How to improve medical insurance, how to improve the medical insurance system

Social medical insurance + commercial insurance.

In accordance with the requirements of the "Decision on the Establishment of the Basic Medical Insurance System for Urban Employees" (Guo Fa [1998] No. 44), the framework of the basic medical insurance system for urban employees includes six parts: First, the establishment of a reasonable and affordable common payment mechanism The basic medical insurance premiums are jointly paid by the employer and the individual, reflecting the mandatory characteristics of the national social insurance and the unity of rights and obligations. Medical insurance premiums are paid jointly by units and individuals, which can not only expand the medical insurance funds, but more importantly, clarify the responsibilities of units and employees, and enhance personal self-protection awareness.

In this reform, the state has stipulated the control standards for the employer's contribution rate and the individual's contribution rate: the employer's contribution rate is controlled at about 6% of the total wages of employees, and the specific proportion is determined by each locality, and the payment rate of employees is generally 2% of their own salary income. The second is to establish a co-ordinated ** and personal account, and the basic medical insurance ** is composed of the overall use of the social co-ordination and the personal account used by the individual.

All individual payments are transferred to personal accounts, and unit payments are transferred to personal accounts at about 30%, and the rest are established as a co-ordination**. The personal account is used exclusively for personal medical expenses, which can be carried forward for use and inheritance, and the principal and interest of the personal account belong to the individual. The third is to establish a payment mechanism with separate accounts and a clear scope, and coordinate the payment of individual accounts to determine the scope of their respective payments, and the overall planning of the first major payment of large and inpatient medical expenses, and the personal account mainly to pay small and outpatient medical expenses.

In accordance with the principle of "determining expenditure by revenue and expenditure, and balancing revenue and expenditure", the minimum payment standard and maximum payment limit should be determined according to the actual situation of each locality and the ability to bear it. Fourth, the establishment of an effective medical service management mechanism, the scope of payment of basic medical insurance is limited to the provisions of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities within the standard medical expenses; The medical institutions and pharmacies that provide basic medical insurance services shall be managed at designated points; Social insurance agencies and basic medical insurance service institutions (designated medical institutions and designated retail pharmacies) shall settle expenses in accordance with the settlement methods stipulated in the agreement. Fifth, the establishment of a unified socialized management system of basic medical insurance to implement a certain level of social management, in principle, to the prefecture level or above administrative districts (including prefectures, cities, prefectures, leagues) as the overall unit, can also be the county for the overall planning of the unit, by the overall planning of the area of social insurance agencies responsible for the unified collection, use and management, the full amount of the Baosen Noisy certificate of the full collection, reasonable use and timely payment.

Sixth, establish a sound and effective regulatory mechanism, basic medical insurance, the implementation of special financial account management; Social insurance agencies should establish and improve rules and regulations; The overall planning area should set up a basic medical insurance social supervision organization to strengthen social supervision. It is necessary to further establish and improve the first-class budget and final account system, financial accounting system, and internal audit system of social insurance agencies.

Summary. According to the original intention of the formulation of China's medical insurance system, the realization of universal coverage has always been an important goal, for the current more serious problem of adverse selection, we must clarify its causes, from the perspective of enhancing the binding force, improving the top-level design, improving the overall level, improving the supply and management of flexible employment personnel, and increasing the attractiveness of low-risk groups, improve the medical insurance system, and continuously improve it, so as to achieve the goal of effectively resolving the problem of adverse selection and promote the universal coverage of social medical insurance.

Hello I don't know what kind of confusion you have encountered, can you describe it to me in detail and see if I can give you some advice?

Hello dear dear, research shows that health insurance is beneficial to the health of insured individuals, and has a greater impact on people with poor socioeconomic status.

Does health insurance improve health.

On the one hand, medical insurance relieves workers' worries and makes them work with peace of mind, so as to improve labor productivity and promote the development of production; On the other hand, it also ensures the physical and mental health of workers, and ensures the normal reproduction of labor combustion and hydraulic power. Medical insurance is designed to compensate the insured person for financial losses due to the risk of illness. After the insured user incurs medical expenses for medical treatment, the insurance institution will give him a certain amount of economic compensation.

Your state of mind is better, your heart is at ease, and your health will get better and better<>

So whether adverse selection in health insurance proves that the intervention is effective.

I remember a little girl once told me that a guarantee is not actually how much you need to protect, but a security heart, and when your heart settles down, you will feel that the people around you are noisy and things are kind, your heart and your body are slowly getting better, and the positive magnetic field will attract each other because Yinchun is surrounded by positive energy.

It is basically impossible to eliminate adverse selection, all that can be done is to minimize adverse selection, or reduce the negative impact of adverse selection.

So whether adverse selection in health insurance proves that the intervention is effective.

Proven. It should work.

Why is it effective? Sorry for the trouble, thank you thank you.

Isn't it already being done to gradually improve the top-level design, improve the overall level, improve the supply and management of insurance for flexible employees, increase the attractiveness of low-risk groups, improve the medical skin insurance system, and continuously improve it.

According to the original intention of the formulation of China's medical insurance system, the realization of universal coverage has always been an important work goal, for the current more serious adverse selection problem, we must eliminate and clarify its causes, from the perspective of enhancing the binding force, completing the imitation of the top-level design, improving the overall level, improving the supply and management of flexible employment personnel, and increasing the attractiveness of low-risk groups, improve the medical insurance system, and continuously improve it, so as to achieve the goal of effectively resolving the problem of adverse selection and promote the universal coverage of social medical insurance.

Legal analysis: medical insurance** is known as the "life-saving money" of the people. In terms of medical insurance services, there are often some problems of "urgency, difficulty, sorrow, and hope", such as providing a lot of materials, delaying reimbursement and asking for help, and not being able to report across regions.

In order to solve these problems and break through the "blockage" of medical insurance reimbursement, the "Opinions on Optimizing Convenient Services in the Field of Medical Insurance" was officially issued by the Standing Committee.

Legal basis: "Opinions of the National Medical Security Administration on Optimizing Convenient Services in the Field of Medical Insurance" (11) Strengthen the data support of medical insurance services. In accordance with the goal of building a unified national medical insurance information platform, relying on a unified national technical system and architecture, accelerate the implementation and application of medical insurance information platforms in various places, and interconnect with the national integrated government service platform.

Fully implement the application of 15 information business coding standards, realize the "one-code communication" of the national medical insurance system and various business links, and gradually realize the aggregation, in-depth mining and application of medical insurance data. We will improve the ability of integrated medical insurance management, convenient services, intelligent supervision and scientific decision-making, and improve the modernization level of medical insurance governance capabilities. Strengthen the management of insurance data for key groups such as employees in the new and repentant employment forms, such as flexible employees, newborns, orphaned children, and de facto unsupported children, to prevent "missing insurance" and "breaking insurance".

With the national integrated government service platform as the data sharing hub, establish a data sharing and exchange mechanism between the medical insurance department and the departments of education, public security, civil affairs, human resources and social security, health, veterans' affairs, taxation, market supervision, rural revitalization, and the Disabled Persons' Federation, strengthen the comparison and dynamic maintenance of personnel information, and make the basic data of insurance participation.

Medical security refers to the right and guarantee of citizens to receive material assistance from the state and society in accordance with the law when they are sick. The state establishes a basic medical insurance system, and the insured persons enjoy the basic medical insurance treatment, and the part of the medical expenses that should be paid by the basic medical insurance can be reimbursed.

The scope of medical insurance coverage is:

1. Students in all kinds of primary and secondary schools (including vocational high schools, technical secondary schools and technical school students), children and other residents under the age of 18 are registered in urban households in this city;

2. Urban household registration in this city, non-employed residents aged 18 and above;

3. The elderly aged 60 and above (referred to as the elderly from low-income families) who are registered in urban areas of the city and do not enjoy pension or pension benefits on a monthly basis (the elderly with household registration in other places shall be charged according to the normal standard);

4. The city's urban household registration, the subsistence allowance and the severely disabled (the low-income households and the severely disabled in other places are charged according to the normal standard);

5. Students who are not registered in the city's urban household registration and are studying in various primary and secondary schools (including vocational high schools, technical secondary schools, and technical schools) in the city, and have obtained Kaishout student status in the city.

Legal basis]:

Article 30 of the Social Insurance Law of the People's Republic of China.

The following medical expenses are not covered by basic medical insurance**:

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.