Continued focus on promoting equitable closely integrate people's livelihood

January 14, 2016

 
 
 
Continued focus on promoting equitable closely integrate people's livelihood
- Understanding of "the State Council on the integration of urban and rural residents in the basic medical insurance system view" expert

People's Republic of China National Health and Family Planning
2016-01-13

Medical insurance system, especially government-led basic medical insurance system for the masses to share the burden of medical costs, an important institutional arrangements to protect people's health. With the rapid progress of China's urbanization, the differences between urban and rural areas is gradually narrowing, according to the drawbacks of urban and rural household registration division set up a new rural cooperative medical system and basic medical insurance system for urban residents increasingly apparent, when the identity of different people for medical treatment and health care Behind each of reimbursement policies often make the difference between the insured individual and hospitals scratching their heads, can not "guarantee" to set barriers between systems and also with the people of urban and rural residents increased mobility trend does not match. In this context, the State Council issued the "integration of urban and rural residents in the basic medical insurance system of opinions" (hereinafter referred to as "Opinion"), for the integration of the new rural cooperative medical insurance system for urban residents and forth explicit requirements, described in the basic medical insurance system for the accurate a recipe proposed on the basis of the pulse, to reform and improve our basic medical insurance system construction to achieve universal and equitable access to basic health care is important.
Looking at the "Opinions" text, "six uniform" is the most prominent highlights:
Unified coverage in terms of current and new rural cooperative medical insurance for urban residents are covered rural and urban non-working population, population coverage showed obvious characteristics of rural-urban divide. "Opinion" provides medical insurance system covering urban and rural residents of existing and new rural cooperative medical insurance for urban residents all should be insured (co) personnel, which broke the eligibility of insured urban and rural distinction between urban and rural residents do not respect the insured household registration restrictions by nature, has a equally insured qualification. Meanwhile, the "Opinions" also allowed to participate in the basic medical insurance difficulties and flexible employment of migrant workers to participate in the urban and rural residents in health insurance to those unstable employment status, did not establish a fixed labor relations and labor units, constantly changing work units or regular migration migrant farmers, self-employed persons and other opened the door, to avoid the crowd drifted outside safeguards.
Consolidated financing policy, medical insurance for urban residents and the new rural cooperative approach to the implementation of a fixed amount financing, equity financing is difficult to reflect to some extent. In this regard, the "Opinions" clearly put forward a unified standard of urban and rural residents in health care financing system, the existing medical insurance for urban residents and the new rural cooperative individual contributions gap larger areas can be taken to pay the difference between the way, use 2--3 years progressively transition. And gradually establish a mechanism for individual contributions and per capita disposable income of urban and rural residents of convergence. These requirements define the direction of development of urban and rural residents in health care financing mechanism, proposed the establishment of income-related financing mechanisms, but also meet the current income gap between urban and rural residents of the larger, family income lack of effective means of investigation realities presented by urban and rural areas or areas Suitable methods for file contribution income level points, with a strong operational.
Unified security benefits in terms of current, new rural cooperative medical insurance for urban residents and the scope of protection are simultaneously including hospital fees and outpatient expenses, "Twelve Five" period, the proportion of paid medical insurance for urban residents and the new rural cooperative hospital costs are policy areas reached 70% and 75%, in the case of relatively low funding levels have been is not easy. "Opinions" provisions within the urban and rural residents in the basic medical insurance policy to pay the proportion of hospital costs range remained at about 75 percent, and gradually increase the level of protection of the clinic. This means that in some places close 方新农 may want to keep the hospital expense ratio does not fall within the scope of its policy in the list of drugs and medical services expand the catalog, the medical insurance for urban residents will have to pay hospital fees within the policy range to further increase the proportion of 5 percentage points, to further improve the level of medical care for urban and rural residents will have a positive role in promoting.
Unified health insurance directory and unified point management, the current around the new rural cooperative medical insurance for urban residents and determined drug list, health care institutions designated project directory and scope, management practices, etc. vary, and there is some overlap, which makes participate The new rural cooperative medical insurance for urban residents or rural residents facing different medicines, medical services and medical platform, resulting in a difference between the actual level of treatment of urban and rural residents objectively. For this reason, the "Opinions" requires a unified urban and rural residents and medical services Medicare drug directory project directory, unified urban and rural residents Medicare designated agency management.
In the consolidated fund management, the current and the new rural cooperative medical insurance for urban residents have established a fund financial system, accounting system and fund budget and final accounts management system, and funds into the financial account management, but the overall level of the different parts of the Fund, the Fund is also an integrated manner There are different forms of unified revenue and expenditure and transfers gold. "Opinions", urban and rural medical insurance system in principle to implement the city (prefecture) level co-ordination, encourage conditional area to the provincial co-ordination. This helps to reduce the differences between security benefits in different regions, thereby increasing the fairness of different residents received basic medical treatment, but also help enhance the anti-risk ability of urban and rural residents in the basic medical insurance fund. "Opinions" also provides that, when improving the overall level of classification to strengthen fund management, and fully mobilize the county government, managers manage institutional funds managed by the enthusiasm and initiative, and called on all localities by promoting payment reform, the establishment of a new order for medical treatment and other measures control medical costs unreasonable growth, these measures have helped improve the efficiency of the basic medical insurance fund, so that the limited health insurance funds can guarantee a higher output capacity.
Urban and rural residents and the new rural medical insurance laminated on policy differences is the starting point of their integration, the elimination of differences, the progressive unification policy is to integrate the system in the form of an inevitable requirement is to determine the key to urban and rural residents in the basic medical insurance system really achieve integration. Unified policy integration and basic medical insurance system for urban and rural residents must always follow the principle of fairness, adhere to ensure equitable access to urban and rural residents eligible to participate in the basic medical insurance, the fundamental goal of equitable access to basic medical insurance to guarantee fair rules of urban and rural residents in the basic medical insurance rights in the field of justice and equal opportunity. Around the integration of the new rural cooperative medical insurance system for urban residents in the process, it should be an overall plan to deepen the work of medical reform, to promote health care reform measures, medical, medical field to promote synergy and continuously improve urban and rural residents in the basic medical insurance system for sustainable financing efficiency and funds to effectively implement health care system to promote sustainable development, promote social equity and justice, enhance the well-being of the people of the reform objectives. (Department of National Health and Family Planning Commission of new rural cooperative medical research center deputy director, researcher Li Wang early, the new rural cooperative medical research centers Research Associate National Health and Family Planning Commission Zhao Donghui) (Source: Health News Network, January 13, 2016)