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Original title: Some local health insurance funds cannot be paid to the officer – There are two reasons
Jingwei China-Singapore customer, November 20, on the 20th, the State Council Information Office held a press conference. Chen Jinfu, deputy director of the National Health Insurance Administration, said that there are indeed some cases of periodic deficits in the functioning of health insurance funds in some areas. On the one hand, it is due to the expenditure of funds caused by the gradual increase in investment in the protection of poverty alleviation benefits. The fund’s operating income and expense issues exist objectively. Look at it objectively and completely.
At the press conference, some journalists asked questions, concerned that health insurance has achieved remarkable results in alleviating poverty, and found that poor people have been cured and received too much medical care in some places. Some local health insurance funds have not reached current income. May I ask the health insurance department what is the answer to this?
Chen Jinfu, deputy director of the National Health Insurance Administration Source: China Net
Chen Jinfu said that, from a broad point of view, this is indeed a major problem in fighting poverty through health insurance. For example, small illnesses are cured and some areas, especially poor counties, have experienced periodic deficits in the functioning of health insurance funds. This is indeed the case. From the perspective of the overall national strategy, we have increased investment in medical services for the poor in the fight against poverty, greater protection and greater investment of funds. This is a necessary cost, which also reflects the country’s overall solution to absolute poverty. determination. For this part of the investment, the central government has invested 27.5 billion in medical assistance this year.
Chen Jinfu introduced that since 2018, among the poor, the state has helped more than 10 million poor people to get rid of poverty, and the total health insurance spending has reached more than 330 billion. In solving absolute poverty, all localities use various financial resources, cut food and clothing, and increase investment. It must be said that there is still a large investment.This investment cannot be measured simply by a periodic deficit.
On the other hand, Chen Jinfu said that there have in fact been problems such as “little illnesses, big cures” for the poor, significantly higher hospitalization rates and higher referral rates. Due to the high incidence of serious diseases in poverty-stricken areas and the relatively insufficient medical resources in this region, the high rate of medical utilization at this stage is an objective phenomenon. It cannot be said that the poor use more medical resources just for a very small number of cases. Furthermore, the reasons for the deficit in the health insurance fund in poor areas must be viewed from two aspects.One is to gradually increase the expenditure of funds generated by investing in protecting the benefits of poverty alleviation.on the other hand,The problem of the income and expenses of the operation of long-term local funds also exists objectively.Therefore, the shortfall in funds in some areas is due to increased protection of poverty alleviation benefits and increased spending on funds, as well as the long-term fund operating balance factor. So, look at it objectively and completely.
In addition, Fan Weidong, head of the Department of Treatment Protection of the National Health Insurance Administration, said that during the critical period of poverty alleviation, some places have added some complementary protection measures in addition to the triple protection system. Overall, it has a positive side and has played an active role in solving poverty caused by disease and the return to poverty due to disease. But at the same time,The establishment of these measures has the support of local finances, in the long term, the sustainability of the system remains a concern.Therefore, since the issuance of the three-year action plan for poverty alleviation through health insurance in 2018, the department of health security has put forward governance requirements for such local supplemental security measures that have been implemented in some places outside the development stage and outside the local reality. From the current point of view, governance measures continue to be implemented and gradual progress has been made, basically stopping the tendency to arbitrarily add safeguard policies and measures, and vigorously promoting the integration of safeguard measures outside the triple safeguard system in the triple national safeguard. Within the institutional framework.
Fan Weidong said that the next step will be to combine the consolidation of the poverty alleviation results with the implementation of the rural strategy, and take strong measures mainly in the following aspects:
One is to actively strive to increase financial investment.Accelerate the improvement of a robust and sustainable funding mechanism, increase the fund’s operational management and early warning of risks, and resolutely maintain the objective of avoiding systemic risks. Improve the financing and benefit adjustment mechanism, balance the sharing of financial responsibilities of all parties, actively strive to increase financial investment in health care, expand financing channels for assistance funds, consolidate and improve the level of planning general, expand and strengthen the common pool and improve the ability to withstand risks.
The second is to improve relevant medical safety systems and mechanisms.To adhere to the basic system, basic policies and basic standards, we are accelerating the study of the medical safety benefits list system, focusing on standardizing local decision-making powers, standardizing the limits of the triple security system, promoting the integration of the system and exercising guarantee synergy. Local governments at all levels must administer in accordance with laws and regulations to promote sound systems and mechanisms.
The third is to guide local governments to properly manage excessive guarantees.It is necessary to resolutely stop the “no cost and subsidy” for medical treatment, classify and rectify some safeguard measures that clearly exceed the standard and confuse the protection function of the system, and guide local governments to do a good job in policy transition and convergence in stages.
The fourth is to strengthen departmental coordination, standardize, and guide poor people to seek medical treatment.Coordination with the health department is necessary to standardize graduated diagnosis and treatment, promote standardized and reasonable provision of medical services by designated medical institutions, do a good job of advertising health insurance and relief policies. poverty, and guiding poor people to seek medical treatment in a reasonable and scientific manner. (Jingwei China-Singapore APP)
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