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Original title: Request for comments on personal health insurance account reform ends, families to share 800 billion account funds
With the expiration of the 12-day public comment period, the formal introduction of the reform of personal health insurance accounts is gradually approaching, and the main theme of this reform will be to “weaken” and “activate” personal accounts.
The “Guiding Opinions on the Establishment and Improvement of the Mechanism of Mutual Benefits for Outpatients of the Basic Health Insurance for Employees (Consultation Project)” (hereinafter, the “Guiding Opinions”) recently issued by the National Health Insurance Administration clarified the direction of the reform of the personal health insurance account. Like the personal account reform in old-age insurance, it chose the “make small” path and unit payments are no longer credited to personal accounts. At the same time, more outpatient expenses will be included in the scope of the health insurance reimbursement.
China Business News learned from relevant people that the reform of personal health insurance accounts has been brewing for a long time, and the general direction of the reform has been written in the health insurance programmatic document “Opinions of the CPC Central Committee and of the Council of State on the deepening of the reform of the medical security system “. Relevant government departments will expedite the counter-signature process after absorbing public opinion and reviewing the draft for comments. Official documents are expected to be issued as soon as possible. According to the annual health insurance work schedule, the industry expects January 1 of next year to be a more appropriate policy adjustment window.
Liao Cangyi, a researcher at the Tsinghua University Medical Services Governance Research Center, said in an interview with CBN that the reform of personal accounts should advance simultaneously with the improvement of the ambulatory protection mechanism. Insured employee benefits must be resolved to ensure that insured benefits are not reduced. , To achieve a smooth transition of system reform.
The focus of the controversy over the reform of individual health insurance accounts
The current health insurance fund consists of a common fund and a personal account fund. The general fund is used primarily to pay for inpatient medical expenses, outpatient medical expenses for prescribed illnesses, and outpatient medical expenses for serious illnesses. Personal accounts are primarily used to pay for general outpatient medical expenses, drug purchase expenses, and inpatient medical expenses borne by individuals. Individual accounts and general funds will be managed in special accounts after their respective delimitation of payment ranges, with separate accounting and special funds for exclusive use, and will not be embezzled.
The biggest controversy that arose in this public consultation is why the reform of personal health insurance accounts is no longer included in the unit payment, and it is necessary to reduce personal accounts, which would “damage” the personal interests of the insured ? Why should we adopt the capital replacement method instead of the incremental method to carry out reforms, such as retaining the current size of the personal account and increasing the outpatient management at the same time?
China Business News learned that the health insurance account has been in operation for 22 years, and its drawbacks have been very obvious, and academic circles have heard many suggestions to cancel the personal health insurance account. Zheng Bingwen, director of the World Social Security Research Center of the Chinese Academy of Social Sciences, believes that the personal health insurance account fund has grown steadily, showing an expanding scale trend, and there are many problems.
The data shows that the size of the funds in the personal account for basic health insurance for employees has gradually increased, from 29.1 billion yuan in 2003 to 842.8 billion yuan in 2019; per capita account funds have increased from 365 yuan in 2003 to 3478 yuan in 2019. It has increased almost 10 times in 2016; the share of GDP has increased from 0.2% in 2003 to 0.8% in 2019.
Zheng Bingwen said there are four main aspects of personal health insurance accounts problems, including the existence of welfare losses, the inability to use for mutual aid, resulting in moral hazard, and the high cost of administration. of personal accounts.
For example, the deposit funds deposited in the special financial account of the social security fund are calculated at the interest rate of a three-year lump sum savings deposit with zero deposits. The average annual interest rate is around 3%, which is lower than the growth rate of the average social wage for a long time. This leads to the goal of system design. Vertical accumulation has become impossible and young people cannot accumulate enough medical funds for their old age through personal health insurance accounts.
Liao Cangyi, a researcher at Tsinghua University Medical Services Governance Research Center, said in an interview with China Business News that from the perspective of the balancing structure of China’s employee health insurance funds, there has been structural imbalances and unreasonable allocations. In the proportion of income from the employees’ health insurance fund, social pooling accounted for 4.8% and personal accounts for 3.2%, resulting in insufficient social pooling to resolve medical risks in the current period and an excessive accumulation of individual accounts. Judging by the data released by the National Health Insurance Administration, at the end of 2019, the personal health insurance accounts of China’s employees had a balance of 100.096 million yuan for the current period, and a cumulative balance of 827.7 billion yuan. yuan. It is difficult for the huge precipitation fund to effectively play the role of health insurance risk mutual benefit protection.
Judging by the reality of China’s health insurance fund, it is difficult to achieve the incremental method proposed in the consultation. Although the overall balance of China’s health insurance fund is relatively large, due to the relatively low level of overall planning, the pains and joys between regions are uneven. There have been instances where the health insurance fund has no current balance for many years, and the cumulative balance has also bottomed out.
“At present, the open source space for basic health insurance in China is not large. For most regions, the spending pressure is enormous. It is the best option to carry out structural reform of the personal account. from the institutional level. For areas with a shortage of funds, the reform of the personal account cannot be delayed, “Liao Cangyi said.
The weakening of personal accounts is a direction of local reforms, that is, minimizing the proportion of unnecessary personal accounts. For example, as of 2017, in Zhejiang Province, the person accounts in some coordinating districts are all made up of individual employee contributions.
Family mutual aid goes from pilot to national
Strengthening mutual family help is a highlight of the guide. Before this, Zhejiang, Fujian, Shandong and other places have started related explorations. This is an important move to “activate” more than 800 billion yuan of health insurance funds.
The nature of the personal health insurance account is closely related. Although the personal health insurance account is owned by the individual, it remains part of the health insurance fund and cannot be arbitrarily controlled by the individual, rather than being used exclusively for health insurance expenses.
Due to the large balance of funds in the personal health insurance account, fraudulent insurance such as “stealing” the health insurance account and buying health products have appeared. To activate the efficiency of use of the precipitation fund of the personal health insurance account from the supply side, some places have proposed to adequately expand the applicable object of the balance fund, that is, increase the coverage of the personal account through from the form of family accounts, such as the family mutual aid network in Ningbo, Zhejiang. Members of the mutual aid network can request the establishment of their mutual aid health account and transfer part or all of the funds from their individual account to the mutual aid health account. During the medical settlement, the mutual aid network members can use the funds from the mutual aid health account in accordance with the regulations.
After the guide is officially issued, mutual family aid accounts will be distributed throughout the country. In addition to paying my own expenses, my personal account may also pay for the medical expenses of my spouse, parents, and children, including the self-paid portion of hospitalization for these close relatives, and the expenses incurred by the person for the purchase of medications and medical consumables at designated retail pharmacies. As well as your individual payment for participating in basic medical insurance for urban and rural residents.
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