There gaps in health insurance coverage is not

high security level and there is obstruction to run 


  

 

People's Daily 

  

  

  


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Got sick, security is one common dream.

China today, "universal coverage" has been achieved at the institutional level. However, in reality, there are still gaps in health insurance coverage to protect the level is not too high, there are a lot of running obstruction.

Dreams into reality, the need down to earth. How to fit health care under conditions of people in particular to cover more people more difficult? How to adapt to the economic development stage and effectively improve the level of protection under the premise, and never without some big users to the tube? We really entered the era of universal health care, but also how long?

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1.25 billion insured

Complete coverage system

Daughter, born just one hundred days, Sun Lin, Beijing residents do go to the children to participate in "resident health care" procedures. "Many people in the formalities, all within a one year old baby insured." Staff said, "In the past there is no way a child would like insurance, only to buy commercial insurance." Sun Lin felt that although children illness can not spend too much money, but with much more health care or mind at ease.

Been called for the protection of "one old and one small" medical insurance for urban residents, the pilot in 2007 and quickly cover a large number of urban non-employed residents. Thus, the basic medical insurance in China in the social insurance system implemented in the first "Full coverage."

At present, all Chinese citizens can participate in appropriate health insurance through access to basic health care. Specifically, employers and employees, forced to participate in the basic medical insurance; no employee of the individual businesses, not to participate in employer social insurance practitioners and other flexible part-time employment may choose to participate in the basic medical insurance; rural areas Residents can participate in the new rural cooperative medical care; urban unemployed residents can participate in the basic medical insurance for urban residents; residents of rural migrant workers to choose according to their own insurance; civil servants and other public health services.

"Universal coverage" to achieve the same level in the system, the actual coverage is rapidly expanding. Department who provided the latest data show that the "Eleventh Five-Year" period, China's urban basic medical insurance covers about 4.2 million people, the number of new rural cooperative Senate combined 8.3 million, a total of approximately 1.25 billion people, the basic universal coverage.

Worry

Not insured by about 10%

And are mostly poor people

Although the vast majority of people have health insurance, but is still about 10% of the population is not insured, there is no guarantee when the chemists.

From Anhui to Beijing to dry decoration Liu friends admitted he knew in his hometown for a new rural cooperative, also know that you can participate in the Beijing urban medical insurance, but have their own pay. "I'm not sick two or three times a year, at most, a cold, something for good, do not want these things out on the first."

It is understood that, as the new rural cooperative medical insurance for urban residents and the implementation of "voluntary insurance, serious co-ordination", so some people chose not insured.

On the one hand, voluntary insurance will inevitably lead to the exclusion of vulnerable groups on the economy, and ultimately the formation of "special needs access to health care did not guarantee" such a situation. On the other hand, protect the goal as "catastrophic insurance", many ordinary insured objects, especially the young people in rural areas do not actually benefit, so do not want insurance.

China Medical Insurance Research Vice President Xiong Xianjun that the insured to increase support for vulnerable groups, should bear more financial responsibility. Over the past few years, governments at all levels have done a lot of effort. "Eleventh Five-Year" period, the central government allocated 509 billion yuan of special funds to help place the closure and bankruptcy of state-owned enterprises, 625 million people uninsured retirees include all the basic medical insurance for urban employees throughout the country to provide health insurance subsidies for Poor Families. Xiong Xianjun said research found that residents in many places, guaranteeing health insurance, no health insurance is precisely that part of the Poverty Line just after the residents, because they do not enjoy policy support.

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Medicare National Roaming

Start effective essay

Difficult for transferring health insurance, has been plagued by many people. This year, the state has a number of policies, health care, "National Roaming" was obviously accelerated.

July 1 this year, Human Resources and Social Affairs, Ministry of Health, Ministry of Finance issued the "flow of the employment relationship between the transfer of basic health care continuation Interim Measures" began. In recent years, the increasingly frequent movement of persons, especially migrant workers, although the participation of the urban basic medical insurance or the new rural cooperative medical care, but when the current employment relationship is often difficult to smoothly continue health insurance difficult to enjoy the health insurance benefits. And this approach is focused on solving the insured health care caused by movement between the employment problem of the transfer continue. Means clear, the urban basic medical insurance, mobile employment area where overall planning and participate in new employment in urban basic medical insurance, the new employment to employment agencies to inform the agencies for the original transfer procedures, no longer enjoy the job to the original urban basic medical insurance. Create a personal account, personal account in principle, the transfer relationship with the transfer of their health insurance, individual account balances (including individual payment fee included in some parts and units) through the transfer of the handling agency. "Measures" at the same time clear, residence and other reasons may not be around obstacles.

Next July 1 start of the "Social Security Act" is in the remote settlement of health care has taken a big step. Reimbursement for the current prevalence of different places is difficult, of the insured enjoy basic medical insurance problems, "Social Insurance Law", the relevant administrative departments of social insurance and health administrative departments shall establish a clearing system for remote medical care costs, through the remote collaboration mechanism to protection of the insured enjoy basic medical insurance benefits. This gives the insured person has brought more hope.

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Off-site medical reimbursement

Still troublesome

Qu uncle came to Beijing from Hunan after retirement, and his son live together. To leave his home, he was the most inconvenient is the Medicare reimbursement, "in order to be reimbursed, at least to go back to visit." Between the two places for medical expenses, reimbursement of the gap, bend uncle is also very unhappy. "Beijing doctor, inspection fees, high drug prices high, but Beijing claims the local high proportion. I see the doctor back in Beijing, Hunan, reimbursement, Hunan, reimbursement is low, very uneconomical."

It is understood that although the health care settlement in different places clear of the "National Roaming" principle, but the actual operation of health care relations so that "turn come, then was under the operational" or obstacles.

This balance is one of the most difficult parts of the actual benefits. Medicare payment localities in the present age, contribution rate, to enjoy the very different treatment. Beijing, Shanghai and other places that, if the realization of "National Roaming", economically underdeveloped areas of people get sick, might immediately think of health care relationship to medical conditions, and reimbursement levels are high, so turn to positive " too much. "

In this regard, Xiong Xianjun that the key is the responsibility of the government to clear its own, can not look "is a disadvantage." If you just look at health care, to achieve the "National Roaming" may be economically developed regions will increase a certain burden, but a large number of young workers to the western provinces developed areas to work, pay taxes, contribute to local prosperity, old age pension and then back west may west provinces feel that they "lose" the.

In addition, this problem can also be achieved gradually increase the overall level, that is the first effort to make the prefectural and city levels, and then realize at the provincial level, and then gradually to the "National Roaming" development.

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Reimbursement limit increased

Increase in health insurance benefits

More people into health insurance in the same time, the treatment level is also rising.

"Eleventh Five-Year" period, the basic medical insurance for urban workers, the highest amount paid by the average wage of workers in 4 times to 6 times the maximum Medicare payment limit for residents to residents per capita disposable income of 6 times, at all levels of health care finance for residents Subsidies from the beginning of the period of 40 yuan per person per year to 120 yuan. NCMS funding levels adjusted twice, from 30 yuan per capita increased to 100 yuan in 2009, the proportion of seriously ill hospitalized medical claims more than 20% from the initial to the current 50%.

The beginning of the implementation of the basic medical insurance for urban workers, co-ordinate fund is a payment for inpatient medical expenses, and later gradually extended to the clinic, many with chronic diseases benefit greatly from the insured persons.

In 2009, the department published "to carry out basic medical insurance for urban residents overall guidance clinic," the basic requirements of urban residents based on ability to pay the medical insurance fund, focus on protection of insured residents in the inpatient and outpatient medical expenditure on the basis of serious illness, gradually out-patient medical costs of small scope into the fund. Among them, an early start in Beijing, from January 1 next year, starting about 150 million urban residents who have Medicare insurance reimbursement will enjoy the out-patient treatment, to achieve card for medical treatment, immediate settlement. Outpatient reimbursement Qifubiaozhun 650 yuan, more than Qifubiaozhun in part by the basic medical insurance fund for urban residents to pay 50% of this grant per fiscal year 460.

Worry

Security level is not high

Medical burden not light

Although Medicare has covered the majority of our population, but people are still generally feel "your doctor", "medical burden." In fact, the "wide coverage, the basic security" is, including health care, including one of our basic principle of social insurance.

It is understood that, in 2009, China's basic medical insurance policy for reimbursement of medical expenses within the patient ratio is about 72%; urban residents within the basic medical insurance policy to pay the proportion of hospitalization costs about 55%; policy of the new rural cooperative medical care within the hospital reimbursement ratio is about 55%. Patients, especially patients with serious illness of individuals still had to pay a large medical expenses, "returning to poverty due to illness," the family has many. Therefore, the current "universal health care", still a low level of "full coverage."

Xiong Xianjun said that at present China has adopted a basic medical insurance, is to "guarantee the basic medical needs." Of course, people should have confidence in, the state will conform to the expectations of the people in the next period of time increasing the level of protection. Including: As the economic and social development, improve the ceiling line; increase hospital reimbursement for medical expenses; in regulating the appropriate treatment guidelines and disease treatment on the basis of the service pack to reduce serious illness, the burden of seriously ill individuals; broaden the scope of outpatient co-ordination, and gradually solve common disease, frequently-occurring disease burden of medical expenses.

In addition, to reduce the burden on the one hand to improve the treatment of personal level, on the other hand will have to reduce medical costs. Steady progress in the new medical correction of the present, I believe will bring more benefits to the people.