Stick to fair to promote integration with a view to ensuring people's well-being

- experts interpret the state council about the opinions of the integration of urban and rural residents basic medical insurance system,

The national health and family planning commission of the People's Republic of China

The 2016-01-13

Medical security system especially the government-led basic medical security system is for people to share the burden of medical expenses, and ensure the important system arrangement of the people's health. Along with the rapid advance of urbanization in our country, the differences between rural and urban areas is gradually narrowing, according to the city, township household segmentation set new farming system and the disadvantages of the basic health insurance system for urban residents increasingly apparent, when people go to a doctor of different health status and the discriminating reimbursement policies often make ginseng protect individuals and the hospital scratching his head, not "protect" institutional barriers between setting also along with the people to go with the trend of urban and rural residents' liquidity enhancement does not match. In this context, promulgated by the state council "about the opinions of the integration of urban and rural residents basic medical insurance system" (hereinafter referred to as "opinions"), the integration of new farmers and urban residents health care system is put forward clear requirements, it may be said for the basic medical insurance system on the basis of accurate pulse of a welcome antidote to the reform and perfect the construction of basic medical insurance system and realize everyone equitable access to basic health care is of great significance.

Throughout full text "opinion", "six" is its most prominent window:

In terms of uniform coverage, the new farmers and urban residents health insurance cover rural and urban employment population respectively, coverage has obvious urban-rural division characteristics. "Opinion" regulation, health care system covering urban and rural residents have new farmers and urban residents medical insurance all should join (us), it is to break the ginseng protect qualification of city and township, make urban and rural residents in terms of coverage without being limited by the household registration properties, with the same insured qualification. At the same time, the "opinions" also allows for the worker is basic medical treatment insurance have difficulties rural migrant workers and personnel of flexible obtain employment in urban and rural residents health care, to the employment status is not stable, no fixed labor relationship with the unit, often transform work unit or often migration of rural farmers, self-employed, such as opened the door, to avoid such people free from the guarantee.

In unity financing policy, urban residents medical insurance and new farming and a fixed quota financing way, to a certain extent to raise equity. To this, the "opinions" clearly put forward the unified urban and rural residents to raise standards of health care system, the existing urban residents medical insurance and new farming and individual pay cost standard gap larger area, can adopt the difference to expend means, use 2 to 3 years time transition step by step. Gradually establish individual pay cost standard and urban and rural residents per capita disposable income of corresponding mechanism. Above requirement made clear the development direction of urban and rural residents health financing mechanism, proposed pegged to the income of financing mechanisms, also suit the current our country urban and rural residents income gap is larger, the family income is lack of effective means to investigate the reality, puts forward the urban and rural or regional income level along the suitable method of payment, has strong operability.

In the unified security benefits, at present, the new farmers and urban residents health care coverage are including inpatient and outpatient expenses at the same time, the "twelfth five-year" period, urban residents medical insurance and new farming policy within the scope of hospitalization expense payment proportion reached 70% and 70% respectively, in the case of funding level is relatively low has is not easy. "Opinion" regulation, urban and rural residents basic medical insurance policy within the scope of hospitalization expense payment proportion to remain at around 75%, and gradually raise the level of outpatient service guarantee. This means that in some parts of the new farming and may be in medicine and medical service project directory and expand under the condition of maintaining its policy within the scope of hospitalization expense payment proportion is not falling, urban residents health care policy within the scope of medical expenses to pay scale and increased by 5%, to further improve the level of urban and rural residents health care will have a positive role.

In unified health insurance directory and designated management, new farmers and urban residents around the current health care medicines, medical service project directory, and scope of designated agencies, management measures and so on each are not identical, and there are some overlapping, which makes the farmers to participate in new, or the medical insurance for urban residents of urban and rural residents face different medicines, medical services and medical treatment platform, objectively caused the actual treatment level of difference between urban and rural residents. Therefore, the "opinions" requirement unified urban and rural residents health care medicine and medical service project directory, unified urban and rural residents health orgnaization management approach.

In consolidated fund management, the new farmers and urban residents health care are established fund financial system, accounting system and budget management system, and will fund into the fiscal revenue management, but the level of funds as a whole across different, means to plan as a whole fund is unified collection state and adjust the different forms such as gold. "Opinions" put forward that urban and rural residents health care system in principle, (to) class as a whole, encourage conditional region implement provincial plan as a whole. This helps reduce to ensure treatment differences between different areas, and improve the fairness of different regional residents get basic health care benefits, as well as to enhance the risk resistance ability of the urban and rural residents basic medical insurance fund. "Opinion" at the same time regulation, to strengthen fund raising their overall level of classification management, give full play to the government at the county level, management of orgnaization of agency of fund management enthusiasm and initiative, and requires payment by advancing reform, the establishment of a new medical order and other measures to control the unreasonable growth of medical expense, these measures can help improve the efficiency of the use of the basic medical insurance fund, make the limited medical insurance fund can output higher support capability.

Urban and rural residents medical insurance and new farming in the differences of policy is the starting point of the integration, to eliminate differences, gradually unified policy is the necessary requirement of system integration in form, is also a judgment of urban and rural residents basic medical insurance system is the key to realize integration. The integration of urban and rural residents basic medical insurance system and policy of unified must always adhere to the principle of fairness, adhere to ensure equitable access to urban and rural residents basic medical insurance of the qualification, the basic goal of equitable access to treatment of insurance of primary medical treatment, on the rules of fair security rights in the field of urban and rural residents in the basic medical insurance a fair chance and fair. Around the integration of new farmers and urban residents in the process of health care system, the activities of the overall plan should deepen the reform to promote reforms in the field of health care, medical treatment, medicine, collaborative, continuously improve the sustainability of financing of urban and rural residents basic health care system and funds use efficiency, earnestly implement the sustainable development of medical insurance system, and promote social equity and justice, promote the objectives of the reform of the people's well-being. (the author is the national health and family planning commission, deputy director of the new rural cooperative medical research center, researcher wang made earlier, the national center for health and family planning commission of new rural cooperative medical research associate professor dong-hui zhao) (source: health net, on January 13, 2016)