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Investigation of the people's livelihood: health care "roaming" across the country, which steps are?

2016年09月21日

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Specific policies, ginseng protect level, reimbursement scope, each district is not the same

Investigation of the people's livelihood: health care "roaming" across the country, which steps are?

Our reporter He Yong li gang

08:28 September 21, 2016

Source: People's Daily - the People's Daily

The core reading


Long-distance real-time settlement, is that many of the floating population. At present, people club department has put forward the "city, province, across the province" of the national health care network "three steps" way of thinking. Expert proposal, to truly realize the long-distance medical instant settlement, need around between reinforcing plan as a whole, share information, should also promote apanage supervision, avoid fund waste. Strengthen the classification diagnosis and treatment, prevent "crowding out".

Recently, the hainan has signed a cooperation agreement with 30 provinces, take the lead in realizing a complete coverage of long distance medical billing. Now there is such a group: they are home sick, but to return to the original ginseng to reimburse medical. Under the background of population flow of increasingly frequent, long-distance medical especially cross-regional, can generally realize real-time settlement? Health care "roaming" across the country, have to wait long? Our reporter interviewed.

Back to submit an expense account, such as 3 weeks to get money

Medicare patients across the province long-distance medical can't immediate settlement, is a long-term problem in health care institutions and ginseng protect people around.

In 2009, guangzhou began to try to develop a long-distance medical across the province. Due to local policies, level of ginseng, reimbursement of medical insurance and so on have very big different, advancing the long-distance medical networking settlement is particularly difficult. In June 2011, after many efforts, guangzhou three with hunan, hainan, yunnan provincial medical insurance agencies, and fuzhou, nanchang, changsha, nanning, chengdu, capital of pan-pearl river delta cities such as medical insurance agency orgnaization, signed the "pan-pearl river delta region part of the province and the provincial capital city of social medical insurance long-distance medical cooperation framework agreement to jointly explore the implementation of pan-pearl river delta regional medical insurance one long-distance medical instant settlement work.

In Beijing, the medical insurance ginseng protect patients in hebei province yan jiao yan was at the hospital, emergency, or fertility, can back to Beijing to submit an expense account. "Still hasn't been implemented different health care reimbursement immediately." "Ginseng in Beijing, according to the relevant person in charge of the hospital after a patient sees a doctor to yan jiao, only reimbursement process generally have to go three to four months, the fastest also need about a month. That doesn't include complex relocated procedure time before reimbursement."

De-jun wang old man 68 years old, come from the northeast. In 2011, the son of uncle wang bought a house in Beijing, take him up.

Considering the age, uncle wang early do good long distance medical care procedure for yourself. "For a temporary residence permit first, then to the district health centers, streets, and specify the three hospital cover JiZhang, then back to my hometown in liaoning health center, please affix one's seal, collected the chapter, the different medical insurance formalities done. In this way, we don't need referral hospital in Beijing proved."

De-jun wang, however, it was not until I was ill in hospital, found that a set of red tape has just saved a referral. Really want to submit an expense account, a bit of trouble didn't also less: after hospitalization, first reported to home health care center, "is what disease, in which hospital to see, have to say, have specific to the bed."

After discharge, saving all kinds of documents, or have to go home. "It also just, the key can't at that time, let me again after 3 weeks to get reimbursement of money." De-jun wang glum, although their hometown house is still there, but for a long time not to live, he had to sufficiently far back to Beijing. Three weeks later, de-jun wang gave up himself to go back to hometown's younger brother, please help to deal with. "My brother is in the past, as a result, not my id card, not yet, have to and your id card express in the past."

The reimbursement procedures, de-jun wang straight sighed: "in the hospital, was released from the hospital medical insurance settlement, harder."

Need to improve the overall level, to promote information sharing

This year the government work report, to accelerate the basic medical insurance nationwide network and long-distance medical settlement. For different medical insurance settlement, are now facing real challenges?

Addition long-term research of social security of the Chinese academy of social sciences research associate Dong Wenyong believe that health care long-distance real-time settlement does fit the needs of many people. However, to truly achieve healthcare long-distance real-time settlement, the current biggest obstacle is around the low level of health care as a whole.

Because each region as a whole "three directories" basic medical insurance, basic medical insurance drug catalogue, diagnosis and treatment project directory and service of medical treatment of insurance of primary medical treatment facilities projects) are not the same, and so on in different parts of the patients in accordance with the standards of different settlement, which bring great difficulty to different ground treatment real-time settlement.

"Hypothesis of medical insurance fund according to the county as a whole to calculate, is each kind of medical insurance system there may be thousands of different medical insurance plan. Health insurance starting line, pays a proportion, sequester, etc., are not the same, each kind of medical insurance system in the face of very large data processing and accounting operation, etc. This is for medical institutions and health care institutions management ability of great challenge." Dong Wenyong said.

The second question, it is how to implement the national information network. At present, our country has not establish unified health care long distance medical information technology specification and standard, only around, according to local conditions to develop the design of the general lack of unified thought and long-term planning, cause the overall regional network information not unicom, unable to share data resources, objectively restricts the long-distance medical insurance settlement.

In guangzhou, long-distance medical treatment and health care and settlement is also facing some practical difficulties.

According to introducing, different ground treatment was patient and hospital direct settlement, but the hospital and patients in the medical insurance fund or charge management. If settlement, will cause stress to the hospital go to a doctor. Around at the same time, the fund scale, the ability to pay is uneven, out the largest number of medical treatment, health spending sharply increasing, make some payment ability weak areas to increase pressure. Plus all policies, level of ginseng, reimbursement of medical insurance of the inherent differences, to reach beyond the benign operation of the direct payment, you also need to over time, slowly.

Should execute apanage supervision, strengthen the classification diagnosis and treatment

In April this year, people club department held a press conference, puts forward the ideas to promote national health care network "three steps" : one is the city as a whole, the second is to solve the problem of different ground treatment in the province, 3 it is to solve the problem of long distance across the province medical.

From the current practice, because of the overall regional economic development level and medical resource allocation is diverse, achieve the ultimate goal still has a long way to go. Short-term goal, therefore, should be considered first to break the boundaries of provincial regional management, actively explore in inter-provincial long-distance network settlement is given priority to, other various settlement way of combining the different ground treatment and settlement patterns. Long-term goals should be a unified national drug catalogue, diagnosis and treatment and service facilities directory, realize the long-distance medical nationwide network settlement.

Dong Wenyong Suggestions to implement medical insurance provincial plan as a whole as soon as possible, realizing the unity of ginseng protect personnel to the standard. "Improve the overall level, is not only guarantee the equity of health care needs, and improve the health relationship transferring mechanism of important conditions." He believes that the current system of medical insurance are the two urban and rural residents, two sets of orgnaization of agency of. Around fundamental purpose of health care system, the rational allocation of medical resources, as far as possible to meet the demand of the medical service of the masses, to solve the basic medical burden.

Second, Dong Wenyong suggest that promote information networking as soon as possible. Around the health information exchange, is the necessary premise to realize long distance across the province health care. Hope to promote system integration, as soon as possible by means of information technology, will be around health care information, data networking, we will accelerate the establishment of a perfect unified information platform.

Third, dependency Dong Wenyong Suggestions to implement health care regulation. Medical insurance fund regulation, it is a big difficulty, health care and inter-provincial long-distance medical, further increasing the difficulty of the medical insurance fund supervision. Suggest a local administrator for health care, including medical insurance regulation, to overcome the long distance medical network across the province regulatory inconvenience, avoid the waste of medical insurance fund.

However, at the same time, to solve the problem of long distance across the province medical may also bring some other negative impacts.

First of all, if inter-provincial long-distance medical can achieve instant settlement, so many patients in poor health conditions will flow to the big hospital, lead to medical insurance funds, all kinds of medical resources to the big city, big hospital. This will make the medical level of imbalance between different regions. Second, patients with nonlocal influx could form "crowding out" of local patients, make local patients "medical care" phenomenon intensified.

Dong Wenyong thinks, in advancing beyond the full-scale coverage at the same time, strengthen hierarchical diagnosis such as auxiliary policy is imperative. Hierarchical diagnosis system perfect, the patient can be more easily in ginseng protect local doctor, would not be affected by different insurance settlement "attract" a sick, and then ran to the medical resources relatively concentrated city visits. For different people live, if live in the ginseng of community hospitals can watch the disease and health insurance, you could walk just don't have to go to 3 armour hospital, while they are convenient, also not let big hospitals are overwhelmed.

The People's Daily (2016 - September 21, 23)