Recently, the General Office of the State Council issued the Opinions on the Comprehensive Implementation of Serious Illness Insurance for Urban and Rural Residents (hereinafter referred to as the Opinions), which deployed to accelerate the construction of serious disease insurance system for urban and rural residents, build a solid network of basic medical security for the whole people, and benefit more people.
The Opinions put forward that by the end of 2015, serious illness insurance will cover all urban and rural residents who are insured by basic medical insurance, and the burden of seeing a doctor for seriously ill patients will be effectively reduced; By 2017, a relatively complete serious illness insurance system will be established, which will be closely linked with medical assistance and other systems, play a supporting role together, effectively prevent the occurrence of catastrophic family medical expenditure, and significantly improve the fairness of medical security for urban and rural residents.
The Opinions specifies five work measures. First, improve the financing mechanism. A certain proportion or amount will be allocated from the basic medical insurance for urban residents and the new rural cooperative medical care fund as the major disease insurance fund, and the insured people will not pay additional fees.
The second is to improve the security level. The coverage of serious disease insurance is connected with the basic medical insurance for urban and rural residents. If the insured suffers from serious illness and has high medical expenses, the serious illness insurance will guarantee the compliance medical expenses borne by individuals after the basic medical insurance for urban and rural residents is paid according to regulations. In 2015, the payment proportion of serious illness insurance should reach more than 50%, and with the continuous improvement of financing ability and management level of serious illness insurance, the payment proportion should be further increased to more effectively reduce the burden of personal medical expenses.
Third, strengthen the convergence of different security systems. Complementary linkage among basic medical insurance, serious disease insurance, medical assistance, emergency medical assistance, commercial health insurance and charity assistance systems should be well done, with clear division of labor, detailed measures, good convergence in policy formulation, treatment payment, management services and other aspects, and efforts should be made to ensure that serious patients are fully insured. For patients who still have difficulty in self paying after serious illness insurance payment, civil affairs departments and other departments should implement relevant relief policies in a timely manner.
Fourth, standardize the undertaking services of serious illness insurance. In principle, commercial insurance institutions are selected through government bidding to undertake serious disease insurance business. The premium obtained by commercial insurance institutions for serious illness insurance shall be accounted separately to ensure capital security and solvency. We will standardize the bidding and contract management of serious illness insurance. The profitability of commercial insurance institutions should be reasonably controlled in accordance with the principle of balance of income and expenditure, capital preservation and meager profit.
Fifth, strict supervision and management. We will strengthen supervision over the operation of serious illness insurance, urge commercial insurance institutions to improve service quality and level, and actively accept social supervision. We should strengthen the supervision of medical institutions, medical service behaviors and quality, strengthen the norms of diagnosis and treatment, standardize medical behaviors, and control medical expenses.
