The most expensive thing for poor households in Xingshan County, Hubei Province to see a serious illness is 1200 yuan.
Tan Banghua, a villager in Gudong Village, Xingshan County, Hubei Province, who had just been discharged from the hospital, received 24,600 yuan of supplementary insurance money for precise poverty alleviation medical assistance from the adjuster, plus 45,700 yuan for reimbursement of basic medical care and serious illness insurance of the new rural cooperative medical system. She only needed to pay 1,200 yuan for this admission. This is the first reimbursement since the implementation of the supplementary insurance policy for medical assistance in Xingshan County. In October last year, Xingshan County introduced measures. The average patient only needs to pay 12,000 yuan at his own expense, and the poor households only need to pay 1,200 yuan at their own expense. The rural five-guarantee object, the urban three objects, and the urban and rural orphans don’t spend money to see a doctor.
Compliance medical expenses, capped at 12,000 yuan for patients at their own expense.
"Although the new rural cooperative medical system and medical insurance for urban residents have reduced the medical burden, serious illness and serious illness still make many families ‘ A disease returned to before liberation ’ It has become a roadblock for the masses to get rid of poverty and become rich and well-off. " Tan Yeming, secretary of the county party committee of Xingshan County, said that Xingshan County is a poverty-stricken county in the old area of western Hubei, and there are 25,700 rural poor people with a population of 180,000, of whom more than 30% are poor or return to poverty due to illness.
The Tan Banghua family is typical. In 2006, the couple built a two-story building at home by working, and their lives gradually entered a well-off society. However, a serious illness destroyed everything. In 2011, Tan Banghua suffered from chronic myeloid leukemia, with medical expenses as high as 350,000 yuan, and paid more than 200,000 yuan at his own expense, owing a huge foreign debt. Now the whole family only relies on her husband’s income of more than 2,500 yuan a month to make a living.
Xingshan implements the precise poverty alleviation model of "basic medical care of the new rural cooperative medical system (or medical insurance for urban residents)+serious illness insurance of the new rural cooperative medical system (or medical insurance for urban residents)+supplementary medical assistance insurance". For the overflow part after reimbursement of the basic medical care and serious illness insurance policy, Xingshan County finances the insurance company, and the insurance company is responsible for the implementation and payment of the supplementary medical insurance system for precise poverty alleviation, providing medical care for the residents of the county.
According to this model, the compliance expenses of the medical insurance for the new rural cooperative medical system and urban residents will be reimbursed by the supplementary medical assistance insurance after the first reimbursement of basic medical care and the second reimbursement of serious illness insurance. The standard is: 100% reimbursement for the compliance expenses of more than 12,000 yuan; 90% will be reimbursed for the part of the rural poor and urban and rural subsistence allowances that is less than 12,000 yuan at their own expense; For rural five-guarantee objects, urban three-no-objects, urban and rural orphans, all the parts below 12,000 yuan at their own expense are reimbursed.
According to this standard, the average patient’s compliance medical expenses are only 12,000 yuan at his own expense; Rural poor households and urban and rural low-income households pay up to 1200 yuan at their own expense; Rural five guarantees, urban three no objects, urban and rural orphans do not have to spend their own money.
This does not mean that all medical expenses can be reimbursed. Wan Wei Mao, a poor resident of Dali Village, Zhaojun Town, Xingshan County, spent 145,901.39 yuan in Wuhan Asian Heart Hospital in January this year because of congenital heart disease. After being reimbursed by the basic medical care and serious illness insurance of the new rural cooperative medical system, the county finance provided him with assistance of 33,062.5 yuan according to the New Deal, but there is still 13,848.97 yuan to be paid at his own expense, because Wan Wei Mao has some out-of-pocket expenses.
"The financial bottom is the part that is compliant and self-funded. Those that are not compliant and self-funded cannot be reported, which is the case in the whole province and the whole country." Zou Zhichuang, director of Xingshan County Joint Management Office, explained.
Insurance costs 10 million yuan, which the county finance can afford.
On the morning of April 12, Niu Xiaofang, a low-income household, came to the service window of Xingshan Branch of PICC P&C Insurance Company to handle the supplementary insurance payment for precise poverty alleviation medical assistance. For the medical expenses of more than 5,400 yuan, the new rural cooperative medical system reimbursed more than 3,300 yuan, and the self-funded part was reimbursed for more than 1,600 yuan with the approval of PICC P&C Insurance, so it only took less than 500 yuan.
"A small payment of less than 4,000 yuan will go directly to the patient’s account within one day, and a large payment can be settled within one week." Yu Shoucheng, general manager of PICC P&C Xingshan Branch, introduced that after the implementation of the new policy, people’s medical treatment and reimbursement procedures have changed, and PICC P&C Xingshan Branch, which is responsible for the implementation of compensation, has set up a settlement and payment window for medical assistance supplementary insurance. The medical assistance supplementary insurance undertaken by PICC P&C Insurance is a part of the company’s insurance business involving agriculture, countryside and farmers in Xingshan County. Although it risks losses, it is of great significance to the company’s local market layout.
"At present, we are coordinating the medical institutions in the county to pay for medical expenses. When patients leave the hospital, they will be reimbursed for three times and one stop. Serious illness insurance and medical assistance reimbursement for medical treatment outside the county still have to be handled by various insurance companies. " Zou Zhichuang said that when a patient goes to the county for medical treatment and leaves the hospital, he can implement the basic medical care and serious illness insurance of the new rural cooperative medical system in one stop; For medical treatment outside the county, the basic medical care of the new rural cooperative medical system can be completed at the time of discharge, and the serious illness insurance needs to be handled by the handling commercial insurance company; The supplementary medical insurance needs to be handled by the People’s Insurance Company of China, Xingshan Branch.
Wang Xiaobo, the county magistrate of Xingshan County, said that before the introduction of the policy, Xingshan County made a detailed investigation, and based on the data of the serious illness expenses of the insured objects in 2014, the county finance needs to arrange 10.23 million yuan to insure with insurance companies this year in order to cover the entire county. This 10.23 million yuan includes 5.23 million yuan of county financial special funds and 5 million yuan of integrated civil affairs department medical assistance funds.
"Whether the medical assistance supplementary insurance system can operate normally is a prerequisite." Wang Xiaobo said that the public budget revenue of the county finance increased from 300 million yuan in 2011 to 950 million yuan in 2015, which more than tripled. The medical assistance supplementary insurance accounted for about 1% of the fiscal expenditure, and the finance was fully able to bear it.
Reduce unreasonable expenses and strictly prevent excessive medical treatment.
Zou Zhichuang introduced that in the first quarter of this year, a total of 2,030 people in Xingshan County received insurance payment of 3.37 million yuan, with an average of 1,553 yuan at their own expense, accounting for 33.9% at their own expense, down 13% from the same period last year, and the minimum living allowance, five guarantees and poverty alleviation targets did not exceed 15%.
At the beginning of the operation, it looks good, but there are concerns outside — — Will there be over-medical problems after the medical expenses are fully covered?
"According to the data we have, the high hospitalization expenses basically occur in secondary and tertiary medical institutions." Ren Qi, director of the Xingshan County Health and Family Planning Bureau, said that for the second-and third-level medical institutions outside Xingshan County, the higher-level health and family planning administrative departments have formulated a series of medical behavior norms and corresponding cost control measures to reduce the burden of patients’ medical expenses, thus reducing the government’s financial expenditure pressure and enabling the medical assistance supplementary insurance system to be promoted in an orderly manner.
Ren Qi said that in 2015, Xingshan County reduced unreasonable treatment costs by more than 1.26 million yuan.
In addition, Xingshan County adopted a graded diagnosis and treatment system, and determined the fixed-rate payment catalogue of 200 single diseases in the county, 112 hospitalized diseases in towns and villages, and 49 hospitalized referral diseases outside the county. "The price of most common diseases is fixed, which reduces the space for over-medical treatment." Ren Qi said that at present, Xingshan County has three second-class hospitals and seven township hospitals, with 883 beds and 5.0 beds per 1,000 population, which largely ensures the controllability of over-medical treatment.
