The improvement of the social security system is an important criterion for improving the indicators of people's happy life.
As a typical representative of the social security system, the improvement of the medical insurance system is a very typical example of improvement.
Nowadays, our country pays attention to the improvement of people's medical insurance system, which is based on the important position of medical care in the happy life of the people in the mainland.
At the same time, it also has the original intention of helping to improve the physical health level of the whole people.
As we all know, generally speaking, you have to have money in the medical insurance card to use it, so if you don't have money, can you go to the doctor according to the normal process?
This question has been bothering many people's minds, let the outpatient doctor tell you the truth!
1. What is medical insurance?
The full name of medical insurance is called social medical insurance, which is a measure based on national policies to provide medical care for all people.
It can be said to be a veritable safety net and an important guarantee for everyone's health.
Medical insurance is a way to collect the money of all people who participate in medical insurance, and there are many subsidies from the state treasury.
After all, medical care is the most basic social undertaking for people, and the importance of the state to it is self-evident.
And this money is more like a pool, which is used for the reimbursement of a part of the expenses of people suffering from serious diseases.
This concept is more like a concept of "I am for all" in our current society.
To put it another way, if someone unfortunately has a serious illness and needs a high amount of medical expenses, the money in these pools can naturally be used by him, provided that he is covered by medical insurance.
For this patient, this is another concept of "all for one", which is in line with the concept of justice in people's hearts.
However, health insurance is not available everywhere.
Depending on the development of the region's medical and insurance industries, there will be significant gaps in the applicable pharmacies, hospitals, etc.
It must be noted here that medical insurance can only be used in some designated institutions.
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That is to say, it does not mean that you can get unimpeded with a medical insurance card, and if you encounter some private hospitals or individual pharmacies, it is very likely that the medical insurance card cannot be used.
This requires us to pay attention to the fixed-point signs when we see a doctor or buy medicines. This kind of sign must be determined in advance for the convenience of the people.
When paying for medical expenses or medicines, you can be reimbursed with a medical insurance card.
In layman's terms, it means that you pay less, and the state will help you pay for this part of the money.
All the money paid by people to participate in health insurance, as well as the money from the state financial subsidy, are pooled and kept by special personnel.
Since this money involves the reimbursement of the health expenses of more than one billion people on the mainland, there is also a very strict management system accordingly.
Each expenditure of medical insurance expenses is reviewed by a special person, the purpose is to ensure that the money is not wasted and can really fall where it should be used.
Nowadays, the improvement of Internet technology can also play a role in the reimbursement of medical insurance.
From the beginning, you must have a medical insurance card and must pay offline, and now you can use mobile phone QR codes and other online reimbursement on the Internet.
Behind this is the positive role that the improvement of science and technology has brought to the cause of all levels of society.
2. Can the balance be reimbursed if it is zero?
From the reimbursement of the medical insurance card that people are currently exposed to, it is usually to pay a certain amount of money into the medical insurance card, and then reimburse their medical expenses within the limit of this money, but this is obviously a very serious misunderstanding.
Outpatient doctors with many years of work experience said that the amount of this reimbursement is not directly related to the balance in their health insurance card.
In an extreme example, if you don't have any money in your health insurance card, but you still have health insurance, your expenses will still be reimbursed.
The principle of reimbursement involves two accounts in the medical insurance business. These two accounts are called "Individual Accounts" and "Pooled Accounts" respectively.
Individual accounts and pooled accounts are different in many ways, including but not limited to the source of funds, the purpose and characteristics of funds, etc.
Let's start with personal accounts. Personal account, as the name suggests, is an account system formed based on the money paid by individuals in the medical insurance card.
There are some formal units with better benefits, and they will also regularly inject a certain amount of money into the medical insurance card as one of the sources of personal accounts.
The biggest feature of the personal account is that the money in the medical insurance card belongs to you. You can't say that you can use your medical insurance card to reimburse others, and you can't withdraw cash and get cash.
On the other hand, pooled accounts are different from individual accounts.
Co-ordination refers to the money accumulated by the public and the state finance into the medical insurance industry, which is the fund pool we mentioned above.
The items to be reimbursed in the pooled account are even more stringent, after all, there is a very large public interest involved.
And the money in these pooled accounts is not said to belong to the state, but more like the common property of every people.
You can only apply for reimbursement when you want to use it, not that you can allocate it arbitrarily.
The money in the pooled account is often kept and disbursed by the government's medical insurance related departments, and the management is relatively strict.
Therefore, many people may be clear at this point, why can no balance be reimbursed? Naturally, it is because of the protective role of the pooled account.
There is no balance in the health insurance card, usually the funds in the personal account are cleared.
Therefore, at this time, it is natural that you cannot use the money paid in your personal account to reimburse your own surgery fees or medicines.
But let's not forget that there is also the guarantee of the state behind us. That's right, when there is no money in the health insurance card, the pooled account can also be reimbursed.
As long as you say that you are enrolled in medical insurance and have paid your medical insurance premiums on time, you will be able to enjoy the relevant insurance benefits.
Even, the mainland social insurance law also stipulates that the medical expenses for some major diseases can be paid from the pooled account.
Therefore, when there is no balance on the medical insurance card, it is equivalent to losing the ability of the individual to reimburse. However, the society still subsidizes patients, and the state finance still has a certain guarantee for patients' medical expenses.
This independent relationship can better ensure the safety and stability of patients' medical treatment, and is more conducive to improving people's sense of gain and happiness.
3. Medical reimbursement process
Of course, it is not enough to know some theoretical knowledge, medical insurance, as a de facto behavior, must require people to understand the corresponding process in order to obtain the corresponding protection.
First of all, we must choose a designated medical institution, and this is actually the second misunderstanding of many people about this medical insurance system.
Therefore, you must pay attention to the fact that you must choose a designated hospital, otherwise you will have to pay high medical expenses.
After completing the basic medical treatment process, it comes to the payment link.
It is worth noting that reimbursement does not directly help you pay the money in the hospital during the payment process. When it comes to paying off your medical bills, you still pay your own money.
Then, when you have completed the payment, the doctor in charge will provide you with a medical invoice. Note! This invoice must be kept, otherwise you will lose the cornerstone of health insurance.
Once you have an invoice or some detailed bills of expenses, you can submit it to the health insurance department for application.
This application step will take a while. However, the government's request for convenience for the people will not be too long.
The content of the review mainly includes whether the expenditure is real and effective, whether the hospital or the drug is covered by the insurance, etc.
After the review is completed, the medical insurance staff will allocate a certain proportion of the part from the pooled account for reimbursement.
4. Optimization and suggestions
Although the medical insurance policy has a fairly well-established foundation in the mainland, there are some small details that need to be paid attention to.
First of all, there is a question of convenience, which many patients understand wrongly.
There are even many patients who choose not to be reimbursed after participating in medical insurance due to the troublesome reimbursement process, and bear the expenses silently.
This kind of behavior is tantamount to violating the original intention of our country to establish medical insurance.
In this regard, the government must let the people know that medical insurance is for the people, which is a very convenient behavior, and there is no need to go through cumbersome steps.
In fact, this also requires the government to simplify the work and reimbursement process and give people more convenience.
In terms of the design of the system itself, the scope of insurance can also be expanded according to changes in the actual situation, and a certain number of hospitals can be added.
Let people run less errands and spend more favorable time on disease treatment.
The proportion of reimbursement can also be flexibly adjusted according to the needs of the national finance.
It must be in line with the original intention of the establishment of the medical insurance system, as well as the need to maintain people's happy life and physical health.
summary
Medical insurance is one of the major construction projects of the mainland's social security system.
In medical insurance, people also have many misunderstandings, such as the medical insurance card can not be reimbursed if there is no money, which is obviously wrong.
The separation of individual accounts and pooled accounts provides a second line of defense for each patient in terms of independence. These two lines of defense work together to support and maintain people's happy lives.
In terms of the construction and structure of the medical insurance system, the government and relevant departments must also listen to the voices of the people, and appropriately expand the insurance coverage in order to improve people's livelihood and well-being.
Resources:
1. The public released 2024-06-04 "Everyone should know about this medical insurance knowledge"
2. Easen 2024-01-09"It's so useful! 30 knowledge points of medical insurance! 》
3. Official account of Community Health Service Center of Fenggang Town, Dongguan City 2024-07-31 "Medical Insurance Classroom|Read what is medical insurance? 》