居民醫(yi)保(bao)個人(家庭)賬戶(hu)是怎(zen)么來的?
城鄉居(ju)(ju)民(min)(min)基(ji)本醫(yi)療保(bao)險(xian)制(zhi)度(以(yi)下簡(jian)稱(cheng)居(ju)(ju)民(min)(min)醫(yi)保(bao))整合(he)了(le)(le)原有的(de)城鎮(zhen)居(ju)(ju)民(min)(min)基(ji)本醫(yi)療保(bao)險(xian)(以(yi)下簡(jian)稱(cheng)城鎮(zhen)居(ju)(ju)民(min)(min)醫(yi)保(bao))和(he)新(xin)型農(nong)(nong)村合(he)作醫(yi)療(以(yi)下簡(jian)稱(cheng)新(xin)農(nong)(nong)合(he))兩(liang)項制(zhi)度。其(qi)中,新(xin)農(nong)(nong)合(he)于(yu)(yu)2003年起開(kai)始推(tui)行,主(zhu)要解決大(da)病醫(yi)療費用,為(wei)提高農(nong)(nong)村居(ju)(ju)民(min)(min)參保(bao)積極性,擴大(da)制(zhi)度的(de)覆蓋(gai)面(mian),在(zai)建立大(da)病統籌(chou)基(ji)金的(de)同時,建立了(le)(le)個(ge)(ge)人(家(jia)庭)賬(zhang)戶,主(zhu)要用于(yu)(yu)支付小(xiao)額門診費用。城鎮(zhen)居(ju)(ju)民(min)(min)醫(yi)保(bao)于(yu)(yu)2007年起開(kai)始推(tui)行,開(kai)展門診統籌(chou),不設(she)個(ge)(ge)人賬(zhang)戶。
新醫改推(tui)進過(guo)程中,提出(chu)普遍開展門(men)診統籌(chou),各(ge)地新農(nong)合的個人(ren)(家庭)賬戶隨之逐步向門(men)診統籌(chou)過(guo)渡。特別是(shi)隨著2016年(nian)城鄉居民醫保的整合,制(zhi)度保障能力不斷提升,大部分地方取(qu)消(xiao)了新農(nong)合個人(ren)(家庭)賬戶,但也有個別地方保留了這一做法。
居民醫保個人(ren)(家庭(ting))賬戶的 功能和存在的問題是什么(me)?
居(ju)民(min)醫保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)個(ge)人(ren)(家庭(ting))賬戶,主要用(yong)(yong)(yong)(yong)于支(zhi)付參保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)在(zai)(zai)門(men)診(zhen)發生的(de)(de)醫療(liao)費用(yong)(yong)(yong)(yong),在(zai)(zai)制度(du)(du)建立初期對培育個(ge)人(ren)參保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)意識、促(cu)進(jin)個(ge)人(ren)參保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)繳(jiao)費、迅速擴大參保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)覆蓋面等發揮了(le)積(ji)極作用(yong)(yong)(yong)(yong)。但這一方式還存(cun)在(zai)(zai)一定局(ju)限(xian)性(xing),而且隨著居(ju)民(min)醫保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)籌資標準提高和保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)能(neng)(neng)力增強,實(shi)踐中其弊端(duan)逐步顯現(xian)。一是額度(du)(du)很小,保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)不足(zu),實(shi)際上難以起(qi)到門(men)診(zhen)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)的(de)(de)作用(yong)(yong)(yong)(yong)。二是共(gong)濟(ji)(ji)能(neng)(neng)力差,僅限(xian)于個(ge)人(ren)或(huo)家庭(ting)使用(yong)(yong)(yong)(yong),還削弱基金整體(ti)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)能(neng)(neng)力。三是易誘(you)發濫用(yong)(yong)(yong)(yong)。居(ju)民(min)醫保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)門(men)診(zhen)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)向(xiang)門(men)診(zhen)統籌過(guo)渡和轉換,相較(jiao)于原有的(de)(de)個(ge)人(ren)(家庭(ting))賬戶,可以在(zai)(zai)全體(ti)參保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)中實(shi)現(xian)互助共(gong)濟(ji)(ji),提高居(ju)民(min)醫保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)基金的(de)(de)共(gong)濟(ji)(ji)能(neng)(neng)力,符合社會保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險風險共(gong)擔(dan)的(de)(de)基本原則,有利于為參保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)提供(gong)(gong)更加(jia)公平的(de)(de)醫保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)待遇,為解(jie)決上述(shu)弊端(duan)提供(gong)(gong)了(le)實(shi)現(xian)途徑。
做好居民醫保(bao)門診保(bao)障(zhang)有(you)哪些措施?
城(cheng)鄉居(ju)民(min)(min)醫(yi)保個人(ren)(家(jia)庭)賬戶取(qu)消(xiao)并不會降低居(ju)民(min)(min)的(de)醫(yi)保待遇,而是通(tong)過推進門(men)診(zhen)統籌進行替(ti)代實(shi)現(xian)的(de)。門(men)診(zhen)統籌有利于提(ti)高(gao)城(cheng)鄉居(ju)民(min)(min)醫(yi)保基(ji)金共濟能力、增強基(ji)金共濟效應(ying),能更好的(de)保障城(cheng)鄉居(ju)民(min)(min)醫(yi)保待遇,為參保群眾提(ti)供更多(duo)實(shi)實(shi)在(zai)在(zai)的(de)權益。
各地推進門(men)(men)(men)診(zhen)統(tong)(tong)籌(chou)后,可將門(men)(men)(men)診(zhen)小病(bing)醫(yi)療(liao)費(fei)(fei)用(yong)(yong)納入(ru)統(tong)(tong)籌(chou)基金(jin)支(zhi)付范圍,群(qun)眾在基層醫(yi)療(liao)機(ji)構(gou)發生的(de)(de)常見(jian)病(bing)、多發病(bing)的(de)(de)門(men)(men)(men)診(zhen)醫(yi)療(liao)費(fei)(fei)用(yong)(yong)均可報銷,比例在50%左右。同時,為減輕參(can)保群(qun)眾的(de)(de)門(men)(men)(men)診(zhen)大(da)病(bing)負(fu)擔,對于一些主要在門(men)(men)(men)診(zhen)治(zhi)療(liao)且費(fei)(fei)用(yong)(yong)較高的(de)(de)慢性病(bing)、特殊疾病(bing)(如惡性腫瘤(liu)門(men)(men)(men)診(zhen)放化療(liao)、尿(niao)毒癥透析、糖尿(niao)病(bing)患(huan)者胰島(dao)素治(zhi)療(liao)等(deng))的(de)(de)門(men)(men)(men)診(zhen)醫(yi)療(liao)費(fei)(fei)用(yong)(yong),也納入(ru)統(tong)(tong)籌(chou)基金(jin)支(zhi)付范圍,并參(can)照住院(yuan)制(zhi)定相應的(de)(de)管理和支(zhi)付辦(ban)法。
國家在完善(shan)城(cheng)鄉居民門(men)(men)診(zhen)(zhen)保障(zhang)政(zheng)策的同時,還(huan)不斷加(jia)大(da)財政(zheng)對居民醫保的投入,人均財政(zheng)補助標準逐年(nian)(nian)提高,2013至(zhi)2018年(nian)(nian)每年(nian)(nian)分別為280元、320元、380元、420元、450元、490元,2019年(nian)(nian)財政(zheng)補助已經達到520元,是2009年(nian)(nian)的6.5倍(bei)。籌資水平的提高,進一步加(jia)強了制度保障(zhang)能力,為做好門(men)(men)診(zhen)(zhen)保障(zhang),將保障(zhang)范(fan)圍進一步向門(men)(men)診(zhen)(zhen)小(xiao)病延伸提供(gong)了有力支持(chi)。
2019年(nian)居(ju)民醫保還有哪些惠(hui)民舉措?
為貫徹落實中(zhong)央有關要求(qiu),2019年(nian)城(cheng)鄉(xiang)居(ju)民(min)(min)醫(yi)(yi)療保障(zhang)安排(pai)了一(yi)系列(lie)惠民(min)(min)舉措。一(yi)是提(ti)(ti)高(gao)財(cai)政(zheng)(zheng)(zheng)(zheng)補(bu)助(zhu)(zhu)標準。2019年(nian)城(cheng)鄉(xiang)居(ju)民(min)(min)醫(yi)(yi)保人(ren)(ren)均財(cai)政(zheng)(zheng)(zheng)(zheng)補(bu)助(zhu)(zhu)標準新增(zeng)(zeng)30元,達到每人(ren)(ren)每年(nian)不低于(yu)520元,新增(zeng)(zeng)財(cai)政(zheng)(zheng)(zheng)(zheng)補(bu)助(zhu)(zhu)一(yi)半(ban)用于(yu)提(ti)(ti)高(gao)大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)保障(zhang)能力(在2018年(nian)人(ren)(ren)均籌資(zi)標準上增(zeng)(zeng)加15元)。二(er)是提(ti)(ti)高(gao)大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)保障(zhang)水平。降低并統(tong)一(yi)大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)起付(fu)線(xian),原(yuan)則(ze)上按上一(yi)年(nian)度居(ju)民(min)(min)人(ren)(ren)均可支配收入(ru)的50%確(que)定,大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)政(zheng)(zheng)(zheng)(zheng)策(ce)范圍內報(bao)銷比(bi)例由(you)50%提(ti)(ti)高(gao)至60%。三是落實醫(yi)(yi)保精準扶貧(pin)(pin)任務。充分發揮基本(ben)醫(yi)(yi)保、大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)、醫(yi)(yi)療救助(zhu)(zhu)三重保障(zhang)功能,著力解決(jue)流動貧(pin)(pin)困人(ren)(ren)口斷(duan)保、漏(lou)保問題;大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)對(dui)貧(pin)(pin)困人(ren)(ren)口實施傾(qing)斜(xie)支付(fu),起付(fu)線(xian)降低50%,支付(fu)比(bi)例提(ti)(ti)高(gao)5個百分點(dian),全面取消建檔立卡貧(pin)(pin)困人(ren)(ren)口大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)封頂線(xian);醫(yi)(yi)療救助(zhu)(zhu)增(zeng)(zeng)強(qiang)托底保障(zhang)功能。四(si)是加強(qiang)公共服(fu)務。鞏固完善異(yi)地(di)就醫(yi)(yi)直接結(jie)算,優(you)化異(yi)地(di)就醫(yi)(yi)備案流程。整合城(cheng)鄉(xiang)醫(yi)(yi)保經辦資(zi)源,大(da)(da)力推進(jin)基本(ben)醫(yi)(yi)保、大(da)(da)病(bing)(bing)(bing)保險(xian)(xian)、醫(yi)(yi)療救助(zhu)(zhu)“一(yi)站式服(fu)務、一(yi)窗口辦理(li)、一(yi)單制結(jie)算”,方便(bian)群眾(zhong)享受(shou)待遇。
來源:國(guo)家醫療保障局網站
監制:荊克
編輯:何舟
校對:張智萍