In recent years, there has been good news about medical insurance.
Yesterday we talked about new policies such as remote medical insurance settlement and the increase in outpatient chronic diseases, and today we continue to take stock of the medical insurance policies that are "closely linked" with our money bags in 2024.
▍If the medical insurance has not been paid for 25 years, it can be paid in a lump sum[1]
The medical insurance was not paid, and the hospitalization was panicked. Due to job change and other reasons, some urban employees have paid medical insurance premiums for less than 25 years when they retire, which will affect their medical insurance benefits after retirement.
Now the remedy is here! Wuhan, Tianjin, Guangdong, and most other parts of the country can make up for it all at once. If you want to know the specific operation, just ask the local medical insurance department directly.
Can Resident Medical Insurance Become Employee Medical Insurance?
If both the resident medical insurance and the employee medical insurance have been paid for a period of time, can they be added together? In other words, can the time of paying the resident medical insurance be replaced by the time of the employee medical insurance?
In most areas, the rules are OK. The time to pay the resident medical insurance can be made up to the difference, or converted into the time of the employee medical insurance.
Employee medical insurance is for those who work in the unit, and participate in the employee medical insurance through the unit after formal work.
Resident medical insurance is for people who are not covered by employee medical insurance.
In terms of reimbursement ratio, employee medical insurance is higher than resident medical insurance.
Resident medical insurance is a lifelong medical insurance treatment that can be enjoyed for a lifetime after paying for one year.
In the current social security system in mainland China, male employees must be 60 years old, and female employees can only legally retire at the age of 50 or 55.
Social Insurance Law of the People's Republic of China
▍Mutual recognition of the payment period of medical insurance in different places!Officially implemented in March [1,5]
The current medical insurance system in mainland China has not achieved national overall planning, and there are significant differences in the minimum payment period of medical insurance for employees in different regions.
For example, in Tianjin, for the payment of employee medical insurance, it is stipulated that men must pay at least 25 years and women must pay at least 20 years, and must pay for no less than 5 years in Tianjin.
In Hunan, the minimum number of years of contribution for male employees is 30 years, for female employees is 25 years, and the number of years of actual contributions in Hunan Province is not less than 10 years. This kind of regional difference profoundly shows that the social security policy and structure of mainland countries are too complex.
From March, the payment period of medical insurance in different places will be mutually recognized
On January 26, the medical insurance bureaus of Chongqing and Chengdu jointly issued a new regulation "Administrative Measures for Mutual Recognition of the Payment Period of Basic Medical Insurance for Employees in Chengdu and Chongqing (Provisional)". Starting from March 1, 2024, the payment period of employee medical insurance in Chongqing and Chengdu can be mutually recognized, which is the first cross-provincial attempt in the country.
According to the Measures, if you work in Chongqing and Chengdu, when you reach retirement age, the medical insurance contributions of the two provinces can be added together when the medical insurance retires. However, if the years of payment overlap, such as in 2018, both Chongqing and Chengdu paid medical insurance, do not count twice.
The "Measures" stipulate a criterion, that is, you must have 20 years of actual contribution time. When you meet this standard, you can go to the place where you have actually paid for the longest time to go through the medical insurance retirement procedures.
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▍What is the direct relationship between the reform of medical insurance payment and the people? [3-5]
It should be noted that although there is a surplus in medical insurance at present, the proportion of the elderly and retired workers is getting higher and higher, and the demand for medical expenses will only increase, and this growth is hard and unavoidable. Therefore, it is necessary to continue to deepen the reform of payment methods, reasonably control the rate of cost growth and hospitalization rate, and ensure the smooth operation of the fund.
Huang Xinyu, director of the Department of Pharmaceutical Management of the National Health Insurance Administration, revealed that the purpose of the medical insurance department's implementation of the DRG/DIP payment method reform is not to simply "control the fee", but to use the means of medical insurance payment to guide hospitals to pay more attention to what patients really need, use symptomatic techniques and methods to treat, and not engage in unnecessary large examinations and large prescriptions (prescribing a lot of drugs), so as to better protect the interests of the insured people.
Frequently Asked Questions and Answers (Q&A) - Reform of Medical Insurance Payment Methods [5]
1. Will the Medicare Payment Reform shorten the length of hospital stay?
The DRG/DIP payment method may shorten the length of hospital stay, but most importantly, it will ensure that the quality of treatment is just as good. Make sure that patients don't have to come back to the hospital because they are discharged too early, or have a relapse and come back, so post-discharge care and checkups will follow. Hospitals need to find a balance between efficiency and quality of care.
2. After such a change, will the medical insurance payment standard be deliberately low?
Setting payment standards is not imaginary, nor is it deliberately underpriced. The health insurance department is based on previous spending data and used big data analysis. The payment standard for each disease is calculated based on the average cost of patients in the past, and will be adjusted in a timely manner according to economic development, price changes, etc., to ensure that patients can receive reasonable and necessary treatment.
3. What is the disease classification and payment standard?
This is not a decision made by the Health Insurance Bureau. From the very beginning, when setting up disease groups, it is real, objective, and multi-party participation. For example, the DRG version 1.0 in 2019 was verified by merging several major DRG versions in China at that time, coupled with the clinical demonstration of experts organized by the Chinese Medical Association, and more than 6,200 case data from 30 pilot cities.
The DIP 1.0 version in 2020 is also based on the previous work in Shanghai, Guangzhou and other regions, using about 60 million data samples from 10 provinces and cities in the eastern, central and western regions, and obtained through big data analysis. After these are determined, each place will refine it according to its own situation, and finally use it for medical insurance payment. In the future, the Health Insurance Bureau will continue to adjust and update to ensure that it is more in line with the actual situation.
4. Will the medical insurance payment reform affect the medical expenses borne by patients?
This change will not affect the patient experience at checkout. Patients are reimbursed on a pro-rata basis when they are discharged from the hospital and are billed immediately. The medical insurance department will settle the bill on a monthly basis, and the cost of the disease should be paid by the medical insurance fund.
If the patient does less unnecessary medical treatment, the out-of-pocket portion will be reduced. Hospitals can get reasonable medical insurance payments according to the type of disease.
What is the DRG/DIP payment method reform?
Let's talk about DRG first, Chinese means diagnosis related group, that is, according to the patient's condition, they are divided into different groups, the people in the group are similar, and the treatment is similar.
For example, the medical insurance will give the hospital a fixed amount of money according to which DRG the patient Lao Li belongs to, regardless of how much Lao Li's medical expenses actually spent. In this way, the hospital will find ways to improve efficiency and reduce unnecessary tests and treatments, because they can keep the money saved. On the other hand, if the money spent is more than the money given, then the hospital will have to pay out of its own pocket, so it will not "conduct a big examination and prescribe medicine indiscriminately".
Let's take a look at DIP, which means diagnosis and treatment package in Chinese. This is to bundle all medical services related to a disease, such as examinations, surgeries, treatments, etc., and then set a fixed price for this large package of services. This approach can encourage hospitals to manage costs and use resources wisely on the premise of ensuring quality.
The purpose of this DRG/DIP reform is to change the old way of paying according to the paid items, because it is easy to lead to overtreatment and high costs. By setting fixed standards, hospitals need to find their own ways to manage costs and improve the quality of care.
This method of health insurance payment has been tried in many countries, and the results are not bad.
▍The cumulative balance of the medical insurance fund is 3.4 trillion yuan, and there is no "wave of surrenders" [2-3]
Many people are worried that the medical insurance fund will not be able to make ends meet, and when they have to use medical insurance for reimbursement, they will run out of money.
Zhu Yongfeng, deputy director of the Department of Regulation, Finance and Regulations of the National Health Insurance Administration, said at a press conference that in 2023, the total income of the basic medical insurance pooling fund (including maternity insurance) will be 2.7 trillion yuan, the total expenditure will be 2.2 trillion yuan, the current balance of the pooled fund will be 500 billion yuan, and the cumulative balance of the pooled fund will be 3.4 trillion yuan.
This shows that the money for medical insurance is generally sufficient, we have a family foundation, which is equivalent to a reassuring pill, and everyone can be more assured about the operation of the medical insurance fund.
Has there been a "wave of surrenders" recently?
Zhu Yongfeng, deputy director of the Department of Regulation, Finance and Regulations of the National Health Insurance Administration, said that by the end of 2023, the number of people enrolled in basic medical insurance in mainland China will reach 1.334 billion, and the participation rate will remain above 95%.
Judging from the latest situation at the end of March 2024, the scale of residents' medical insurance participation is basically the same as that of the same period in 2023, and there is no so-called "surrender wave".
Among them, 371 million people participated in the basic medical insurance for employees, 963 million people participated in the basic medical insurance for residents, and the number of employees participating in the medical insurance increased by 9 million, accounting for 27.8% of the total number of insured people.
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From 2024, you can make a one-time supplementary payment, China Accounting News 2024-04-192. The "new regulations" on the payment period of medical insurance, mutual recognition of the payment period in different places!Officially implemented in March 2024, Shanghai Hotline Information, 2024-02-223. The cumulative balance of the medical insurance fund in 2023 will be 3.4 trillion yuan, Workers Daily, April 12, 2024 4.National Health Insurance Administration: The number of people insured by medical insurance has reached 1.334 billion, and there is no so-called "surrender tide", China Industry Network 2024-04-125.From March 1, Chengdu and Chongqing employees will be mutually recognized for the payment period of basic medical insuranceChongqing Daily2024-01-26
Tips: Popular science articles do not provide professional diagnosis and treatment opinions, please carry out specific diagnosis and treatment under the guidance of professional doctors, the picture comes from Visual China.