Although the cumulative balance of individual accounts in 2023 will hit the highest level in history, exceeding one trillion yuan, it is self-evident that its future and operational changes will have a great impact on the overall medical insurance fund.
Text | Asian chess
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National Health Insurance Administration: In 2023, the medical insurance pooling fund will achieve a reasonable balance
Zhu Yongfeng, deputy director of the Department of Regulation, Finance and Regulations of the National Health Insurance Administration, said that the operation of the medical insurance fund will be generally stable in 2023, and the overall fund will achieve a reasonable balance.
According to the official website of the National Health Insurance Administration, the total income and total expenditure of the basic medical insurance fund (including maternity insurance) in 2023 will be 3,335.516 billion yuan and 2,814.033 billion yuan, respectively.
By the end of 2023, the cumulative balance of the national basic medical insurance fund will be 4,775.556 billion yuan. Among them, the cumulative balance of the employee pooled fund, the personal account of employees and the medical insurance of urban and rural residents was 2,640.6 billion yuan, 1,386 billion yuan and 758.9 billion yuan respectively, accounting for 55%, 29% and 16% respectively.
In 2023, the income of the basic medical insurance fund for employees (including maternity insurance) will be 2,288.057 billion yuan, of which the income of the overall fund will be 1,663.607 billion yuan. The fund expenditure was 1,771.780 billion yuan, of which the overall fund expenditure was 1,162.058 billion yuan. The cumulative balance of the basic medical insurance fund for employees (including maternity insurance) at the end of the year was 2,640.589 billion yuan. The income of the basic medical insurance fund for urban and rural residents was 1,047.459 billion yuan, and the expenditure was 1,042.253 billion yuan.
By the end of 2023, there will be 550,400 cross-provincial networked designated medical institutions, including 198,000 cross-provincial networked designated medical institutions and 352,400 designated retail pharmacies.
Zhu Yongfeng said that with the deepening of the aging of the population and the decline in the proportion of employees on the job to retirement, the rigid increase in medical expenditure will continue. For example, the annual number of visits to medical and health institutions has increased from 4.46 billion in 2006 to 8.416 billion in 2022, the total health expenditure has increased from more than 980 billion yuan in 2006 to 8.5 trillion yuan in 2022, and the per capita health expenditure has also reached 6,044 yuan. These changes are not only the result of demographic changes, but also the results of economic and social progress and the increase in the price level, which requires the medical insurance department to continue to deepen the reform of payment methods, reasonably control the growth rate of expenses and hospitalization rates, etc., to ensure the smooth operation of the fund.
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The personal account shrank sharply, plummeting by 180 billion yuan
Judging from the 2023 medical insurance fund data reported by the National Health Insurance Bureau, one of the most profound data for pharmacies is the change in personal account data.
Three years ago, the General Office of the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Aid Security Mechanism for Basic Medical Insurance for Employees." The guidance mentions that at that time, the personal account of in-service employees can only include the basic medical insurance premiums paid by individuals, in principle, controlled at 2% of the base of their own insurance contributions, and the employment unit will no longer help to pay, and the basic medical insurance premiums paid by the original unit will be included in the overall fund, and the increased overall fund will be mainly used for outpatient mutual aid protection, improve the outpatient treatment of insured personnel.
In 2023, the personal account income of employees' medical insurance will be 624.5 billion yuan, and this data will be about 763.3 billion yuan in 2022, a decrease of 138.8 billion yuan in 2023 compared with 2022, a decrease of 18%. The reduction did not evaporate for no reason, but was included in the employee pooling fund and is still used for the insured employee groups, which also proves the changes brought about by the above-mentioned policy reforms.
In 2023, the scope of use of the medical insurance fund will be further expanded, and the scope of expenditure in the personal account of employees will be expanded, which can be used for the common use of family members. Statistics show that in the past year, about 326 million people have enjoyed the outpatient treatment of employee medical insurance, and personal account expenditure increased by 7.9% year-on-year.
In 2023, the expenditure of employees' medical insurance accounts will be 609.7 billion yuan, an increase of 41.2 billion yuan or 7.2% from the previous year. In the case of "one decrease and one increase", it is equivalent to a sharp decrease of 180 billion yuan in the accumulation of employees' medical insurance personal accounts in 2023 compared with the previous year, a decrease of up to 92%, accelerating the "shrinkage", which further proves that the improvement of the personal account inclusion method does not affect the expenditure of the individual account, but only affects the income of the individual account.
The person in charge of most chain pharmacies also firmly believes that the pooling fund pool will be larger in the future, and now it is to put the part of the enterprise investment into the overall planning, and the next step may also be to include the personal account.
This institutional reform also set up a three-year transition period, during the transition period, the relevant detailed measures are gradually implemented, among them, the most concerned by chain pharmacies is naturally the National Health Insurance Bureau issued in February last year "on further doing a good job in the designated retail pharmacies into the overall management of outpatient notice".
Now, the "three-year transition period" has come to an end, and there are still many blocking points, which are not only seen in the frequent proposals of the representatives of the two sessions this year on the blockage points related to the overall fund, but also in the implementation of medical reform policies in various places, and there are difficulties inside and outside the hospital.
Taking the out-of-hospital as an example, after the personal account shrunk, the designated retail pharmacy opened last year was included in the overall management of the outpatient clinic, and the chain longed for this move to allow them to "lose the east corner and gain the mulberry". However, after the reform of outpatient mutual aid security, a prominent problem has been encountered, although electronic prescription circulation platforms have been established in various places, but the circulation efficiency is not high. Some pharmacies circulate an average of less than 1 prescription per day. Even if there is a chain of Internet electronic prescriptions that can alleviate this problem, it only strengthens the existing customer base, not an increase in the outflow from the hospital.
Zhu Yongfeng said that in the next step, the National Health Insurance Administration will promote the solution of the problem of cross-coordination area mutual aid of individual accounts, so that the insured can further benefit from the reform of outpatient mutual aid.
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The account has shrunk, where will the pharmacy go?
Although the cumulative balance of individual accounts in 2023 will hit the highest level in history, exceeding one trillion yuan, it is self-evident that its future and operational changes will have a great impact on the overall medical insurance fund. Because the growth rate of expenditure is greater than the growth rate of income, with the stagnation of personal account income, personal account expenditure continues to increase, and the accumulated balance of individual account will eventually be used up. Under the trend of accelerated shrinkage of personal accounts, how to make the new deal "blossom" and bear good fruits, and what kind of mentality should the chain face the adjusting policies...
The reform of individual accounts has led to the reduction of the scale of individual accounts, which has naturally affected the customer flow of pharmacies. However, on the whole, the improvement of the individual account accounting method has improved the mutual aid capacity of medical insurance and enhanced the outpatient protection of the insured. At the same time, the accelerated outpatient co-ordination promotes the outflow of prescriptions, which can partially hedge the impact of the individual account reform.
Zhang Jing (pseudonym), the person in charge of a chain in Hunan, said that after the outpatient co-ordination, their stores in Hunan have increased significantly. He believes that at present, many chains in various places have not negotiated good policies, understood policies, and failed to do a good job in policies. "This policy environment is very good, we need to strive for it, we must believe in the standardization of laws and regulations, go to the norms, and the norms will eventually become the dividends of chain development. ”
Ni Yuanfeng, director of the Drug Administration Department of the Shanghai Municipal Health Commission, believes that outpatient co-ordination, including electronic prescription circulation, is a good practice for the linkage of the three medical institutions. At present, many hospitals and retail pharmacy terminals have been built, and the information system is also very perfect. However, when it comes to uploading electronic prescriptions to the platform after review, details such as who is responsible for the follow-up medication and whether to build a unified catalog to implement it still need to be resolved through joint discussion.
Some of the practices from Shanghai were affirmed at the forum. Taking the "Shanghai Pharmacy" App as an example, the hospital issues a generic name of the drug, and the insured can check the nearby pharmacy with the generic name drug in the app and go directly to buy it. In addition, Shanghai's employee medical insurance, residents' medical insurance, and community assistance targets for retired people returning to Shanghai have all realized the overall planning of pharmacy outpatient services, truly benefiting the people.
Reference sources: Jiefang.com, official website of the National Medical Security Administration, China Youth Daily
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