With the rapid development of social media and digital technology, we have become Xi to getting information on the Internet. However, not all information is true and accurate.
Recently, there has been a rumor on the Internet that "Jiangxi pharmacies have stopped coordinating the payment of quotas", which has attracted widespread public attention. The actual situation is that the current medical insurance outpatient co-ordination policy has not been adjusted and is still implemented normally within the specified scope.
However, this is just a rumor without factual basis, and the local medical security department responsible for the implementation of this policy has verified it and clearly pointed out that the medical insurance outpatient co-ordination policy is still being implemented without any adjustments.
Such online rumors not only misled the public, but also almost inspired some designated retail pharmacies and Internet hospitals to take advantage of policy loopholes.
Violations and handling of retail pharmacies and Internet hospitals
With the drive of profits, some pharmacies even misinterpret the medical insurance policy, falsely advertise that "outpatient co-ordination is not used, and the quota will be cleared at the end of the year", and even some institutions issue prescriptions online in violation of regulations through medical platforms to obtain outpatient co-ordination funds. These actions pose a major safety hazard to the health care system.
In this regard, at present, the medical security departments of relevant regions have carried out inspections of relevant Internet hospitals and designated retail pharmacies, and found that some Internet hospitals have issued prescriptions for traditional Chinese medicine decoction pieces beyond the scope, directly prescribed prescriptions without consultation, and issued prescriptions to the same patient multiple times a day, which are being formally and strictly dealt with in accordance with laws and procedures. The Internet medical institutions and designated chain pharmacies involved are also actively rectifying.
Optimization and adjustment of the outpatient mutual aid guarantee mechanism of basic medical insurance for employees
In this context, it is all the more necessary for us to correctly understand and use the Guiding Opinions of the General Office of the State Council on Establishing and Improving the Outpatient Mutual Aid Security Mechanism for Basic Medical Insurance for Employees (Guo Ban Fa [2021] No. 14). Starting from January 1, 2023, Jiangxi Province will start the implementation of the outpatient mutual aid guarantee mechanism for basic medical insurance for employees.
Under the new policy, the general outpatient medical expenses of insured employees in a natural year will be included in the pooled fund for reimbursement according to the policy. Specific adjustments include: the minimum payment line has been reduced from 600 yuan to 300 yuan, the payment ratio has been increased by 5 percentage points, and the annual payment limit has also been increased.
At the same time, the insured person can purchase drugs in designated medical institutions or designated retail pharmacies with a prescription and enjoy the outpatient co-ordination reimbursement treatment, but the diagnosis and treatment and review must be carried out in strict accordance with the regulations, and it is strictly forbidden to arbitrage the outpatient co-ordination fund. At present, the policy is being implemented and has not been adjusted.
The medical insurance fund is the people's "life-saving money"
The medical insurance fund is not only an individual's "treatment money", but also a "life-saving money" that everyone can rely on. Therefore, the abuse of this policy could pose a danger to the fundamental interests of the general public, which cannot be ignored.
Therefore, we need all medical insurance designated medical institutions and designated retail pharmacies to strictly abide by laws and regulations, and strictly prohibit all violations.
For institutions with abnormal growth in medical insurance settlement data and suspected of illegal centralized card swiping, the medical insurance department will suspend its medical insurance services and conduct joint inspections with relevant departments. Once verified, it will be dealt with seriously, and if the circumstances are serious, it will be handed over to the judicial organs for disposal.
When understanding and applying medical insurance policies, we also need to pay attention to the fact that outpatient reimbursement should comply with relevant policy regulations, and individuals need to pay a certain percentage out of pocket. At the same time, we also want to remind the majority of insured people that they are not allowed to use medical insurance to purchase daily necessities and health products, and they are not allowed to exchange non-medical insurance and non-special drugs for medical insurance and special drugs.
In addition, we also welcome the general public to supervise and report the violations of the province's medical insurance designated medical institutions and insured. Only by working together to maintain a good medical insurance environment can we ensure that everyone can enjoy the medical insurance treatment correctly and avoid the normal medical insurance services affected by rumors.
To this end, we call on the insured to improve their awareness of consumer rights and interests protection, make good drug purchase choices according to the actual situation, and use medical insurance rationally, so as to play a positive role in promoting the extensive social effect formed by medical insurance interest groups.
Write at the end
In general, in the face of misleading rumors, we need to be vigilant, obtain and disseminate accurate information in a timely manner, and do not believe, spread or spread rumors. At the same time, we must also correctly understand the medical insurance policy, use the medical insurance treatment in compliance, and actively participate in maintaining the medical insurance environment to ensure that every medical insurance fund can be used where it is most needed.