Health care reform no longer gathered outside the city of retirees continued to pay dispute – polartec

Health care reform: no longer gathered outside the city of   retirees continued to pay dispute – Politics – people.com.cn original title: health care reform: no longer gathered outside the city continued to pay retirees controversy LuKun drawing in January 3, 2016, the State Council issued the "on the integration of urban and rural residents in the basic medical insurance system" (hereinafter referred to as the "opinions"). The two system, the integration of the basic medical insurance for urban residents and the new rural cooperative medical insurance to establish a unified basic medical insurance system for urban and rural residents, increasing the proportion of individual payment. In the first issue of the "Qiushi" magazine in 2016, Lou Jiwei, the Treasury Secretary, published a signed article, referring to the establishment of a reasonable and sustainable financing mechanism for medical insurance, and to study the payment policy for retirees from medical insurance. How to promote the integration of urban and rural medical insurance? Why should we increase the proportion of individual contributions? Should retired workers continue to pay medical insurance? These three issues have become the focus of public opinion. Urban and rural integration is the key to clear the unified management of the integration of the two system of basic medical insurance for urban residents and the new rural cooperative medical insurance, the establishment of a unified basic medical insurance system for urban and rural residents, experts believe is the key to the reform of medical insurance system. "Tianjin, Chongqing, Guangdong, Zhejiang, Shanghai and other provinces have announced the implementation of urban and rural medical insurance system, some of the first two pilot counties and also achieved good results, but in the lack of top-level design, methods and experiences of these regions merged with different, which is the next step in the development of urban and rural the overall health insurance also brings some uncertainty." Wang Wan, associate professor of Insurance Economics College of foreign trade and economic cooperation, told reporters. "The first management right now the central is very difficult, there is no unified view, in some provinces and cities in the local health insurance management rights to people and social sectors, and in some places the management rights to the health sector, and even some provinces have ownership is not uniform, so the bull management, personnel are not unified the information system is not unified, urban and rural areas will be difficult." A person in charge of the health sector in Jiangxi told reporters. In Shaanxi, Yulin, the old horse in Xi’an do auto parts business for many years, for a hospital medical insurance reimbursement from Yulin, Xi’an seven or eight times also did not reimburse for success. "We hope that the two guarantees will be merged as soon as possible, and we should improve the overall planning of urban and rural areas, and solve the problem of reimbursement for medical expenses in different places, so that we can not see such a disease." He said. The Ministry of human resources and Social Security Research Institute of medical director Wang Zongfan that old expectations on behalf of the majority of people: "urban and rural health care institutions would reduce duplication of construction, health care information system docking, business process and management coordination and payment standards and the level of treatment is not uniform, due to repeated insured rate of about 10% the waste of money etc.." Xie Zilong, chairman of the National People’s Congress and chairman of the people’s dispensary, said in an interview with reporters: "I have been concerned about the issue of health care for many years and submitted bills several times. Because of the independent operation of the urban residents’ medical insurance and the new rural cooperative medical system, the number of repeated investments in institutions and system construction is staggering every year, and a county can increase more than 100 annually. 聚集医保改革:不再分城里城外 退休人员续缴引争议–时政–人民网 原标题:聚集医保改革:不再分城里城外 退休人员续缴引争议   鲁坤 制图   2016年1月3日,国务院印发《关于整合城乡居民基本医疗保险制度的意见》(下称《意见》),提出整合城镇居民基本医疗保险和新型农村合作医疗保险两项制度、建立统一的城乡居民基本医疗保险制度,适当提高个人缴费比重。在2016年第一期《求是》杂志上,财政部长楼继伟发表署名文章提到,建立合理分担、可持续的医保筹资机制,研究实行职工医保退休人员缴费政策。   城乡医保并轨如何推进?为何要提高个人缴费比例?退休职工到底是否应该续缴医保?这三个问题成为舆论关注的焦点。   城乡统筹并轨是关键,统一管理需明确   整合城镇居民基本医疗保险和新型农村合作医疗保险两项制度,建立统一的城乡居民基本医疗保险制度,被专家认为是医保制度改革的关键。   “天津、重庆、广东、浙江、上海等省市已经宣布实施城乡居民医保并轨,一些率先试点两保统筹的县市也取得了不错的效果,但在缺乏顶层设计的前提下,这些地区并轨的方式和经验各有不同,这对下一步全国推进城乡医保的统筹也带来了一些不确定性。”对外经贸大学保险经济学院副教授王琬告诉记者。   “首先管理权问题就很棘手,现在中央还没有统一的说法,在地方医保并轨中有些省市把管理权归了人社部门,而有些地方把管理权给了卫生部门,甚至有的一个省里都有归属不统一的问题,这样多头管理,人员不统一、信息系统不统一,城乡统筹将很难进行。”江西卫生部门一位负责人告诉记者。   户口在陕西榆林的老马在西安做汽车配件生意多年,为一次住院医保报销往返榆林、西安两地七八次也没有报销成功。“希望两保尽快合并,而且要提高城乡统筹的力度,解决异地就医报销问题,这样我们看个病也不用这么折腾了。”他说。   人社部社会保障研究所医保研究室主任王宗凡认为老马的期待代表了大多数民众:“城乡医保统筹可以减少机构重复建设、医保信息系统不对接、业务办理和管理方式不协调、缴费标准和待遇水平不统一、因10%左右的重复参保率而造成的资金浪费等问题。”   全国人大代表、老百姓大药房董事长谢子龙在接受记者采访时说:“医保统筹的问题我关注了很多年,数次提交议案。由于城镇居民医保和新农合两者独立运行,每年在机构和系统建设上的重复投资数目惊人,一个县每年能多出100多万元的投入,由此造成的医保关系转接不畅,导致流动人口重复参保、结算标准不统一、报销不便等问题格外突出。这些问题只有城乡医保并轨才能解决。”   对外经贸大学保险经济学院教授于保荣说:“城乡统筹需要解决的根本问题还是医疗服务体系的问题。我国不同级别的医疗机构的业务水平差异大,基层医疗机构无论是医生还是业务技术水平,都不如大城市大医院,老百姓看病不放心。异地就医报销的复杂,有行政和财政隶属关系及地方保护的问题,各自为政和医疗卫生资源配置严重不平衡使得异地就医和报销困难,阻碍了医保的作用发挥。”   专家介绍,《意见》明确提出“六统一”的要求:统一覆盖范围、统一筹资政策、统一保障待遇、统一医保目录、统一定点管理、统一基金管理。各省市区要在2016年6月底前对整合城乡居民医保工作提出规划和部署,确定时间表和路线图,健全工作推进和考核评价机制,落实责任制,确保各项政策落实到位。这也给城乡医保统筹确定了方向和目标。   提高个人缴费比例,将使医保系统更可持续   《意见》首次明确提出,在提高政府补助标准的同时,要适当提高个人缴费比重,这一改革方向也被有些人认为是财政在医保支付中遇到困难的表现,也让人担心提高了个人缴费比例会否影响到部分参保人的积极性。   “近六年来,城镇居民基本医疗保险人均财政补贴的增幅一直高于个人缴费的增幅,从而使人均筹资中财政补贴的比例越来越大,到去年已超过80%,去年城镇居民医保政府补贴标准是每人380元,个人缴费标准是每人120元,财政补贴和个人缴费比达到空前的4:1。”于保荣说。很多专家都提出应该防止医保“泛福利化”倾向。   “完善居民医保筹资机制的基本原则,就是要回归社会保险的属性。”王宗凡说,“现在已经有一些地区出现了报销资金收不抵支的现象,而居民收入的增长,将给医保的出资比例调整提供条件,居民医保缴费比例财政和个人分担比的调整目标应确定为3:1甚至是2:1,当然这需要过渡期,不可能一蹴而就。”   有些人可能会担忧,因为个人出资比例的提高,会有一些百姓因经济困难退出医保,或在遇上大病时因病返贫。对此,于保荣表示,具有社会保险功能的医保政策并不是“无限兜底”的政策,对贫困人口,国家有医疗救助体系“兜底”。   化解职工医保缺口,退休人员续缴引争议   “我们这些退休职工年轻时还没有医保制度,但我们那时也都付出过艰辛的劳动。”陈金补是鞍钢的一位退休老职工,他快退休那几年才开始缴纳医保,他们不希望国家要求退休职工继续缴费。“毕竟我们现在退休工资也不多,但大病小痛都来了,看病不用医保不行啊。”   “城镇职工基本医保自创立以来就采用的是退休人员不缴费、在职人员缴费养老的筹资模式,这有时代发展背景。但是,随着社会经济的发展、人口结构的变迁,社会抚养压力的日趋加大,原来的那套做法或许将难以为继,也并不是一种可持续性的做法。”中国社会科学院经济研究所微观经济研究室主任朱恒鹏研究员告诉记者。   2014年全国职工基本医疗保险参保已达2.8亿人,其中退休人员7000多万人,在职退休比将近3:1,这就表示每三个在职职工所缴纳的医保费用供养一个退休老人。老龄化社会的到来让这种局面变得更加严重,老年人的医疗费用持续攀升,资金支付压力陡增,医保能否应对这种趋势风险确实严峻。   “财政资金为医保基金无限兜底,这种做法在国际上也罕见。”于保荣教授说,“医保基金毕竟是保险而非纯福利,必然要求参保人通过缴费来承担义务和享受权利。如果退休职工不缴费,则压力将全部由在职人群承担。即便强令财政资金承担这部分责任,也不过是增加全民的税收负担来补充资金缺口,最后还是羊毛出在羊身上。”朱恒鹏说:“退休人员继续缴纳医保是代际转移和代际公平问题,社会医保体系全民共有,相关政策的调整应经过充分的讨论和认证,要慎重考虑退休人员的实际承担能力。”   医疗体制深入推进,医保效率才能提高   “虚假住院”、“走读”骗报销、提高药价、过度医疗造成医保费用支出增加……近几年医保面临的问题,如何在改革中进行有效治理?   “医保财政补贴负担加重是多方面因素造成的,医保统筹基金常常被套取,医保人员监守自盗,有的医院想方设法骗保。还有医院和医务人员的监管不严,过度医疗和过度检查也浪费了太多的社会资源和医保资金。因此,想要使医保更高效更有保障,就必须从医疗制度性改革的深化来下手。”朱恒鹏说。   “我国医保从覆盖率、支付比例、社会效果等在世界上都算是非常好的,但是由于医疗体制改革还有很多问题需要解决,所以医疗保险的推动也受到一定影响。”王琬说,“强化医保部门和医疗部门的博弈,实现更高质量的医保费用控制,提高医保的实际运用效率、减少资金浪费等,都已经到了关系医保体系能否持续发展的关键时期,而对于长期的动态平衡,还需要更加严格的保险制度来实现。”   全国政协委员、福州市第二医院副院长林邵彬在接受媒体采访时表示,应尽快出台“全民基本医疗保险法”或者加快修订社会保险法,建立城乡居民一体化基本医疗保障体系,按照参保对象经济水平和医疗需求设定不同的精细化保障层次,并确定与之相适应的筹资与待遇水平,以满足不同经济水平人群的医疗保障要求。   朱恒鹏则提醒:“改革要有理有据,在达成广泛共识的基础上推进,同时在法律的框架内进行。政府不应在法律未作修改的情况下随意改变基本原则,这样会影响到医保制度的严肃性和可靠性。”   “《意见》还着重强调了要建立健全医保经办机构和医疗机构及药品供应商的谈判协商机制和风险共担机制,推动形成合理的医保支付标准,引导定点医疗机构规范服务行为,控制医疗费用的不合理增长和非理性浪费。只有医疗体制改革和医保统筹同步,才能更好地让百姓受惠于这项制度体系。”于保荣向记者解释。   浙江省人社部门一位工作人员对记者表示:“《意见》所涉及的内容在浙江已经基本完成,至于这次提出的提高个人缴付比例、完成城乡医保的大统筹等问题需要以国家后续的政策和文件为准。当然,医保的统筹和改革已经迫在眉睫,值得期待。”   “1998年国家开始实行城镇职工基本医疗保险制度以来,发挥了社会统筹共济性的优点,但随着经济社会的发展,医保制度也已走到了一个必须要深化改革的当口,注重平衡性和安全性更加重要。”王宗凡说。相关的主题文章: