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Recently, the General Office of the State Council issued the "Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism" to initiate the implementation of the employee medical insurance outpatient mutual aid guarantee reform.
The core content of this reform can be summarized as "one two three three", namely, adjusting one structure, enhancing two kinds of mutual aid, achieving three "inclusion", and expanding three types of "payments.
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First, adjust a structure, that is, adjust the billing structure of the overall fund and personal accounts.
The original billing structure is based on the 1998 "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees".
In the case of a total of 8% of the contributions of the unit and individual employees, the part included in the overall fund is 4.
The second is to strengthen the two kinds of mutual aid, namely the enhancement of "great mutual aid" and "small mutual aid.
"Great mutual aid" refers to social mutual aid in the overall fund, and "small mutual aid" refers to family mutual aid in personal accounts.
Third, to achieve three "includes", that is, to include the three expenses into the scope of mutual aid protection of the overall fund.
The first is outpatient expenses.
Fourth, expand the three types of "payments", that is, allow the use of personal accounts to be extended to the three types of expenses of family members (spouse, parents, children), and implement family mutual aid.
The first is the medical expenses of family members.
In the context of deepening the reform of the medical security system, the reform of the mutual assistance security of the employee medical insurance outpatient clinics has three important meanings.
First of all, it is conducive to returning to the roots and helping each other.
The reform adjusts the structure of the overall fund and personal accounts, establishes a sound outpatient mutual aid guarantee mechanism, and better solves the problem of fragmentation caused by the excessive proportion of personal accounts in the medical insurance fund, which is conducive to enhancing the risk protection function of the medical insurance fund and returning to society The origin of mutual insurance.
Secondly, it is conducive to complementation between large and small, and synergy between family and society.
This reform not only strengthens the protection of the “big mutual aid” of the overall fund, but also innovatively implements the protection mechanism of the “small mutual aid” of individual accounts, which is conducive to mutual supplementation of large and small mutual aid and promotes the coordinated protection of family and society.
Thirdly, it is conducive to strategic purchase, and the three medicines are linked together.
This reform is conducive to making better use of the strategic purchasing role of the medical insurance fund by expanding the overall fund and incorporating outpatient services into mutual aid, optimizing the allocation of primary medical resources, improving primary medical service capabilities, facilitating the masses’ primary medical care, and advancing the three-medicine linkage.
