Neglected old people of new Beijing Nationality: without Beijing medical insurance, they can only see a doctor at their own expense (Figure)

With more and more one-child families in big cities, their parents also face the dilemma of how to "provide for the aged" Staying at home is "empty nest old man"; depending on children in other places, but facing the difficulty of medical reimbursement It is difficult to provide for the aged For some old people, it is difficult to see a doctor first At present, there are three basic medical insurance systems of urban employees, urban residents and new rural cooperative medical system in China, more than 2000 overall medical insurance agencies, more than 2000 Medical Insurance catalogues and reimbursement policies A person can move, but the medical insurance relationship is difficult to transfer Medical insurance information is not connected to the Internet, policies are not unified, and reimbursement for medical treatment in different places is facing difficulties In July and August this year, the State Council issued two documents, proposing to accelerate the cross provincial real-time settlement of medical insurance costs The reporter of Beijing News learned that the medical reform office of the State Council has put forward a schedule for the settlement of medical insurance in different places By 2015, it will comprehensively push forward the direct settlement of medical insurance in different places in the province, focusing on the study of cross provincial settlement methods for medical treatment in different places for retirees and other people [dilemma] dare not see a doctor to become the "new Beijing" elderly normal, which is a group ignored by the policy of benefiting the people After they had spent their first year in Huajia, they came to Beijing to rely on their only child After applying for several certificates, they finally had a "Beijing hukou", but they could not enjoy basic pension and medical security treatment in Beijing This group is known as the "new Beijing old people" Because there is no Beijing medical insurance, as Beijing citizens, they can only see a doctor at their own expense In the autumn of 2005, Lao Li of Jiangxi settled in Beijing with his daughter When you are a Beijinger, you don't need to spend money to go to the park or take the bus If you go abroad for a trip, you can get a passport on the spot That is, we can't enjoy "citizen treatment" on the issue of basic medical insurance Because Lao li felt that he had paid the medical insurance in Jiangxi, and that his health was still strong at that time, he didn't care about the reimbursement of medical expenses for the elderly in other places But in the past two years, Lao Li suffered from cerebral thrombosis and other diseases, which cost nearly ten thousand yuan But because Mr Li's medical insurance was paid in Jiangxi, his medical insurance could not be reimbursed in Beijing, so he had to pay for it himself What's more difficult for the "new Beijing elderly" is that there are great differences in the medical insurance catalog of different regions, but many items (especially outpatient expenses) are the reimbursement scope of Beijing medical insurance, which do not meet the reimbursement conditions of the old medical insurance, and they have to pay their own expenses For example, in 2012, the "registration fee" of many top three hospitals in Beijing was renamed as "medical service fee" The outpatient fee per person was set as yuan, yuan and yuan respectively according to the doctor level, which was 8-14 times higher than the original registration fee Beijing Medical Insurance granted a fixed reimbursement of yuan, but the "new Beijing elderly" could only pay for themselves together with the drug fee Now, when Lao Li talked about seeing a doctor, he shook his head Dare not see a doctor, has become a lot of places for the elderly normal ■ according to the current regulations of Beijing Municipality (jlshjf [2004] No 287 document), before the retirement of the elderly in Beijing, they can enjoy the medical insurance treatment in other ports, and the medical insurance relationship cannot be transferred, nor can they enjoy the basic medical insurance treatment in Beijing In 2010, Beijing launched the medical insurance for urban residents, limiting the retirees without medical insurance who can participate in the medical insurance for residents to educated youth or the "third tier" returnees to Beijing This means that even if the elderly who settled in Beijing with their children did not participate in the medical insurance before retirement, they could not participate in the medical insurance for urban residents in Beijing There is a dilemma of "new Beijing residents" in the whole country, which is the epitome of the difficulty of medical insurance transfer and medical treatment for the elderly in many places The reporter of Beijing News inquired about the current regulations of human resources and social security bureaus in Shenzhen, Dalian, Guangzhou, Shanghai, Hangzhou and many other big cities The old people who are resettled with their children in different places, or who enter the household with their children, cannot transfer the original pension insurance and medical insurance relationship Zhou Bo and his wife, who are nearly 70 years old, have lived together for six years with their only daughter who graduated from university and settled down in Guangzhou They have also made efforts to move their families to Guangzhou, but found that they could not transfer their pension and medical insurance relationships before retirement "Old people, the most needed medical reimbursement policy can not enjoy, a paper account, what is the significance for us." A few years ago, Zhou Bo and his wife went through the formalities of "medical treatment in different places" in their hometown of Yancheng However, a few years later, the old couple almost did not go to those hospitals to see the disease, and they were carrying the disease "First, the designated hospital is far away from home Second, outpatient expenses are not reimbursed Even if they are hospitalized, they will be reimbursed back to Yancheng The time and energy that are wasted and the cost of going back and forth may be higher." ■ according to the above-mentioned Reply of the urban human resources and social security department, the elderly who enter the household with their children, if there is no medical insurance, can participate in the local urban residents' medical insurance in the community where the new household registration is located in the year when the household registration is changed There are also many conditions for participating in local residents' medical insurance For example, in Shenzhen, when the elderly take part in the medical insurance for the first time, they have to pay a certain fee Yuan Jianyong, then director of Shenzhen social security fund administration, once explained publicly that, taking the average monthly wage of Shenzhen employees as an example, the elderly need to pay 70000 yuan at a time [solution] 1 Why is it difficult to reimburse in different places? There are three kinds of medical insurance systems: medical insurance for urban employees, medical insurance for urban residents and new rural cooperative medical insurance in China The total participation rate of urban and rural residents has reached more than 95%, which is close to the goal of "everyone has medical insurance" Why is it so difficult for the insured to make reimbursement and settlement in different places? According to Li Zhen, professor and director of the Institute of social security, School of public management, Renmin University, the overall planning level of China's residents' medical insurance and the new rural cooperative medical system is relatively low The overall planning fund is mostly based on the city, even one county, and each county has a medical insurance agency In this context, the different levels of residents' insurance contributions, the large scale differences of medical insurance funds, and the different reimbursement catalog and reimbursement proportion lead to the difficulty of remote transfer and settlement of the insured's medical insurance relationship In recent years, the contradiction between the difficulty of cross regional transfer and settlement of medical insurance and population migration has become increasingly prominent In big cities such as Beijing, Shanghai and Guangzhou, more and more elderly people from other provinces are resettling with their children Because the medical insurance relationship cannot be transferred and continued in different places, the burden of difficult and expensive medical treatment is increasing Not only the elderly, but also the nearly 200 million migrant workers in China After working in the city, the new rural cooperative medical insurance system, which used to be insured in the hometown, can not be used It is not stable to work in the city Even if participating in the urban employee medical insurance, it is difficult to pay on time, resulting in the "invalidation" of medical insurance In recent years, migrant workers in many cities have low willingness to participate in insurance, low rate, and even "withdrawal tide" What is the way out for cross province medical reimbursement? As early as four years ago, when the curtain of the new medical reform was opened, the topic of "medical insurance transfer and settlement in different places" was formally put forward As there is no clear timetable and service path, the progress of this work is mainly based on the provincial medical instant settlement (reimbursement) Dai Tao, a researcher and director of the Institute of medical information of the Chinese Academy of Medical Sciences, pointed out that at present, it is difficult to get reimbursement for medical treatment in different places, and it is mainly difficult to get immediate settlement for medical treatment across provinces There are more than 2000 medical insurance co-ordination units in China, and dozens of medical insurance agencies in one province If you want to achieve cross provincial medical settlement, a hospital in Beijing needs to sign agreements with dozens of medical insurance agencies in the province, and separately connect medical expense information, which will increase the pressure on hospitals On July 24th this year, the website of the general office of the State Council released the "main work arrangements for deepening the reform of the medical and health system in 2013" to the society, in which the most concerned issue of medical insurance reimbursement in other places was specially elaborated The state office requires the Ministry of human resources and social security and the national health and Family Planning Commission to be responsible for their respective responsibilities, vigorously promote the settlement of medical treatment in different places, and gradually promote the direct settlement of medical treatment in different places in the province Choose to pilot in some provinces to explore the establishment of cross provincial real-time medical settlement mechanism Sun Zhigang, director of the medical reform office of the State Council, said that the national health and Family Planning Commission is building a national information platform for the new rural cooperative medical system At present, it has connected 9 provincial platforms and 29 large medical institutions, including Beijing, Inner Mongolia and Jilin, laying the foundation for cross provincial real-time settlement [conjecture] the settlement in different places aggravates the difficulty of medical treatment in big cities? According to Sun Zhigang, director of the medical reform office of the State Council, the experts suggest that the leverage of the level of medical insurance reimbursement should be combined with the hierarchical referral By 2015, the overall regional and provincial medical expenses should be settled in different places, and the cross provincial medical expenses should be settled in different places At present, the focus of the work is to comprehensively promote the direct settlement of medical treatment in different places in the province, and study the settlement methods of medical treatment in different places in different provinces for key groups such as retired workers But Sun Zhigang also admitted that in the long run, improving the level of fund co-ordination is an important way to achieve instant settlement of medical treatment in different places However, there are great differences in the level of economic development, financing and payment ability in different regions The financial management system of "dividing revenue and expenditure and contracting at different levels" implemented over the years is also affecting the improvement of the overall level of medical insurance It has been considered that instant settlement of insured people's medical treatment in different places is a benefit to the people But under the current situation of unbalanced distribution of medical resources, will patients be "encouraged" to rush to big city hospitals? More difficult to see a doctor? In recent years, Li Zhen has repeatedly expressed such concerns She said that China's regional and urban-rural development is not balanced, and the population flow also shows very obvious characteristics, "migrant workers flow from the countryside to the city, young people and their parents come to the big cities from small cities." Imagine that if the real-time settlement of medical treatment in different places is generally realized, a large number of patients will flow to cities and large hospitals Then, medical insurance funds and various medical resources will accelerate to gather in large cities and hospitals Accordingly, the amount of medical insurance fund payment in low-income and underdeveloped areas has increased dramatically, and will soon be unable to offset the expenditure "Therefore, the immediate settlement of medical treatment in different places, push or not push, will fall into a dilemma." Li Zhen said that if the government wants to solve the medical insurance for the floating population, the ideal solution is to force the whole people to participate in the insurance, and the poor people will be paid the premium by the government or charity organizations; the local people will participate in the price insurance, and each insured person will participate in the price plus medical insurance in his / her work place of residence, so he / she can choose different levels of insurance, and enjoy the corresponding medical expenses reimbursement in the local area, with equal rights and obligations 。 Dai Tao also believes that if the government does not establish a hierarchical referral system as soon as possible, all patients will be free to choose institutions for medical treatment, and instant settlement for medical treatment in other places will inevitably cause patients to flock to large hospitals in Beijing, Shanghai and other major cities His suggestion is that the lever of reimbursement level of medical insurance should be combined with hierarchical referral For patients who follow the hierarchical referral, the reimbursement rate is high; for patients who go directly to large hospitals, the reimbursement rate is reduced "It can't be like now, the hierarchical referral system hasn't been established In order to encourage people to go to the grass-roots hospitals, the" one size fits all "type of drawing bar, the reimbursement rate of grass-roots hospitals is high, and large hospitals The reimbursement rate is low In this way, it's not fair for the seriously ill " On August 14, the State Council issued several opinions on promoting information consumption and expanding domestic demand, which clearly put forward "promoting the one card social security, building a central and provincial settlement platform for medical insurance expenses, and promoting the cross provincial real-time settlement of medical insurance expenses", adding another commitment to the wish of settling old people with their children in different places in their residences and seeking medical care after retirement [case] five years of unsuccessful operation of remote hypertension medical insurance in 2002, Li Hua, a retired cadre from Xinjiang, came to Beijing with her wife, Ms Zhou