Medical security support "who to protect" and "how to support"? National medical insurance bureau answers hot questions
2021-11-24
Recently, the general office of the State Council issued the opinions on improving the medical insurance and relief system for major and serious diseases (hereinafter referred to as the opinions), clarifying the scope of relief objects, the coverage of relief expenses, the starting payment standard and the proportion of relief. "We should focus on balancing the relationship between efficiency and fairness, mutual aid and the bottom line, and build a strong defense line for the bottom line security of low - and middle-income families." relevant responsible comrades of the National Medical Security Bureau answered reporters' questions on the bottom line of medical security, such as "who to protect", "how to trust" and "to what extent". Build a "safety net" for basic medical security for low - and middle-income families Q: what are the overall considerations in alleviating the burden of medical expenses on people in need and seriously ill patients? A: the opinions focuses on the people, adheres to the principle of ensuring basic health care as much as possible, adheres to doing our best and acting according to our ability, closely adheres to the issues of "who to protect", "how to trust", "to what extent" and "how to establish a long-term mechanism", and speeds up the formation of a multi-level medical security system led by the government and participated by the society. The main measures can be summarized as "1 + 5 + 4": "1" is to focus on one goal, that is, to reduce the burden of medical expenses for major diseases of people in difficulty, consolidate the basic guarantee function of the medical security system, build a "safety net" for basic medical security for low - and middle-income families, and solidly promote common prosperity. "5" is to clarify five key measures, including precise rescue, step-by-step burden reduction, firm support and long-term assistance: first, scientifically determine the scope of rescue objects, cooperate with and improve the accurate identification mechanism of rescue objects, and ensure timely rescue; Second, strengthen the comprehensive guarantee of the triple system, and form an echelon burden reduction mechanism according to the principle of "insurance before rescue" to ensure that all insurance should be guaranteed; Third, we should make overall plans to improve the relief support scheme, do our best and do what we can to ensure that we should save as much as possible, and prevent welfarism at the same time; Fourth, establish and improve a long-term mechanism to prevent poverty and return to poverty due to illness, cooperate to do a good job in risk investigation, ensure early warning and assistance of risks, and firmly stick to the bottom line of preventing large-scale return to poverty due to illness; Fifth, pay attention to giving full play to the role of supplementary security such as charitable assistance and commercial health insurance, explore and establish a support mechanism for social forces to participate in assistance and security, and give better play to the joint force of security. "4" is to strengthen four supporting measures and put forward specific requirements from the aspects of service, organization, capital, capacity and other element guarantee, including standardizing handling and management services, strengthening organization guarantee, strengthening fund budget management, improving the level of grass-roots capacity-building, etc. The burden of medication for patients with major diseases will be further reduced Q: in the new development stage, how can we ensure the stable realization of the tasks and objectives set forth in the opinions and further enhance the underpinning function? A: the opinions put forward clearer requirements on the implementation of specific measures: First, the object classification management is more refined. While doing a good job in providing assistance to low-income people such as the minimum living security, the extremely poor and the people who are easy to return to poverty, we will extend coverage to marginal families with minimum living security and seriously ill patients from families with difficulty in spending due to illness. With the refinement of the identification standards for people in difficulty by relevant departments, the low-income population included in the assistance will achieve a certain growth in addition to the low-income security objects and the extremely poor. Second, the triple system guarantees a smoother connection. Under the framework of the multi-level security system, the functional orientation of medical insurance and medical assistance has been further clarified, the "insurance before assistance" has been implemented, and the comprehensive security efficiency of the triple system has been brought into full play to ensure that all insurance should be guaranteed. Third, there are innovations in the rescue support scheme. According to the support ability of the relief fund, improve the fair and appropriate relief treatment mechanism, reasonably determine the relief treatment standards, coordinate the outpatient chronic diseases and inpatient relief funds, share the annual relief limit, and implement preferential relief for the relief objects with heavy burden. Fourth, the long-term mechanism has made practical moves. We will strengthen early warning and monitoring of high medical expenses, do a good job in early warning of poverty caused by illness and return to poverty due to illness, and make risk research and judgment more accurate. For key monitoring groups, implement assistance according to application, and comprehensive assistance measures are more accurate. Fifth, there is a starting point for the participation of social forces. Guide charitable organizations to carry out various forms of serious illness relief, support medical assistance for employees, standardize mutual assistance on Internet platforms, encourage the development of commercial health insurance, and better meet the security needs of patients with serious illness other than basic medical security. Sixth, supporting measures are more accurate. Guide patients to standardized referral and orderly medical treatment, and strictly control the occurrence of unreasonable medical expenses. We will improve the policy of "diagnosis and treatment before payment" for hospitalized people with difficulties in the city, and reduce the pressure on patients to advance funds. At the same time, with the continuous improvement of the dynamic adjustment mechanism of the medical insurance catalogue and the normalized and institutionalized centralized bidding procurement of drugs and consumables, the drug burden of patients with some major diseases will be further reduced. Solve the problems of policy imbalance and regional imbalance Q: what are the considerations in coordinating and optimizing the support mechanism? A: the opinions focuses on promoting the fair and sustainable development of the relief system and puts forward relevant measures to consolidate the supporting function of medical assistance. It mainly solves the problems of policy imbalance and regional imbalance, focusing on the requirements for standardizing the scope of expenses, rescue standards and preferential measures, which will help to narrow the difference in rescue levels between urban and rural areas and regions, balance the guarantee level of different types of rescue objects, and narrow the treatment difference between people. Specific measures include: First, standardize relief costs and meet basic security needs. Adhere to the basic principle of assistance and focus on solving the basic medical needs within the policy scope of the assistance object. Coordinate the needs of inpatient and outpatient treatment, so as to ensure not only the hospitalization expenses, but also the long-term outpatient treatment and medication expenses of patients with chronic diseases. Do a good job in the connection of payment policies, include the expenses below the starting line of basic medical insurance and serious illness insurance into the relief, and reduce the burden of "threshold fee". Second, reasonably determine the standards, classify and balance the rescue level. According to the principle that the more difficult the economy, the heavier the medical burden and the higher the level of assistance, the "three lines" of treatment payment shall be reasonably set. For example, in principle, the starting payment standard for the objects of subsistence allowances and the extremely poor shall be cancelled. The marginal family members of subsistence allowances and seriously ill patients with difficulty in spending due to illness shall set different starting payment standards with reference to a certain proportion of the per capita disposable income in the overall planning area last year, so as to avoid "sowing sesame seeds" of relief funds and prevent "laziness". In terms of the relief proportion, the relief proportion for the minimum living standard and the extremely poor shall not be less than 70%, and the relief proportion for other relief objects shall be determined by all localities according to the actual situation, which is slightly lower than the minimum living standard. The annual relief limit is also reasonably determined according to the actual support capacity of the fund to avoid unrealistic and blind elevation. The third is to improve the supporting measures, focusing on patients with serious and chronic diseases. From the original inpatient and outpatient chronic and special disease support projects separately set up and funds managed separately, it is adjusted to unified projects, overall funds and shared annual relief quota. For the relief objects who still have a heavy personal burden after being guaranteed by the triple system, the local government shall give preferential assistance at its own expense within the scope of its policy according to the actual situation. In addition, reduce medical costs by clarifying diagnosis and treatment plans and standardizing diagnosis and treatment, and reasonably control the proportion of out of pocket expenses within the scope of policies for people with difficulties. Give full play to the supplementary and guarantee role of social forces Q: what overall consideration has the opinions made in the overall system design for the problem that some patients with special and major diseases still report heavy burden? A: first, the overall implementation of the triple system comprehensive guarantee. Lock in the expenses within the scope of the basic medical insurance policy, improve the triple system echelon burden reduction mechanism, accurately implement the preferential payment of serious illness insurance, consolidate the bottom guarantee of relief, and improve the efficiency of comprehensive security. Second, optimize management services and reduce medical costs. Give play to the role of the purchase and price leverage of the medical insurance fund group, improve the dynamic adjustment mechanism of the medical insurance catalogue, organize centralized bidding procurement of drugs and consumables, and reduce the medical cost of patients. Strengthen supervision, further standardize medical service behavior, guide designated medical institutions to standardize diagnosis and treatment, promote reasonable medical treatment for insured people, and strictly control unreasonable medical expenses. Third, develop supplementary guarantee to meet diversified needs. It is clearly required to give full play to the supplementary guarantee role of social forces such as commercial insurance, social charity and medical mutual assistance, do a good job in the connection between the guarantee scope and the guarantee scheme, work together to resolve the pressure of cost burden outside the catalogue, and clarify the responsibility of personal health security. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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