OFweek Medical Network January 12th: The State Council officially issued the "Opinions of the State Council on Integrating the Basic Medical Insurance System for Urban and Rural Residents", which clearly stated that it is necessary to rationally divide the funding responsibilities of the government and individuals, and improve the government subsidy standards while appropriately raising The proportion of personal contributions. The news officially sat down on the rumors of the previous media.

Recently, some experts reported that some experts have proposed that the proportion of personal payment for Chinese medical insurance is too low, and the ratio between financial subsidies and financial subsidies has expanded to 1:4, which has a “pan-welfare” trend and is difficult to sustain. They advocated gradually increasing the proportion of individual contributions, and adjusted the above figures to 1:3, which triggered heated public opinion.

With the increase in medical expenses and the increase in the level of protection, the pressure on the long-term expenditure of medical insurance funds has increased, and the risk of huge financial subsidies for residents' medical insurance is gradually emerging. It should be acknowledged that compared with the medical insurance for employees, the current medical insurance for urban residents is obviously low in terms of the scale of fund income or from the perspective of individual payment levels. “The proportion of personal contributions is not high” is a basic fact. For example, in 2015, the personal payment for urban residents' medical insurance was only “no more than 120 yuan per capita”, which was not only significantly lower than the government subsidy standard of “380 yuan per person” in the same period, but also far lower than the level of employee medical insurance contributions calculated according to 10% of salary. . Therefore, it is indeed reasonable and necessary to appropriately increase the proportion of individual contributions in order to reduce the risk of funds. It is not only in line with the principle of actuarial balance, but also conducive to the improvement of the incentive mechanism for overpayment.

In addition, the opinions are clear. The coverage of the urban and rural residents' medical insurance system includes all the existing urban residents' medical insurance and the new rural cooperative medical insurance (integrated) personnel, that is, all urban and rural residents except those who are covered by the basic medical insurance for employees. Migrant workers and flexible employees shall participate in basic medical insurance for employees according to law. If they have difficulties, they may participate in medical insurance for urban and rural residents in accordance with local regulations. All localities should improve the mode of participation, promote the protection of insurance, and avoid repeated insurance.

It is worth noting that the opinion also clarified the unified fundraising policy. Adhere to multi-channel financing, continue to implement a combination of personal contributions and government subsidies, and encourage collectives, units or other social and economic organizations to provide support or funding. All localities should take into account the needs of urban and rural residents' medical insurance and major illness insurance, and reasonably determine the unified financing standards for urban and rural areas in accordance with the principle of balance of funds. In areas where the gap between the urban residents' medical insurance and the new rural cooperatives' individual payment standards is large, a differential payment method may be adopted, and a gradual transition will be made using 2-3 years. The actual per capita funding and individual contributions after integration should not be lower than the current level.

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