Where is the different medical insurance settlement pain points

On March 29, 2016

Source: Beijing evening news

How to make health care better follow people "flow", has become a hot topic recently. Relative to how to establish a national unified medical settlement platform, reimbursement funds source of professional field, such as sex, people are more concerned about the future of long distance medical care can avoid some existing in direct settlement "pain points".

As long as it can real-time settlement is not represented

Low reimbursement ratio can also be accepted

On the health of the country during the two sessions this year to settle problems, after retiring from the northeast Liu Depeng particularly interested in their hometown to Beijing. "The prime minister said in the province of different health care real-time settlement can achieve this year. We hope that can break through the bottleneck as early as possible within three to five years, to achieve the national game."

Liu Depeng in 2011 to do a good job in the long-distance health care procedures. "Do good, temporary residence permits to the district health centers, where the streets and specify the three hospital cover JiZhang, then back to my hometown in liaoning health center, please affix one's seal, the collected these chapters, the long-distance medical care procedures set. So we don't need referral hospital in Beijing proved."

Until after Liu Depeng really sick in hospital, however, found that a set of red tape is only saved a referral certificate, to submit an expense account, a bit of trouble nor less. In the hospital after the first report with home health care center, "is what disease, in which hospital has to say, have specific to the bed."

After discharge, saving all kinds of documents or have to go home for reimbursement. "It also just, the key can't at that time, let me again after three weeks to get reimbursement of money." Liu Depeng glum, hometown of the house while it is long in but not to live, he had to sufficiently far back to Beijing. Three weeks later, Liu Depeng abandoned himself back to hometown's younger brother, please help to deal with. "My brother in the past, the result is not my id is not yet, have to and express your id card back."

This time reimbursement procedures, Liu Depeng really feeling: "can't afford to disease, hospitalization, hospital medical insurance settlement harder." Because son work busy, so Liu Depeng is to run the program: "the children were too nervous the pace of life, we don't have the heart to delay time. But after old really cannot afford STH over and over again."

Liu Depeng experiences are not exception, his side will have a lot of friends are retired to the other place and children live together. Liu Depeng said, the old people are looking forward to cure different ground settlement can promote as soon as possible, even for less acceptable. Liu Depeng think everything else can let is located in convenient, "as long as it can realize real-time settlement at different ground treatment, as our home field medical reimbursement ratio to calculate can, lower than our reimbursement ratio in the local doctor, can also accept, as long as don't let us these old guy just toss back and forth again."

Health care long-distance real-time settlement

Maybe the bed would not be so nervous

There are many "migratory birds" not like Liu Depeng do different medical insurance settlement procedure, their outside, sometimes have to entirely at his own expense.

In the middle of October last year, Liu Shurong and his wife also like usual ChengMai fly to hainan for the winter, they have 6 years as migratory birds. At the end of December, Liu Shurong suddenly feel dizzy. Because before she ever had a history of cerebral thrombus, then hurriedly to the local hospital, but the problem is not too serious, but the doctor gave her two weeks of medicine, let her to the hospital every day infusion.

Liu Shurong feel too trouble to have to go to the hospital every day, hoping to hospital treatment, the doctor told her no beds. Liu Shurong thought come from other places, "old birds" too much, so much so that the local medical resources appeared in "difficult" to the hospital. Later, when she went to the hospital every day infusion bag or bottle, listen to ward mates to chat to know the ropes, "the ward many are foreign patients, some people just cold also requires a hospital stay. Why is everyone said, go to a doctor in the field not submitted to the outpatient medical expenditures in the hospital is a must to submit an expense account." Because most of the time spent in Beijing, now different health insurance settlement procedure Liu Shurong also don't want to do, be afraid influence in Beijing for medical treatment, her long distance for future health care real-time settlement is also full of expectation: "not only can own less, the key is to won't someone ailments also was in the hospital at that time, the bed should it won't be so nervous."

Medical treatment in the field and the same Yan Xiaoxian father, to submit an expense account a certain percentage of the outpatient expenses. In the autumn of 2013, Yan Xiaoxian parents help her to take the child to elementary school, adhere to the back to their hometown, but home found the heart out of the problem, less than six months after hometown hospital for cardiac angiography, found three main artery is blocked, get a referral proof returned to Beijing after heart bypass surgery. In doctor Yan Xiaoxian parents listen to ward mates, go home to open a special chronic diseases, can reimburse part of outpatient service. Yan Xiaoxian relatives to help her father to the proof, then Yan Xiaoxian sister to submit an expense account is very confused, "we were together, be in hospital outpatient service documents documents are handed in, a total of nearly 90000, part of the expenses, the final reimbursement for 35000, the office visit YongBao much, didn't dare to ask more look not to come out."

Health care beyond the settlement

The whole process need to increase transparency

Li bin also had an experience goofs off. His father found pancreatic cancer 3 years ago, but in the end more than 70 ten thousand yuan medical treatment expenses only 30000 yuan. Li bin, said he was holding his father's medical documents back to submit an expense account, was told that some in medical insurance drug list of the last cannot submit an expense account. "My father to do chemotherapy, played mabthera, this medicine is to submit an expense account in Beijing, we return to his local consulting, said local can't quote."

Li bin especially dissatisfied with local insurance reimbursement for detail, not "directory of medical insurance drugs there are thousands of species, there are a lot of one-time consumables, diagnosis and treatment projects, etc., which make clear. We ordinary people did not give details, if health care do not reimburse us according to the regulation, we don't know, also can't check, how much is health departments in charge, this is too opaque. Even want to question, there is no evidence at hand."

Yan Xiaoxian said health care workers should have a duty to remind patients how to deal with various situations reimbursement policy, otherwise, it is a kind of inaction, deliberately "in our local, for example, do this can submit an expense account a certain chronic diseases outpatient expenses, the obvious policy can help patients and health care of staff never take the initiative to remind us that ward mates or revealed to us. When countries have good policy, but executives' trapped '."

Expert opinion

Two of the most difficult in field problems

(university of the CPPCC national committee, foreign trade and economic cooperation to clsa insurance, professor, vice President of the school of economics) : from the prime minister li keqiang's words, we can feel the determination of the country is very big, before also has introduced a insurance different ground settlement policy, the direction is right, also is the trend of The Times. But first of all, realize the relocated people health long-distance real-time settlement also accorded with the actual needs of many people. However, health care really to realize long-distance real-time settlement, difficulty is very big. We only said two of the most difficult in field.

The first problem is the health care a long-distance real-time settlement of capital source, that is real time submit an expense account where the money actually comes from, is health, or patients with ginseng protect the earth.

The status quo is basic or municipal health care, or even county as a whole, each plan as a whole to fu biao, reimbursement drugs, reimbursement have financial considerations, because our financial system is "focal points to eat," belong to "sink", so in different parts of the health care level there are still many gaps.

At the same time, the economic developed areas of reimbursement, not only has the fiscal input, there are also the cause of the ginseng protect personnel to pay more. Rights and obligations are equivalent, if did not take part in medical field to the patients health, without payment, nor shall have the right to the local insurance reimbursement.

And patients have enjoyed the convenience of the process, enjoy the higher health resources and services, so the security level is impossible to have too much of a raise. Otherwise, a line of city health foundation will not be brought down?

So, I think, health-care long-distance real-time settlement of the money should be kept by patients ginseng to a just and reasonable.

The second problem is how to implement the national information network.

Health care long-distance real-time settlement is actually a big data strategy, a nationwide public health resources and information sharing, as well as the national healthcare platform construction and unicom, is the material foundation to realize it.

But we now health care or local administrator, each plan as a whole to submit an expense account in a different way, some reimbursement according to the head of a bed, some press disease to plant, some on a per head, health-care starting line, reimbursement ratio, reimbursement and other standards also differ in thousands ways, health care and no unified information interface, operation process is different also, some provinces even not realize city as a whole, these all need technical support and time, in a short period of time is very difficult to build a mature platform for the national healthcare different ground settlement.

The two problems are hard to happen overnight, every step change, have to pay a considerable effort. Improve the overall level, speed up the medical insurance fund in our country information level of medical insurance, medical insurance for the elaborating management, is the key to further implement different reimbursement work in our country.

remind

Live in another place indicates relocated

On December 25, 2014, human resources and social security ministry, the ministry of finance, health and family planning commission jointly issued "about further do a good job in basic medical insurance work guidance on the settlement of long-distance medical expenses (hereinafter referred to as" the guidelines "). Are prescribed file - 2015 basic implementation within cities and provinces, autonomous regions and municipalities directly under the direct settlement of long-distance medical hospitalization expenses, 2016 comprehensive implementation across the province "relocated" retiree hospitalization medical expenses directly and settlement.

File is also a clear definition of the concept of the relocated retirees across the province - leave ginseng as a whole the area live long long distance across the province, and has acquired residence household registration according to the household registration management regulations of ginseng protect retirees. (ming-jie zhou)