It is reported that on August 26, the National Medical Insurance Bureau issued the Guiding Opinions on Establishing and Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients (Draft for Comment), clearly proposing to establish and improve the economic security mechanism for all employees' general outpatient medical expenses, including on-the-job employees and retirees.
Starting with chronic outpatient diseases such as hypertension and diabetes, the general outpatient medical expenses of frequently-occurring and common diseases will be gradually included in the scope of payment of the overall fund.
Extended data:
Changes in employee medical insurance:
1. Improve personal account entry methods.
Methods and levels for scientifically and reasonably determining personal accounts. Personal accounts of on-the-job employees are included in the basic medical insurance premiums paid by individuals, and the inclusion standard is controlled within 2% of the base of my insured payment in principle. The basic medical insurance premiums paid by the unit are all included in the overall fund; In principle, the individual accounts of retirees are allocated by the overall fund according to the quota, and the amount allocated is calculated at about 2% of the basic pension during the reform in this area, and will not be adjusted in the future.
2. Standardize the scope of personal accounts.
Personal accounts are mainly used to pay 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.
Explore the personal accounts of spouses, parents and children participating in the basic medical insurance for urban and rural residents. Personal accounts shall not be used for public health expenses, physical fitness or health care consumption and other expenses that are not covered by the basic medical insurance. Improve the management measures for the use of personal accounts, and do a good job in revenue and expenditure information statistics.
3. Strengthen supervision and management.
Improve the management service measures, innovate the system operation mechanism, guide the rational use of medical resources, and ensure the stable operation of medical insurance funds and the effect of system guarantee. Strictly implement the fund budget management system and strengthen the fund audit system and internal control system. Establish a dynamic management mechanism for the whole process of personal accounts, and strengthen the audit of the use and settlement of personal accounts.
Strengthen the supervision of outpatient medical behavior and medical expenses, establish a fund safety prevention and control mechanism, crack down on insurance fraud, and ensure the safe, efficient and rational use of funds. Innovate the management mode of outpatient medical services, improve the monitoring, analysis and assessment system of medical services, and guide medical institutions to control the cost of medical services.
4. Improve the payment mechanism suitable for outpatient medical treatment.
Primary medical services are paid per head, and the combination of payment per head and chronic disease management is actively explored; For daytime surgery and eligible outpatient special diseases, payment shall be made according to the disease type and the population related to disease diagnosis; For outpatient expenses that are not suitable for package payment, they can be paid by project.
China Net-National Medical Insurance Bureau: The outpatient expenses of medical insurance for employees are to be included in the reimbursement.
China Economic Net-The outpatient expenses of medical insurance for employees will be included in the scope of reimbursement, and the reimbursement ratio will start at 50%.