On July 6, 2014, shandong started the construction of insurance system for the whole province. Those who participate in the basic medical insurance of residents shall be covered by the medical insurance coverage; If residents and workers use 18 anti-tumor drugs, they can receive up to 200,000 yuan of individual compensation in a medical year. Rural poor people, the big sickness insurance began to pay half the standard. Under the comprehensive application, the actual reimbursement rate of people's medical treatment is 70%.
"The ambulance rang, a pig white." Some families are overwhelmed by the disease. To achieve the "guarantee of disease and disease" is an important part of building a moderately prosperous society in all respects.
As early as 2012, Qingdao first took the lead in implementing the medical assistance system for medical treatment in the country. Government USES price negotiation mechanism and sharing mechanism, the nine apt material into security range, completed the basic medical insurance for urban residents, basic medical insurance for urban workers, and new type of rural cooperative medical care (hereinafter referred to as the "new farming close") "the unity of" three risks in urban and rural areas as a whole security system.
Since the integration of basic medical insurance for residents in 2014, shandong has launched the whole province's insurance system construction. Now, the actual reimbursement rate of people's medical treatment is 70%.
To participate in the basic health insurance coverage, the individual does not need to pay another fee
In 2014, through the integration of the basic medical insurance for urban residents and the new rural cooperative medical system, the formation of residents' basic medical insurance system, shandong eliminated repeat ginseng protect residents of 2.54 million people, save the government subsidies of 830 million yuan.
At the same time, shandong has carried out the insurance work to compensate the high cost of medical treatment, and implemented the management mode of overall planning, accounting management, independent accounting and standard operation. After the integration, the people who participate in the basic medical insurance of residents will be covered by the medical insurance coverage. In addition, explore the establishment of multi-level major disease supplemental insurance. In 2014, shandong took the lead in completing the construction of the integrated work and medical insurance system, and formed the gradient reimbursement model.
While the government-led, shandong give play to the role of market mechanism, set access conditions, according to the province government through purchasing the selected three commercial insurance institutions, improve operation efficiency and service quality. People club hall residents in shandong province health researcher at qing-guo zhang said, a serious illness ginseng protect residents only need a social security card, serious illness insurance compensation within the scope of the medical expenses can be in the medical establishment that decide a dot the immediate settlement, the medical expenses after checking by commercial insurance institutions allocated to the medical establishment that decide a dot in a timely manner.
To implement the residents' health insurance, the problem of source of funds should be solved first. Shandong from residents' basic medical insurance funds according to the proportion of 10% transfer, by the residents of orgnaization of agency of insurance of primary medical treatment as a whole the area allocated to commercial insurance agencies by the regulation, don't need individual also pay cost. Specific financing standard, implement dynamic adjustment. In 2014 and 2015, the standard for the financing of residents' health insurance was 32 yuan per person, and in 2016 it was 52 yuan per person and 62 yuan per person in 2017.
Residents' health insurance, a medical year of the maximum of 300,000 yuan per person
It is often necessary to use a lot of imported drugs, special medicines, special medical devices and other products not covered by the basic medical insurance catalogue.
Before the implementation of a serious illness insurance system, shandong urban health care, although town worker medical insurance drug catalogue including 2400 kinds of drugs, but malignant tumor targeted drugs for the treatment of a serious illness such as basic medicines and equipment needs to be at his own expense. According to the reimbursement method of "major disease type + amount", the insurance funds of major diseases only compensate for 20 major diseases such as childhood leukemia, lung cancer and cerebral infarction.
Since 2015, the residents' disease insurance has been settled by the past medical and medical expenses, and the entire transition has been settled according to the medical expenses. Ginseng protect a medical residents annual hospitalization medical expenses incurred and included in the scope as a whole fund pays chronic disease outpatient costs, first by the residents' basic medical insurance compensation, average hospitalization expense fund to pay not less than 70%, outpatient expense fund pays is not lower than 50%. Then, the compliance medical expenses that the resident individual accumulates burden exceeds the part that the resident big disease insurance rises to pay standard, by the resident big disease insurance compensates.
It is understood that the standard of insurance for major diseases is 12,000 yuan, with 50% compensation for the part below 100,000 yuan. The compensation of over 100,000 yuan (including 100,000 yuan) and RMB 200,000 yuan shall be 60% compensation. More than 200,000 yuan (including 200,000 yuan) is compensated for 65 percent. In a medical year, residents will be given a maximum compensation of 300,000 yuan per person.
In December 2016, in response to residents, shandong further expanded the scope of compliance medical expenses to include 18 anti-tumor targeted drugs and specific drugs (including imported drugs). By adding a serious illness raised 10 yuan per person per year, a separate compensation, fu biao is 20000 yuan, the part of fu biao above 40% of the compensation, a medical treatment inside year, residents of a serious illness insurance funds pay limitation of up to 200000 yuan.
On January 1 this year, shandong province launched the employee health insurance system to compensate 18 anti-tumor targeted drugs and specific drugs. The insurance of the staff of the whole province is raised by the standard of 20 yuan per person per year, and the standard of payment is 20,000 yuan, and 60% compensation for the above standard. In a medical year, the insurance fund for the employees of the staff will be compensated with the maximum of 200,000 yuan per person.
Comprehensive power, shandong realize in hospital compensation proportion about 11%, about 70% overall expenses, the province's basic health care, along with a serious illness insurance highest pay limitation to 450000 yuan of above.
In 2016, the shandong dailyinsurance fund compensated the medical expenses of 196.45 million people with a total compensation of RMB 32.6 billion, with a compensation rate of 110%. Since the implementation of the insurance system for residents, the total compensation for medical treatment of 449.87 million has been 8.883 billion yuan.
The rural poor will be included in the basic medical insurance free of charge, and the standard of insurance for major diseases will be halved
"Poor people make up more than half of the poverty," he said. "when it comes to serious illness, 12,000 yuan is a lot of money." Zhang qingguo said.
Starting in 2016, shandong health policy tilt to the poor, rural five guarantees, urban and rural minimum living guarantee object and leads the life is very difficult because of illness and other personnel, approved by the local government to residents' basic medical insurance individual capture to expend part through urban and rural medical assistance and other financing channels. For individuals, the equivalent of free access to basic health insurance and health insurance.
In August 2016, poverty alleviation and development office, work in shandong club hall and departments jointly issued, clearly put forward the rural poor residents of a serious illness insurance fu biao in half, from 12000 yuan to 6000 yuan, the medical expense reimbursement ratio increased by 5% per paragraph. In a medical year, residents will be given a maximum compensation of 500,000 yuan per person.
Based on this, Qingdao has pushed forward the reform of health insurance. Began on January 1 this year, Qingdao in the basic medical insurance and major medical insurance, on the basis of the first introduced the features, apt to material of supplementary medical insurance system, help people share the shift, catastrophic diseases and rare disease frequently hundreds of thousands of yuan of drug costs. At present, the special drug has been extended to 41 species, and the price decline can reach up to 70% after introducing the negotiation mechanism. The system has fully covered 8.1 million residents. Ginseng protect people use apt special material of medical expenses incurred by the regulation, 80% according to the proportion of reimbursement, do not set the highest pay limitation, outside the scope of medical treatment charge a year accumulative total more than 50000 yuan of above parts, the unification according to 70% of the expenses, highest pay 200000 yuan a year.
Without new financial and personal burdens, Qingdao by adjusting the medical care expenditure structure, revitalize the stock funds, raised from 270 million yuan a year to about 550 million yuan a year, at the same time balance as a whole from the calendar year one-time transfer 3 billion yuan in funds, specially used for supplementary health insurance reserves, sustainability of the fund operation greatly enhanced.
In the first five months of this year, Qingdao has paid more than 150 million yuan for universal health care, and 3,4328 people (6,7852) have enjoyed the relevant protection. "In the course of the development of the major medical insurance in shandong," zhang said, "in the process of advancing the medical insurance system in shandong province, the road to the poverty of poverty and poverty through institutional construction is given to the people of shandong province," zhang said. "it gives the people the guarantee of sustained stability."
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