Unit payment part is no longer included, why should the individual account of medical insurance be adjusted? Political interpretation

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 Unit payment part is no longer included, why should the individual account of medical insurance be adjusted? Political interpretation


u2014u2014Before the adjustment, the individual account includes all the individual payment and 30% of the unit payment

According to the decision of the State Council on establishing the basic medical insurance system for urban employees promulgated in 1998, the basic medical insurance premium is jointly paid by the employer and the employees. The payment rate of employers should be controlled at about 6% of the total wages of employees, and the payment rate of employees is generally 2% of their wage income. With the development of economy, the payment rate of employers and employees can be adjusted accordingly.

The basic medical insurance fund consists of pooling fund and individual account. The basic medical insurance premium that worker individual pays, all count into individual account. The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish the overall planning fund, the other part is transferred into the individual account. The proportion that delimits into individual account is 30% or so of unit of choose and employ persons commonly, specific proportion is decided by area of plan as a whole according to the pay scope of individual account and worker age and other factors.

In other words, in the past, the money in the personal account of medical insurance was the total payment of individual medical insurance and 30% of the payment of unit medical insurance.

Qiu Yulin, a professor of labor and personnel College of Renmin University of China, said that the personal account of employee medical insurance has the function of reimbursement for outpatient expenses, but the design of personal account is the product of a specific historical period. At the beginning of the implementation of the employee medical insurance system, the state considered that in the past planned economy period, employees did not need to pay insurance premiums and lacked the awareness of participating in insurance. Therefore, the government needs to establish a mechanism that can make the public accept the payment smoothly, and at the same time, cultivate personal saving consciousness and control medical expenses. Therefore, the mode of combination of unified accounts has been established, resulting in personal accounts.

Different from the previous public medical and labor insurance medical treatment, the new basic medical insurance for employees requires enterprises and individuals to pay jointly. From never paying to paying, there is a problem of the compliance of the employees. The funds of individual account do not participate in the overall planning and can be carried forward for use, which is conducive to improving the enthusiasm of employees to participate in insurance and the compliance of payment. This is the first major reason for setting up a personal account. Wang Zhen, a researcher at the Institute of economics, Chinese Academy of Social Sciences, said.

Q2. Why should we adjust the method of personal account?

Personal account is actually a compromise between social environment and policy objectives in the process of medical insurance system reform. At present, the personal account has basically achieved the two goals of ensuring the smooth progress of the reform and encouraging the enthusiasm of individuals to pay fees. Qiu Yulin said, however, the current increase in medical expenses is no longer the result of simple personal lack of saving consciousness. Factors such as social and economic development, expansion of medical demand, progress of medical technology, changes in disease spectrum and medical service misconduct have all exacerbated the sustained growth of medical expenses.

Qiu Yulin believes that with the proposal of policy objectives such as fair participation of everyone, deepening the function of medical insurance, and reducing the burden of units and individuals, personal accounts can not fully meet the current needs. Deepening the function of medical insurance depends on the large amount of funds, especially the scale of the overall fund. However, the individual account disperses the total amount of the overall fund and reduces its security ability. In addition, the situation that the individual payment is fully entered into the individual account and the higher proportion of the unit payment is transferred into the individual account greatly reduces the mutual aid function of the medical insurance fund.

In fact, the accumulation of personal accounts is limited, Wang Zhen, a researcher at the Institute of economics, Chinese Academy of Social Sciences, explains that although statistically speaking, the medical expenses of the elderly are higher than those of the young, so that they can be accumulated in the young and used in the old. However, for individuals, they are faced with disease risk in the whole life cycle, and the accumulation function of personal accounts is limited. In 2018, the per capita accumulated amount of employee medical insurance personal account was only about 2300 yuan; the per capita hospitalization expenses of employee medical insurance in that year had exceeded 11000 yuan. If there is no mutual aid, this figure is also limited to alleviate the high medical expenses after old age.

At present, the outpatient treatment of some serious diseases and chronic diseases and daytime surgery have been included in the scope of overall payment in most areas. Beijing, Shanghai, Zhejiang, Guangzhou, Qingdao, Xiamen and other places have gradually carried out the exploration of the reform of the personal account system and the overall planning of outpatient expenses. Wang Zhen believes that, from the perspective of effect, it improves the outpatient treatment level of the insured and the use efficiency of medical insurance funds.

The core measure of the reform at the national level is to establish and improve the overall medical cost guarantee mechanism of general outpatient department. The reform opinions are clear, starting with chronic diseases such as hypertension and diabetes, which are heavily burdened by the masses, and gradually include the common outpatient medical expenses of common diseases and common diseases into the payment scope of the overall planning fund. The general outpatient service covers all employees, and the payment proportion starts from 50%.

To enhance the co-ordination ability of medical insurance fund, we should adjust the structure of individual account. This is one of the considerations in the policy of improving the method of recording personal accounts.

u2014u2014The money in the future personal account does not include 30% of the units payment

According to the requirements of the reform, the basic medical insurance premium paid by the individual is included in the personal account of on-the-job employees. In principle, the basic medical insurance premium paid by the unit is included in the overall planning fund. In principle, the individual account of retirees is transferred by the pooling fund according to the quota, and the amount is 2% of the basic pension at the time of the local reform It will not be adjusted in the next year.

According to the above principles, the provincial medical insurance department shall guide the overall planning area to determine the specific proportion or standard of individual account according to the above principles and in combination with local reality. After the adjustment of the unified account structure, the reduction of funds transferred into individual accounts is mainly used to support and improve outpatient mutual aid security and improve outpatient treatment.

In other words, in the future, the amount of money in the personal account of medical insurance will be reduced by one yuan, that is, the basic medical insurance premium paid by the unit will be included in the overall planning fund, and 30% of the past unit payment will be gone.

For the reformed individual medical insurance account, Qiu Yulin said that it is necessary to return to the essence of medical insurance, adjust the personal account to adapt to the new environment, new situation and new policy objectives, so as to realize the continuity of the old and new missions. Based on the function of individual account itself to pay for outpatient minor diseases, the policy demand of establishing outpatient co-ordination also provides an opportunity for the adjustment of individual account u3002

She believes that on the one hand, it is imperative to adjust personal accounts, but reform and adjustment need to adhere to the principles of equity replacement, smooth transition, reasonable conversion and policy coordination. The existing accumulated part (stock fund) of individual account is owned by individual, so the existing personal account can be retained and its functions can be expanded, including maintaining the existing functions of paying outpatient expenses and drug stores, allowing individual accounts to pay for medical insurance expenses of family members (such as residents insurance payment), and can also be used in more fields related to medical insurance.

On the other hand, the individual payment is also entered into the individual account, but the unit payment is gradually transferred to the overall planning fund to establish the outpatient co-ordination, so as to guarantee the outpatient expenses of the insured. In terms of outpatient co-ordination, combined with the existing outpatient coordination system of chronic and special diseases and serious diseases, we should comprehensively adjust from disease type outpatient coordination to expense outpatient coordination, that is, outpatient service items and drugs in line with the three catalogues should be paid according to the medical insurance policy.

Q4. What will be the impact of the reform of personal accounts?

This reform not only improves the method of recording personal accounts, but also expands the scope of use of personal accounts.

The reform opinion is clear, the personal account is mainly used to pay the self paid expenses of insured employees in the policy scope of designated medical institutions or designated retail pharmacies. It can be used to pay the medical expenses borne by the employees themselves and their spouses, parents and children in the medical institutions designated by medical insurance, and the expenses borne by individuals when purchasing drugs and medical consumables in designated retail pharmacies. The purpose of this study is to explore the individual payment of spouse, parents and children participating in basic medical insurance for urban and rural residents.

In terms of the total effect, Wang Zhen said, it should be sober to realize that peoples participation in medical insurance is not for the accumulation of funds in personal accounts, but to better cope with the economic risks brought by diseases. Therefore, only through collective strength and mutual aid can individual risks be resolved. By replacing part of the funds in individual accounts with the outpatient expenses co-ordination security mechanism, the protection of outpatient expenses is not limited to the funds in individual accounts, and the guarantee ability and level can be significantly improved.

With the overall improvement of support capacity and level, there is also a problem of interest adjustment. It should be said that this is also the highest concern of all sectors of society. In the case of outpatient expenses paid by the overall fund, weakening the individual account will not have a negative impact on the insureds outpatient security rights and interests, and the actual level of protection is still improved.

The reason why the establishment of outpatient co-ordination will damage the rights and interests of the insured is actually a misreading of the capital attribute of individual accounts. Wang Zhen said that according to the current law, personal account funds are used by individuals, but the nature of the funds is still medical insurance funds, which are used for special purposes, and cannot be used at will.. Of course, in the process of reform, we should fully consider the current situation of the use of personal account funds, grasp the pace of reform, and take the way of gradual reform under the premise of ensuring that outpatient treatment does not decline.

(function(){( window.slotbydup=window .slotbydup||[]).push({id:u5811557,container:ssp_ 5811557, async:true }Wang Zhen explained that the incentive effect is reflected in two aspects: first, after the outpatient expenses pooling fund is paid, the excessive hospitalization due to the lack of outpatient co-ordination is reduced to reduce the demand for hospitalization. This is also an important measure to promote hierarchical diagnosis and treatment. Second, after the establishment of outpatient co-ordination, outpatient expenses should be standardized. Under the personal account system, some insured people use their personal account funds to buy all kinds of health care products and even daily necessities. Some areas also have illegal phenomena such as cashing out of personal accounts of insured persons. After the outpatient expenses are included in the overall fund payment, the outpatient and pharmacy expenses are included in the unified management of the overall fund, so as to improve the standardized use of the fund, so as to improve the utilization efficiency of the medical insurance fund. New Beijing News reporter Wu Wei editor Chen SI unit medical insurance payment no longer into personal account unit medical insurance payment no longer into personal account employee medical insurance personal account to be used for family members source: new Beijing News Editor in charge: Liu Xiaowu_ NN4113

Wang Zhen explained that the incentive effect is reflected in two aspects: first, after the outpatient expenses pooling fund is paid, the excessive hospitalization due to the lack of outpatient co-ordination is reduced to reduce the demand for hospitalization. This is also an important measure to promote hierarchical diagnosis and treatment. Second, after the establishment of outpatient co-ordination, outpatient expenses should be standardized. Under the personal account system, some insured people use their personal account funds to buy all kinds of health care products and even daily necessities. Some areas also have illegal phenomena such as cashing out of personal accounts of insured persons. After the outpatient expenses are included in the overall fund payment, the outpatient and pharmacy expenses are included in the unified management of the overall fund, so as to improve the standardized use of the fund, so as to improve the utilization efficiency of the medical insurance fund.

Wu Wei, reporter of Beijing News

Editor CHEN Si

Unit medical insurance payment no longer enters individual account