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The author:(作者)hpmailerpublished in(发表于) 2013/12/2 10:00:23 Large balances in each of China healthcare funds： how to spend the money going out
People difficult and expensive to see a doctor on the one hand, on the other hand is the health care Fund "to spend more money out" management of the health insurance fund is facing efficiency challenges. Recently at the annual meeting of the China-health economic society-16th, an official pointed out that, by the end of 2012, the country town 764.4 billion yuan of the cumulative balance of basic medical insurance. Fund balance excessively high rate is not conducive to security roles to play, requires changes in concepts of the Medicare system, reducing balance, increase the proportion of reimbursements.
Beijing Municipal Health Bureau Deputy Director Lei Haichao recently at the annual meeting of the China-health economic society-16th said that by the end of 2012, national town 764.4 billion yuan of the cumulative balance of basic medical insurance. Since 1999, except in 2010, a rate of urban basic medical insurance fund balance is over 20%, including three-year savings rate up to 2001.
In fact, the management of urban basic medical insurance by the society (including basic medical insurance for urban workers and urban residents ' medical insurance) has always been "burn out" the strange situation, every year, there are a lot of balance. Related statistics show that the 2012 annual income of 693.9 billion urban basic medical insurance fund, spending 554.4 billion yuan, urban basic medical co-ordinating the accumulated balance at the end of 494.7 billion yuan, individual account accumulation of 269.7 billion yuan, taken together have greatly exceeded expenditure that year.
From the basic medical insurance system for urban employees and urban residents ' medical insurance individual data as well. In 2011, the national workers ' basic medical insurance fund revenues 494.5 billion yuan, expenditure 401.8 billion yuan, by the end of the year, accumulated balances 568.3 billion yuan, national revenue of 59.4 billion yuan for urban resident basic medical insurance fund, spending 41.3 billion yuan, by the end of the year the cumulative balances reached 49.7 billion yuan.
Some experts pointed out that, using balance principle should be the year of the Medicare Fund, there should be no excessive balances. If the balance is high, not only fail to maximize efficiency, and will be easily diverted, breeds at risk. But from the perspective of reality, the current fund balance ratio is much higher than in developed countries to 10% below horizontal.
Low proportion of insured persons on the one hand complain about reimbursement, on the other hand there are a large number of health insurance fund is "sleeping" State, strengthen the management of medical insurance fund balance is imminent. "Medical capital savings rates are so high is not normal, funds were not used to solve visiting doctor being difficult and expensive problems. "Ray tide said the Medicare system needs to change ideas, reducing balance, increase the proportion of reimbursements, and gradually raise the level of basic health insurance, reduce the burden on insured individuals; it should also raise funds and Manpower Management layers and bigger risk pools. Health insurance coverage and whether the scope should be further improved? Financial subsidies and possible to further increase the individual contribution level? National health family planning Commission reform Division Deputy Donald, and State healthcare Office policy group heads Fu Wei in accept economic reference reported under reporter interview Shi said, from deepening healthcare yilai, basic medical guarantees system of construction accelerated advance, Medicare of guarantees level also in constantly improve, levels Government on town residents Medicare and new agricultural collection of grants standard from 2008 of per capita 80 Yuan improve to has 2013 years of 280 Yuan. By 2015, the health of urban residents and the Government of new-style rural cooperative standards will be raised to more than 360 Yuan per person per year, with the improvement of financial aid, payment there will be a corresponding increase in the level of insured persons.
Fu Wei said that as health care financing levels increase in the future, the basic Medicare benefit levels will also further enhance. By 2015, the policy areas in the new rural cooperative medical insurance, urban residents of inpatient reimbursement in percentage will be about 75%, outpatient and manpower will also be extended to cover all areas and corresponding payout percentage be increased to 50% per cent.
December 02, 2013 Economic information daily(我国医保基金每年有大量结余：钱多到花不出去|医疗保险|基金|结余_新闻资讯
一方面是老百姓看病难看病贵，另一方面是医保基金“钱多到花不出去”，医保基金的管理正面临效率难题。近日举行的中国卫生经济学会第十六次年会上，有官员指出，到2012年底，全国城镇基本医疗保险累计结余7644亿元。基金结余率畸高不利于保障作用的发挥，医疗保障制度需要转变理念，减少结余，提高报销比例。
北京市卫生局副局长雷海潮近日在中国卫生经济学会第十六次年会上表示，到2012年底，全国城镇基本医疗保险累计结余7644亿元。自1999年至今，除2010年外，城镇基本医疗保险基金结余率都在20%以上，其中2001年的结余率最高达到35%。
事实上，由人社部管理的城镇基本医疗保险(包括城镇职工基本医疗保险和城镇居民医疗保险)一直存在钱“花不出去”的怪现状，每年都有大量结余。相关统计显示，2012年全年城镇基本医疗保险基金总收入6939亿元，支出5544亿元，年末城镇基本医疗统筹基金累计结存4947亿元，个人账户积累2697亿元，两者合计已经大大超过当年支出。
从城镇职工基本医疗保险和城镇居民医疗保险的单项数据看也是如此。2011年，全国职工基本医疗保险基金收入4945亿元，支出4018亿元，当年年末，基金累计结存5683亿元；全国城镇居民基本医疗保险基金收入594亿元，支出413亿元，当年年末累计结存也达到了497亿元。
有专家指出，医保基金使用原则应该是当年收支平衡，不应当有过多结余。如果结余量较高，不仅不能使效率最大化，反而容易被挪用，滋生风险。但从实际情况看，目前基金的结余比例已经远高于发达国家控制在10%以下的水平。
一方面是参保者抱怨报销比例低，另一方面却有大量医保基金处于“沉睡”状态，加强医保基金结余管理迫在眉睫。“医保资金结余率如此高是不正常的，资金没有用来解决看病难、看病贵的问题。”雷海潮表示，医疗保障制度需要转变理念，减少结余，提高报销比例，逐步提高基本医疗保险保障水平，减轻参保人员的个人负担；此外，应该提高基金统筹管理层级，做大风险池。医保的保障水平和范围是否应该进一步改善？财政补贴和个人缴费水平是否有进一步提高的可能？国家卫生计生委体制改革司副司长、国务院医改办政策组负责人傅卫在接受《经济参考报》记者采访时表示，从深化医改以来，基本医疗保障制度的建设加快推进，医保的保障水平也在不断提高，各级政府对城镇居民医保和新农合的补助标准从2008年的人均80元提高到了2013年的280元。到2015年，城镇居民医保和新农合政府补助标准将提高到每人每年360元以上，随着财政补助的提高，参保人员的缴费水平也将相应增加。
傅卫表示，未来随着医保筹资水平的提高，基本医保的保障水平也将进一步提升。到2015年，城镇居民医保、新农合政策范围内的住院报销比例将达到75%左右，门诊统筹也将覆盖所有的地区，相应的支付比例会提高到50%以上。
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