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In the current basic medical insurance system, not using one's own medical insurance card to register for medical treatment is a false name for medical treatment, which can be suspended from online settlement of medical expenses, and at worst constitutes a violation of the law. This means that a misunderstanding of "family solidarity" may lead to "trouble". To ensure the smooth implementation of "family mutual aid", it is necessary to add "guardrails".
In real life, some people, especially the elderly, still do not understand the policies and knowledge of medical insurance reimbursement policies, regulations on the use of employees' medical insurance personal accounts, and conditions for "family mutual aid", and are easy to act on their subjective understanding. This requires multi-channel propaganda and education work to build the first "guardrail" for the insured.
Individuals may have knowledge blind spots, but medical institutions and pharmacies must be familiar with medical insurance policies. However, some institutions and personnel act as "spectators" knowing that patients are mistakenly enjoying the policy and do not stop it. This requires the implementation of a shared responsibility system to strengthen the second "guardrail" on the medical and pharmacy side.
Electronic medical records and electronic prescriptions have been popularized, and intelligent review of medical insurance has also become an important regulatory tool. The use of information technology can detect abnormal drug use, such as young workers who have never suffered from cardiovascular and cerebrovascular diseases prescribe a large number of drugs for the treatment of cardiovascular and cerebrovascular diseases and enjoy outpatient reimbursement policies, and intelligent tools are easy to find problems. Only by building the third "guardrail" of information technology supervision can we deal with the massive amount of information generated by "family mutual aid" and greatly improve the efficiency of supervision.
"Family mutual aid" is a measure to benefit the people, and it is necessary to resolutely crack down on the behavior of deliberately taking advantage of the loopholes of "family mutual aid". Insured persons and family members also need to learn more about medical insurance policies and clarify the boundaries of behavior.
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Text: Tang Chuanyan (doctor)
Editor: Yang Zhenyu
Proofreading: Ma Yang
Review: Qin Mingrui, Xu Bingnan
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