance system for urban and rural residents. Integrate handling management resources and implement integrated handling services. Improve the level of information management by improving the medical insurance information management system. Properly handle special problems, do a good job in system convergence and achieve a smooth transition.

On the whole, local exploration provides a useful reference for integrating the medical insurance system for urban and rural residents nationwide. The integration of some areas has achieved initial results, expanded the fund's ability to resist risks, and avoided repeated participation in insurance, subsidies and construction to some extent. However, due to the lack of top-level design and system promotion, the coordinated development of medical insurance system and medical service system needs to be further strengthened, and the financing fairness of medical insurance system needs to be further improved.

third, what is the significance of the central government's decision to comprehensively promote the integration of medical insurance system for urban and rural residents?

integrating the medical insurance for urban residents and the new rural cooperative medical system and establishing a unified medical insurance system for urban and rural residents is an important measure to promote the reform of medical and health system, realize the fair enjoyment of basic medical insurance rights and interests for urban and rural residents, promote social fairness and justice, and enhance people's well-being, and is of great significance to the coordinated development of urban and rural economy and society and the comprehensive construction of a well-off society. Establishing the medical insurance system for urban and rural residents is conducive to promoting fairer security, more standardized management services, more effective use of medical resources, and promoting the sustained and healthy development of the universal medical insurance system.

fourth, what is the general idea of comprehensively promoting the integration of urban and rural residents' medical insurance system? How to grasp the basic principles?

the general idea is to start with the policy, make it easy first and then difficult, step by step, and "unify the system, integrate the policy, balance the level, improve the mechanism and improve the service". Highlight the integration of institutional policies and implement "six unifications"; Highlight the rationalization of the management system, integrate the handling institutions, and provide integrated urban and rural handling services; Highlight the improvement of service efficiency, realize gradual transition and smooth integration, and establish a unified basic medical insurance system for urban and rural residents.

Basic principles: First, overall planning and coordinated development. Integrate the medical insurance system for urban and rural residents into the development of universal medical insurance system and deepen the overall situation of medical reform, highlight the linkage of "medical insurance, medical care and medicine" and strengthen the system convergence. The second is to base on basics and ensure fairness. Based on the level of economic and social development, the burden of urban and rural residents and the affordability of funds, we will fully consider and gradually narrow the urban-rural gap and regional differences to ensure that urban and rural residents enjoy basic medical insurance benefits fairly. The third is to promote it according to local conditions and in an orderly manner. Strengthen the connection before and after the integration, ensure the smooth continuity and orderly transition of work, ensure that the basic medical insurance benefits of the people are not affected, and ensure the safety of the fund and the smooth operation of the system. The fourth is to innovate mechanisms and improve efficiency. Adhere to the separation of management and operation, improve the management and operation mechanism, and further promote the reform of payment methods. Give full play to the role of the market mechanism and mobilize social forces to participate in the basic medical insurance service.

5. how to implement the "six unifications" in the process of integrating the medical insurance system for urban and rural residents?

to integrate the medical insurance system for urban and rural residents from the perspective of policies, the key point is to integrate its financing and treatment guarantee policies. On the basis of studying and comparing the differences between the original two systems and summarizing the practical experience in various places, the policy integration requirements of "six unifications" are put forward.

first, we should unify the coverage. Medical insurance for urban and rural residents covers other urban and rural residents except the urban employed population. Migrant workers and flexible employees who have difficulties in participating in employee medical insurance are allowed to choose to participate in urban and rural residents' medical insurance.

second, we should unify the fund-raising policy. Adhere to multi-channel financing, reasonably determine the unified financing standards for urban and rural areas, improve the dynamic adjustment mechanism of financing, and improve the financing sharing structure. In areas where there is a big gap between urban residents' medical insurance and the new rural cooperative medical system, different payment methods can be adopted to gradually transition. Gradually establish a mechanism to link individual payment standards with the per capita disposable income of urban and rural residents.

Third, we should guarantee the treatment in a unified way. Gradually unify the scope of protection and payment standards, keep the proportion of hospitalization expenses within the policy range at around 75%, and gradually improve the level of outpatient protection. Properly handle the convergence of special safeguard policies before and after integration, and gradually narrow the gap between the payment ratio within the policy scope and the actual payment ratio.

Fourth, unify the medical insurance catalogue. According to the relevant provisions of the state, all provinces follow the principles of clinical necessity, safety and effectiveness, reasonable price, appropriate technology and affordable funds, and on the basis of the existing urban residents' medical insurance and the new rural cooperative medical system, give due consideration to the changes in the needs of the insured, and formulate a unified catalogue of medical insurance drugs and medical services.

Fifth, unified fixed-point management. Unify the management measures of designated institutions, strengthen the management of designated service agreements, improve the evaluation mechanism, and implement dynamic access and exit. Adopt a policy of equal treatment for social medical treatment.

Sixth, unify fund management. Implement a unified fund financial system, accounting system and fund budget and final accounts management system, strengthen internal control management and external supervision system, promote total payment control, improve fund operation risk early warning mechanism, reasonably control fund balance, prevent fund risks and improve efficiency.