Shenzhen New Medical Insurance Policy 2022

On December 1 this year, Shenzhen employee medical insurance personal accounts will usher in a major reform. The amount recorded in the personal account of the first-tier insured will be reduced from 5% of the payment base to 2%, with the difference After being included in the overall fund, it will be used to increase the reimbursement level of outpatient clinics. Shenzhen City stated in the interpretation of relevant policies that the core of this reform is to transform the outpatient medical expenses of the "unified account combination" employee medical insurance from an individual accumulated security model to a social mutual aid and financial security model. Liao Zangyi, associate professor at the School of Politics and Public Policy and Management at China University of Political Science and Law, told China Business News that for Shenzhen, the outpatient service economic reform is a system adjustment made in response to national and provincial reform trends, and there is no medical insurance. Fund risk issues. Like the national reform, Shenzhen’s outpatient financial security reform is essentially a kind of equity exchange. It replaces the funds in personal accounts with a pooled fund, establishes an outpatient pooling system, and uses the law of large numbers to resolve the outpatient cost burden of insured persons. . Establishing and improving the outpatient financial security mechanism of basic medical insurance for employees is the established goal of deepening my country's medical insurance reform. After the State Council issued relevant guidance in April last year, each province successively issued provincial guidance documents and made arrangements for the province's progress in promoting the reform of the employee medical insurance outpatient financial security mechanism. The outpatient financial security reform is currently being carried out nationwide. Accelerate your progress.

Shenzhen improves outpatient benefits for first-tier insured persons. On the 15th, the General Office of the Shenzhen Municipal Government issued the "Notice on Matters Concerning the Implementation of the "Guangdong Province Employee Basic Medical Insurance Outpatient Financial Security Implementation Measures" (hereinafter referred to as the Notice) will be officially implemented on December 1, 2022. Specific contents include adding general outpatient benefits, reducing funds transferred to personal accounts, standardizing and expanding the scope of use of personal accounts, etc. One of the hot topics in this reform is the adjustment of funds transferred to personal accounts. The notice stipulates that for first-tier participants of basic medical insurance for employees who pay 8% of the payment base, the monthly credit standard for their personal accounts is 2% of their payment base, and the rest will go into the basic medical insurance serious illness pooling fund (hereinafter) (referred to as "Overall Fund"). Retirees who stop paying contributions and continue to enjoy the first-tier benefits of basic medical insurance will have their personal accounts transferred by a fixed amount from the overall fund, and the monthly transfer standard is 2.8% of the average monthly amount of the city's basic pension in 2021. Because the current policy is that first-tier insured persons pay basic medical insurance premiums at 8% of the payment base, of which 5 percentage points are included in personal accounts and 3 percentage points are included in the overall fund. Compared with the old and new policies, the amount of funds transferred into personal accounts has decreased by 3 percentage points, which is the part where some insured persons believe that their rights and interests have been damaged. On the 23rd, reporters consulted the Shenzhen 12345 hotline on the benefits and disadvantages of this reform to insured persons. Hotline staff said that for first-tier insured persons, the disadvantage is that the money in their personal accounts has become less, and the advantage is that outpatient services can also be reimbursed. Generally speaking, for people who see more outpatient clinics, their treatment will become better; if they see less outpatient clinics, they will feel a bit disadvantaged if they have less funds in their personal accounts. Liao Zangyi believes that the outpatient financial reform has not reduced the medical treatment of insured persons. It has carried out structural reform of the system through a kind of equity exchange, further strengthening and expanding the efficiency of the use of personal accounts. "Insured persons believe that their interests have been damaged after the reduction in personal account amounts. One reason is the perception of welfare, and the other reason is that there is a certain lack of understanding of this reform." Liao Zangyi said. Judging from the effect of the policy, for the working people, the insured persons who usually do not use it or use it less often do not have the 3% allocation from the social pooling fund. It seems that less money goes into their personal accounts, but in fact they are reimbursed. There is no change. In the past, the payment by credit card from personal account has been changed to "personal account + overall fund" payment at the same time. In addition, the scope of use of personal account has been expanded, and the whole family has benefited. For working insured persons who usually rely on their personal accounts to buy medicines when sick, the money in their personal accounts was not enough in the past. Now due to this system reform and the payment from the unified fund, the benefits of these insured persons have been improved. level, effectively reducing their personal burden. The notice proposes that on the basis of personal accounts, outpatient benefits for specific diseases and medical treatment, a new level of general outpatient benefits for insured persons in the basic medical insurance for employees will be added. Participants in the first-tier basic medical insurance for employees can select a social welfare institution or other primary medical institution, a second-level or above hospital, or a specialized hospital within the scope of designated medical institutions in the city as a designated medical institution for general outpatient treatment.

The staff of the Shenzhen 12345 hotline specially reminded that on December 1st, what the first-tier insured should do is to try to select a designated medical institution so that they can enjoy the outpatient reimbursement treatment of the first- and second-level hospitals. If they are not selected, they should still follow the The original reimbursement policy is that the first-level hospital pays 70% personally and the overall fund pays 30%. After selection, the first-level hospital’s overall fund payment can be up to 75%, and it can be higher for retirees.

Shenzhen reform has nothing to do with the risk of medical insurance funds. Since the outpatient financial reform involves the adjustment of individual account funds, some insured people may wonder whether it is because "the medical insurance fund is out of money" or because the medical insurance fund is Increased spending on epidemic prevention has increased pressure on funds. In this regard, Liao Zangyi made it clear that the reform of the Shenzhen Medical Insurance Fund personal account system and the outpatient financial system has nothing to do with the risks of the medical insurance fund. It is a system adjustment made in response to the policy reform of the country and Guangdong Province. The "Shenzhen Medical Insurance Fund Budget Implementation Table from January to October 2022" released by the Shenzhen Municipal Medical Security Bureau shows that as of October this year, the current balance of Shenzhen Urban Employee Basic Medical Insurance was 20.749 billion yuan, and the cumulative balance was 177.075 billion yuan. The "Guiding Opinions of the General Office of the State Council on Establishing and Improving the Financial Security Mechanism for Outpatient Basic Medical Insurance for Employees" (Guobanfa [2021] No. 14) issued on April 14, 2021 requires that all provincial people's governments in 2021 Implementation measures will be issued before the end of December to guide each coordinating region to advance implementation. A transition period of about three years can be set to gradually achieve the reform goals. The "Notice of the General Office of the Guangdong Provincial People's Government on Issuing the Implementation Measures for the Outpatient Financial Security of the Basic Medical Insurance for Employees in Guangdong Province" (Guangdong Fuban [2021] No. 56) issued on December 31, 2021 requires all cities to implement measures in 2022 Implementation rules will be issued and implemented before July 1. According to the "Situation Analysis and Countermeasure Suggestions on the Reform of the Economic Security Mechanism of Employee Medical Insurance Outpatient Clinics" published by Li Juan and Wang Zongfan of the Chinese Academy of Labor and Social Security Sciences in the "Lanzhou Academic Journal" on the 15th, a review of 31 provinces and cities across the country , the time for each province to issue documents is concentrated at the end of 2021 and the beginning of 2022, and the issuing unit is basically the general office of the provincial people's government. Most provinces have issued guidance documents for local governments and have made arrangements for the progress of the province's reform of the financial security mechanism for employee medical insurance outpatient clinics. However, as of the end of July, most coordinating regions have not issued implementation documents on the reform of the financial security mechanism for employee medical insurance outpatient clinics, and some cities have issued implementation details under the guidance of national and provincial documents. At present, many places across the country have accelerated the pace of economic reform in outpatient clinics. The Liaoning Provincial Medical Insurance Bureau stated that it is working hard to establish and improve the outpatient financial security mechanism of basic medical insurance for employees. Before the end of this year, all coordinating areas in the province will start to implement reforms. Beijing will launch medical insurance personal account family financial assistance from December 1, 2022, and family members can use the funds in employee medical insurance personal accounts financially. The Hunan Provincial Medical Insurance Bureau recently announced that the province will fully establish a general outpatient coordination system for employee medical insurance by the end of the year. Starting from January 1, 2023, personal accounts will be credited in a new way. After the reform, family members will be allowed to financially use personal accounts with each other.