Establish and improve the basic medical insurance outpatients of employees

Original title: Establish and improve the basic medical insurance outpatients of employees Xinhua News Agency, Beijing April 22, the General Office of the State Administration, issued the "Guidance Opinions on Establishing and Establishing the Basic Medical Insurance Outpatient" (hereinafter referred to as " .

  "Opinions" pointed out that in order to further improve the basic medical insurance system of employees, the employee’s medical insurance system, better solve the problem of outpatient protection of employee medical insurance, and effectively mitigate the burden of medical expenses, and formulate "opinions". "Opinions" proposed, to be guided by Xi Jinping’s new era of Chinese characteristics, comprehensively implement the party’s 19th National Congress and 19th Second Middle School, Three Middle School, Fourth, Five Plenary Segregation, which is doing effort, but also OK, persistence, everyone, improve the system, guide expectations, speed up the key sectors of medical protection, and incorporate outpatient costs into the scope of employee medical insurance policy, reform employee medical insurance personal account, establish and improve outpatient access Mechanism, improve the efficiency of medical insurance funds, and gradually reducing the burden of medical expenses of insured personnel, and achieving a more fairness of the system. The "Opinions" proposed a specific measures to establish and improve the mobility of the employee medical insurance outpatient.

  First, enhance the function of outpatients. Establish and improve the general outpatient cost of the general outpatient cost of employees, and gradually incorporate multiple diseases and common diseases.

General outpatient coordinates to cover all insured personnel of employees, the payment ratio within the policy range starts from 50%, and it can be tilted to retirees. Gradually expanded from the outpatient chronic disease, the range of special diseases, and the length of the disease period, the length of the disease is long, the health damage is high, and the cost is heavy. Synchronize and improve the overall planning of urban and rural residents.

Support for insured personnel to settle and dispensing in fixed-point retail pharmacies. Explore the integration of "Internet +" medical services in accordance with the support. The second is to improve the number of individual accounts. In the case of the basic medical insurance premium paid by the personal account, the employment of the individual account is included in the basic medical insurance premiums, and the standard is controlled in principle of 2% of my payment base. All basic medical insurance premiums paid by the unit are all included in the Co-ordination Fund. The personal account of the retirees is mainly classified by the co-ordination fund, and the amount is gradually adjusted to the co-ordination area according to the "Opinions" implementation reform. The basic pension has a average level of about 2%.

The increased co-ordination fund is mainly used for outpatient access and improves outpatient treatment.

  The third is to standardize the scope of use of personal accounts. Personal accounts are mainly used for payment of insured personnel to pay within the medical insurance policy. It can be used to pay the insured person and its spouse, parents, and children in designated medical institutions, medical expenses, and personal burden on personal burdens, medical equipment, medical supplies in fixed-point retail pharmaceutical, medical consumables. Explore personal accounts for spouses, parents, children to participate in urban and rural residents’ medical insurance. The regulations are not subject to the scope of medical insurance. The fourth is to strengthen supervision and management.

Strictly implement the medical insurance fund budget management system, strengthen the fund audit and internal control construction. Strengthen the review of personal accounts, settlement and other links. Strengthen the supervision of medical behavior and medical expenses, severely crack down on fraud.

Promoting outpatient costs in different places.

Cooperate to promote the construction of the grassroots medical service system.

  The fifth is to improve the payment mechanism of adaptation with outpatients. The basic medical services can be paid according to the human head, actively explore will be combined with chronic disease management by human head; for daytime surgery and eligible outpatient special disease, it is charged for a disease or according to disease diagnosis. Scientifically determine medical insurance drug payment standards.

  "Opinions" requires that all provincial people’s governments must attach great importance to the establishment of coordination mechanisms, and do a good job in work. In the past 2021, the implementation approach will be introduced to guide all-in-laws, and the policies shall be set up for 3 years. Left and right transition period, gradually implement the reform target. We must pay attention to promotional guidance, accurate interpretation of policies, and vigorously promote the importance of medical insurance to build sharing, mutual help, and actively respond to social concerns and create a good public opinion atmosphere. "People’s Daily" (April 23, 2021) (Editor: Yan Yuan, Xuan Zhaoqiang).