Different places in the province for medical treatment next year, the basic realization of the national roaming difficulties

The Ministry of Human Resources and Social Security, the Ministry of Finance, and the Health and Family Planning Commission jointly issued the "Guiding Opinions on Further Completing the Settlement of Basic Medical Insurance Expenses for Medical Treatment and Medical Expenses" in recent days, and has made substantial contributions to the issue of medical settlement for people who are concerned by the people. promote. However, it is impossible to achieve the ultimate goal of “roaming” medical insurance nationwide.

Medical insurance "roaming" to solve 90% of different places for medical treatment

Zhang Axuan from Xiangfan City, Hubei Province retired to the provincial capital and resided with his son. Because he had a heart attack and often needed hospitalization, reimbursement of medical expenses became her “heart disease”:

“Before the provincial capital, it is necessary to record in the health insurance center of the participating places, and you must see a doctor in a pre-specified Provincial City Hospital to reimburse the hospitalization fee.” Zhang Aunt said, “Each time you are hospitalized in the provincial capital, you must first pay for the hospital. Then return to participating in the insurance. Mail is afraid of losing. Tolls in person are not a small expense.”

Auntie Zhang told reporters that even more troublesome is the reimbursement procedures - discharge records, cost lists, expense receipts, inspection reports and other materials are not less, but also to find the hospital seal, proof, get less of these materials for a week time. Then take these materials to the participating health insurance center for review. If the materials are complete, it will take about one month to get the reimbursement part of the expenses. If the materials are not uniform, you have to toss back and forth several times, which is time-consuming and laborious.

The introduction of opinions has given Zhang Alu people a glimmer of hope: In 2015, China will basically realize the direct settlement of hospital fees for medical treatment in different places within the limits of the city and the province (region, city).

“According to the calculation, the 'roaming' in the Ministry of Health and Medical Services can solve 90% of the problems of medical treatment in different places.” According to the relevant person in charge of the Ministry of Human Resources and Social Security, the number of people who go to the province for treatment is relatively small, and most of them can be solved in the city and the province.

Medical insurance nationwide "roaming" a substantial breakthrough

Opinions are clear: In 2016, the settlement of hospitalization expenses for retirees across provinces will be fully realized.

“This part of the staff is mainly educated youth, supporters, and supporters of the city. There are about 2 million people.” According to the relevant person in charge of the Ministry of Human Resources and Social Security, these people are generally old and have a heavy medical burden and do not return to the protected areas for a long period of time. The “running errands” and “advancement support” issues when treating patients for reimbursement have the greatest impact on them. Therefore, the need for direct settlement of medical expenses in other places is most urgent.

"The introduction of opinions is a substantial breakthrough in advancing medical insurance nationwide roaming," said Yan Fuling, director of the Department of Social Security at Central University of Finance and Economics. Although the opinion only provides that the relocation of resident retiree medical expenses in other places can be cross-provincial settlement, the nation-wide medical treatment settlement The establishment of the platform will provide technical support for the realization of a wider range of remote medical treatment settlements for the wider population in the next step, and the speed of achieving comprehensive medical insurance “roaming” will be greatly accelerated.

“The next step, combined with the advancement of the reform of the household registration and residence permit system, where conditions permit, we can explore the possibility of including other inter-provincial residents in the direct settlement of inpatient medical expenses on the basis of summing up experience and provide better services for the majority of insured personnel. Medical insurance settlement service," said the person in charge of the Ministry of Human Resources and Social Affairs.

Medicare cross-provincial "roaming" is still difficult to see

With the relocation of their children to the provincial capital, the educated youth returning to the city, and so on, the issue of medical insurance “roaming” has been solved. When will workers working in other cities and other places solve problems when they can solve the problem?

"The medical insurance nation's roaming" can not be achieved in one step and in one go. It must be orderly." The relevant person in charge of the Ministry of Human Resources and Social Affairs said frankly, "On the one hand, we must establish a hierarchical diagnosis and treatment model. On the one hand, we must consider the support capabilities of the medical insurance fund."

Wang Hua, director of the hospital management research institute of Huazhong University of Science and Technology Hospital, said that the distribution of medical resources in different regions of the country is still unbalanced. The first-tier cities such as Kita-Shangguang have gathered many well-known large hospitals and have also recruited patients from all over the country.

Take the hospital in Beijing as an example, patients in the field accounted for nearly 60% of the total number of medical visits, and this is still the case of direct settlement without medical treatment. If the classification and treatment system cannot be implemented, once medical insurance is completely released, it will increase the concentration of medical personnel to major cities and large hospitals.

Hu Jing, head of the Medical and Health Benefit Division of the Chongqing Municipal Social Security Bureau, said that at present, China's medical insurance is subject to territorial management. Once the medical treatment is fully opened in a remote place, the payment pressure of the medical insurance fund at the outflow area of ​​the population will suddenly increase, eventually affecting the medical insurance of other insured personnel. Treatment and long-term sustainable development of the basic medical insurance system.

To achieve medical insurance nationwide "roaming", Yan Fuling suggested that the state should complete the provincial level co-ordination of medical insurance as soon as possible, and fundamentally break the bottleneck of the system of medical settlement in other places. Mei Yongchuan, the deputy director of the Second Affiliated Hospital of Chongqing Medical University, pointed out that the promotion of immediate reimbursement for medical treatment in other places must follow the diagnosis and treatment policy of “differentiated diagnosis and treatment, and two-way referral” to form “a minor illness into the community, a serious illness into the hospital, and rehabilitation back to the community”. Seek medical network.

"In addition, the realization of medical insurance 'roaming' is still ultimately pointing to the health insurance fund's enrichment." Ruan Fuling said, "The state should increase resources and reduce expenditures to enrich the health insurance fund. From the open source, it is necessary to increase the proportion of financial subsidies and state-owned enterprises' profit allocation; from the point of view, it is necessary to strengthen medical insurance. The supervision and management of the fund will promote the maintenance and appreciation of the health insurance fund and increase the profitability."