Submits an expense account in 300 yuan hospital and does not lose money at most for each person every month in medical insurance of Guangzhou

Submits an expense account in 300 yuan hospital and does not lose money at most for each person every month in medical insurance of Guangzhou
One is from having it to some new policies, must attract every dispute at the beginning when implement. The policy of submitting an expense account from the clinic on August 1 implements one formally, no matter fixed medical unit, join sponsors ordinarily, all present this or that doubt: Why draw the money which is deducted the personal account? Is not it more convenient that the ones that do not select a bit seek medical advice? To from each side sound, according to the real-time data yesterday such as department such as medical insurance such as Guangzhou, clarify and answer doctors and patients' focus questions of both sides.
Join sponsors: Healthy, does not see the clinic, is not it worthwhile to deduct money per month?
Medical insurance place: It is not the personal property to row and deduct partly
Zhang XueWen, division chief of place of the medical insurance says, the medical insurance pool fund belongs to and all joins the sponsor's public resources, row the money not individual that deducted to pay " The personal property " . He says, the medical pool of the ordinary clinic of this city draws and deducts 1% of the personal medical account fund, its fund comes from the medical insurance pool fund, this part of fund all join the sponsor's public resources, in case of not putting under the personal medical account, individual is privately owned that any effect an insurance that do not belong to, and individual hands in and pays and still keeps partly in the personal account. So, per person rows and deducts 1% without damaging individual interests problems, its essence is adjustment of the fund distribution structure of the pool.
On the initial stage of starting in medical insurance, because the ability of running of the system is relatively low, have to set up personal medical account, the responsibility that will protect the little disease of clinic gives and joins sponsors to manage by oneself. But practice proves, there is this law " not enough that many patients ensure, the health person fund is left unused " Drawback. Zhang XueWen says, after setting up the system of protecting the little disease of clinic, it looks that the surface joins sponsors reducing 1% of the personal medical account fund (average 37.8 yuan overall after standing fast at, person the moon) ,Pool share on fund expenditure loud ' Account for 70% of the ordinary clinic pool fund ). When being ill, can get better medical insurance treatment (pool fund and pay limits of 300 yuan for each person at most as joining sponsors. Moon) . Ill to join sponsors with 37.8 yuan per month medical treatment of gaining 300 yuan per month, it is obvious whether to lose or not.
Join sponsors: Limit, go to a doctor hospital to be inconvenient to seek medical advice, why not unlock?
Medical insurance place: What the selected clinic fixed hospital protected is to join sponsors
Zhang XueWen says, in implementing the particular project of the clinic and appointing the chronic disease medical insurance of the clinic, find minority effect an insurance patient get many of hospital seek medical advice, write a prescription within one day, medicine quantity exceed their condition need far, the whereabouts of medicines held is not clear, because it registers, buys a lot of clinic case histories repeatedly, it is extremely difficult to make sure that manage. Adopt the method of seeking medical advice by fixed position, help to concentrate on supervising and managing the situation of seeking medical advice, making a diagnosis etc. which joins the sponsor.
Second, help to observe and join sponsor's condition, so that the pointed treatment, using medicine continuously, improve the result of making a diagnosis. Third, help to set up competition mechanism, shunt patients rationally. It was medical treatment, service quality that joined sponsors and chose the fixed hospital to pay attention to at first independently, secondly it is the medical treatment nearby. The fixed hospital, through the method of raising the quality, widening the service range etc., attract and join sponsors to choose, this measure will play a more greatly role in regulatory management and overall development of the fixed hospital.
Hospital: Submit an expense account 300 at most for each person every month, can hospital lose money?
Medical insurance place: Two month real data, ordinary clinic submit an expense account 600/400 person annual and enough one year
When ordinary clinic conduct policy, come out just, many hospital say patient high 300 submit an expense account standard large hospital 600 yuan for each person annual most for each person every month, small the intersection of hospital and 400 annual limit close the standard to collide with, they " can't regain one's original capital " ," it is the more terrible to cross many people and lose money by fixed position " ,Come out time the intersection of clinic and medical treatment consume yuan of an oddballs, employ. Then, after coming down in two months, how on earth is the situation?
Guangzhou municipal work and Zhang XueWen, division chief of of medical insurance, office of social security, say, since two implement month, ordinary the intersection of clinic and time hospitalization cost is 141.5 yuan, among them the project at one's own expense is 23.4 yuan, pool it pays expense to be 54.1 yuan, among them the large hospital is 55 yuan, the small hospital is 46 yuan. Effect an insurance per capitaly and go to a doctor 1.3 times per month, among them in 0.9 times of large hospital, it is 0.4 times in the small hospital.
Carry on calculated according to this data, it is only 220.8 yuan that the annual medical insurance of each patient of small hospital conducts amount, far lower than the settlement standard of 400 yuan in year; And it is only 594 yuan to conduct amount in annual medical insurance of each patient of large hospital, close to the settlement amount of 600 yuan, but not gone beyond either.
Especially, annual settlement amount healthy people and patient overall average standard of the whole year, because has just implemented now, been selected some number of people only accounting for and always effecting an insurance 19.3% of the number of people, and the majority selects some people to see the doctor (account for 76.9%) at the same time ,Show to join the intersection of sponsor and patient, more, seek medical advice the intersection of proportion and relatively high false appearance in short term. Pass with time, some of increasingly many persons, per person goes to a doctor the number of times will also drop, the medical fee that people submitted an expense account every year will also drop.
Hospital: person are there spaces of profit every year at 1000 yuan?
Medical insurance place: Overspending under will be compensated to use medicine rationally
Zhang XueWen says, it is according to relevant research materials and real data of clinic medical fee of the hospital of in the past which the Ministry of Health announced to settle the standard in year, paid the proportion and estimated out according to the pool money 50%. Rejected and joined sponsors in seeking medical advice and clinic particular project and expenses which appoint chronic disease of the section hospital at the same time, it is " small " and press Two hospitals set up the standard separately ' It is 1000 yuan person altogether annually) ,Accord with the objective actual conditions generally.
Compare resident's medical insurance, the hospitalization cost in one year of each student is only 180 yuan, treatment of submitting an expense account at most in per year reaches 100,000 yuan, and include in hospital, the door is slow, special on the door, clinic. Will come down in one year, not only enough, the fund but also have a balanced budget with a small surplus. person annual it is only only ordinary clinic, " only see the doctor as usual at 1000 yuan of now, neither will compensate, but also we have already reserved certain profit space for the fixed hospital. "
Zhang XueWen says, considers one implements the clinic every year and conducts the policy, there is disparity to might and calculate the result in actual conditions. So long as the hospital uses medicine rationally, checks rationally, treats rationally, charges rationally, while clearing in year, if fixed hospital overspends the expenses, the pool fund will be offered appropriate compensation.
Staff reporter Xu Lei Reporter Lin JiaSong

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