A serious illness added health make difficult people eat "reassuring"

07:49:53 August 01, 2016

Source: guangming daily

The reform of track see implement 】

The new farmers and farmers after a serious illness insurance reimbursement, had a serious illness difficult people will still be a part of the medical treatment cost of poverty Chinese. Henan jiaozuo difficult people on the implementation of a serious illness supplementary insurance has played a good effect. As of July 25, 900 claims for difficult people, 910000 yuan, people praised the "good steel used in the blade".

Since reform implemented in 2009, in the basic realizing a complete coverage of the basic medical insurance system, on the basis of jiaozuo in henan province in order to solve the needy poor look down on disease, poverty due to illness as the goal, actively explore new way to improve the level of difficulty group medical insurance. In henan province, under the guidance of health reform do through the government leading, insurance agency, constructed the difficulties people from the basic medical insurance, serious illness insurance, serious illness supplementary insurance, health care and disease control and emergency rescue, medical expenses (i.e., "three risks YiZhuYi control") of the medical security mechanisms.

This mechanism is the sustainability of risk-sharing, insist on the balance of payments, guaranteed small profit. After repeated calculation, jiaozuo illness supplementary insurance point, determined to be 94%, if the claims within the year spending less than 94%, the balance part into a serious illness supplementary insurance "accumulated surplus funds management. Claim expenses such as year reach or exceed 94%, organized by the municipal public health commission relevant departments and units to review assessment, within the scope of part is beyond 6% (including) shall be borne by a serious illness to undertake supplementary insurance agency, with the rest of the "cumulative surplus funds" to supplement, skimpy share after approved by the municipal government subsidies. Because new difficult people or policy adjustment to cause more than 94% of the annual adjustments spending, upon examination and approval by the relevant departments, shall be subsidies by the municipal government; Caused by insurance institutions themselves factors compensate or pay more, the corresponding expenses shall be borne by the serious illness to undertake supplementary insurance agency.

How can both guarantee difficult crowd medical needs, and reasonable control medical costs? A hierarchical diagnosis and treatment, health care, new farmers and the medical establishment that decide a dot to determine a group of grassroots medical institutions, secondary and tertiary hospital subsidiary medical insurance fixed point hospital of a serious illness as a difficult people, to carry out the first option at the grass-roots level and two-way referral system, guide the patients to a reasonable and orderly treatment; Second, strict control unreasonable medical expenses, grassroots medical and health institutions, secondary and tertiary hospital is not included in the scope of medical insurance reimbursement of medical expenses, shall not exceed 2.5% of the total health expenses, respectively, 2.5%, 20%, beyond the part shall be borne by the medical institution; Three is for medical institutions to carry out the "medical checks and medical intervention, medical review" of risk management, supervision jointly by the competent department of industry and commercial insurance institutions.

The experts called for difficult people eat "reassuring" "preference", in jiaozuo also implements and the entire health management. When signing the urban and rural residents health service, the priority will be signing the needy families into the health service scope, and incorporate the needy families signing rate and the quality of service evaluation content. Through the health management increasingly difficult populace's physical quality and health consciousness, prevent or reduce poverty due to illness, improve the quality of life of the needy and their own hematopoietic capability. (reporter Cui Zhijian)