Every year at the two sessions, small partners who are concerned about the medical industry can hear a high-frequency word "medical reform", and the medical insurance system has been improved through continuous reform.
In the early days of the founding of the People’s Republic of China, the state implemented the system of public medical care and labor insurance medical care. Public medical care mainly protects state workers; labor insurance medical care is to provide medical security for urban workers, which is extracted by enterprises from welfare funds. Free, low-efficiency enterprises often cannot guarantee basic medical care; in rural areas, cooperative medical care was established, but it fell apart in the 1980s with the dissolution of the communes.
The construction of the modern medical insurance system began in the mid-1990s, and many cities across the country began to establish a basic medical insurance system for urban employees through pilot projects. "integration" system.
In 2016, the state integrated the basic medical insurance for urban residents and the new rural cooperative medical care system (NCMS), established country email list a unified basic medical insurance for urban and rural residents, and formed the current medical insurance system.
In 2018, the National Medical Security Administration was officially listed. Originally, the Ministry of Human Resources and Social Security was responsible for basic medical insurance and maternity insurance for urban employees and urban residents, and the National Health and Family Planning Commission was responsible for the new rural cooperative medical care. The responsibilities of price management of drugs and medical services, and the medical assistance responsibilities of the Ministry of Civil Affairs are integrated, realizing the integration of resources of "four powers in one". The State Council also abolished the Medical Reform Office at the same time, marking the entry of a new era for the national medical insurance system.
The development process of the medical insurance system is a product of satisfying the social economy at that time. The main medical expenditure of our country has also developed from the nationwide fight against infectious diseases in the early days of the founding of the People's Republic of China to the prevention of chronic non-communicable diseases. .
2. Basic knowledge points of medical insurance
In order to facilitate the grasp of the key information in medical insurance knowledge, the following brain map is organized, and the most commonly used knowledge points are extracted.
Figure 1: Main knowledge points of medical insurance
(1) Type of medical insurance
Our country's medical insurance is mainly divided into two categories, targeting two groups of people. The first category: employee medical insurance, in-service employees with work units and retirees who enjoy pensions; the second category: urban and rural residents medical insurance, urban and rural residents who are not employed, college students, primary and secondary school students, and children.
(2) Account type
The money we hand over to medical insurance will be divided into two parts, one part is transferred to the personal account, and the other part is transferred to the overall account. The purposes of the two accounts are different . Medical insurance personal account: The personal account paid by employee medical insurance (specifically, the proportion of different age groups in each city is different), used for small medical expenses other than medical insurance reimbursement, and the personal self-pay part of the cost of buying medicine in pharmacies for outpatient treatment. Medical insurance coordinating account: the account we use for medical reimbursement, reimbursement for hospitalization, off-site referrals, outpatient chronic diseases and special diseases.
Originally, urban and rural residents’ medical insurance in some areas also had individual accounts, which were called outpatient co-ordination. On August 26, 2020, the Medical Insurance Bureau issued the “Guiding Opinions on Establishing and Improving the Outpatient Public Relief Protection Mechanism for Employee Basic Medical Insurance (Draft for Comment)”, outpatient service The co-ordination will be completely cancelled after the end of 2020.
(3) Payment amount
The payment amounts of employee medical insurance and urban and rural residents' medical insurance vary from place to place. Take Shanghai's 2020 contribution as an example. The amount of financial subsidies paid by urban and rural residents in Shanghai is relatively high, which can be compared with the average situation in the following countries. This is for reference only.
Figure 2: Example of medical insurance payment
(4) Reimbursement ratio
Reimbursement is divided into outpatient emergencies, and the reimbursement ratios issued by the medical insurance bureaus in different regions are also different in combination with graded diagnosis and treatment, serious illness insurance, medical insurance on both sides, etc. It is necessary to check the official documents issued by the medical insurance bureau every year. The following is an example of the situation in Beijing.