The essence of this measure is the change of the medical insurance settlement system, that is, the hospital is required to pay the reimbursement funds in the insurance policy instead of the patients, and then settle with the medical insurance.
Some scholars believe that from the implementation level, if this measure is to be implemented smoothly, it needs the support of the medical insurance prepayment system. However, at present, the social credit system is not perfect, the level of medical insurance is low, and the proportion of reimbursement is small, so it is difficult to promote "pay after seeing a doctor" to large hospitals.
The settlement method of "seeing a doctor first and paying later" was once widespread after liberation, and was later cancelled. Since the end of 20 10, it has been piloted by Yanzhou City, Jining, Shandong Province. At present, more than 20 provinces in China are exploring this.
There are great differences in support systems between East and West.
The amount of funds advanced by the hospital has increased, will it make the hospital's finances overwhelmed?
In many places along the eastern coast, this obstacle does not exist. Hospitals don't need to actually advance funds, but the medical insurance department "advances" in a unified way.
Kloc-0/9, director of the Medical Insurance Office of a 3A public hospital in the center of Shanghai, told this newspaper that "it will not affect the post-payment of medical insurance patients". She told reporters that Shanghai has fully implemented the total prepayment, and the Medical Insurance Office will allocate112 of the annual medical insurance quota to hospitals on a monthly basis. This part of the funds has little problem in the reimbursement policy for medical insurance patients.
At present, the total prepayment system is only piloted in seven provinces and cities, but it has not been pushed across the country. In other words, most parts of the central and western regions have not implemented the prepaid system, and there is still a lack of a system that is compatible with "paying for medical treatment first".
Hu Aiping, a former associate professor at Shanghai Jiaotong University and an expert in medical insurance training, believes that in order to implement "pay after seeing a doctor" more smoothly, reformers will have the motivation to push medical insurance from the post-payment system to the pre-payment system, which will be a great progress in the reform of payment methods.
Jiao Yahui also said in an interview that the actual situation in different provinces is different and the focus of current medical reform is different. The model of "seeing a doctor first and then paying" can only be gradually promoted, and it can be piloted first, not forced. She said that the Ministry of Health advocates this experience and practice of facilitating the people and benefiting the people. If all localities feel that there are conditions and feasibility, they can choose to learn from them.
How to cover self-funded patients?
Including the Second Hospital of Yanzhou City, Jining City, Shandong Province, which was the earliest pilot, the hospitals that have implemented "seeing a doctor first and then paying" are basically below the county level, but it is not easy to implement this reform in tertiary hospitals.
The main reason is that there are many self-funded patients in tertiary hospitals, and the amount of self-funded medical expenses is very large. At present, the level of medical co-ordination is too low, and there are many problems in settlement in different places. Many scholars and directors of top three hospitals estimate that the self-funded medical expenses in Shanghai account for half or even two-thirds of the hospital's business income, and are not included in the prepayment scope of Shanghai Medical Insurance Bureau. This part of the funds need to be settled with foreign medical insurance institutions, and the cycle is bound to be very long, which will lead to a capital turnover crisis in hospitals.
"It turns out that the Medical Insurance Bureau will give the hospital a working capital, but it will be cancelled after the total amount is prepaid." The financial vice president of a 3A hospital in Shanghai, which specializes in TCM diagnosis and treatment, complained that the amount paid in advance each month is barely enough to cover the expenses. If the medical expenses of self-funded patients are paid in advance, "a series of financial crises are hidden".
The scope of implementation of "seeing a doctor first and then paying" stipulated by the Ministry of Health includes patients participating in medical insurance and the new rural cooperative medical system, "three noes" patients without names, chaperones and addresses, patients in urgent need of rescue, and patients' malicious evasion of fees (especially the latter category) are also hidden concerns of hospitals.
An insider who participated in the New Rural Cooperative Trust in a county in East China revealed that some local hospitals send people out to "collect debts" at the end of each year, which not only increases the workload, but also has the risk of bad debts. In some underdeveloped areas, this situation may be more serious.
Hu Aiping said that foreign countries' response is that the government "covers the bottom" and finances pay for patients who can't afford medical expenses, but our relevant assistance system is still not perfect.
Is medical insurance payment just a "technical reform"?
"We have been doing this work for a long time," said the vice president of Shanghai 3A Hospital, but it is "unimaginable" that "seeing a doctor first and paying later" is fully rolled out.
Hu Suyun, a researcher at the Institute of Population and Development of China Academy of Social Sciences, believes that only when medical insurance payment becomes the "lifeline" of hospitals can the payment system exert its greatest power. However, the current situation in China is as follows: First, medicine is widely used to support doctors, and drug income is more important to hospitals; Second, the overall level of medical insurance is too low. For big city hospitals with concentrated high-quality medical resources, self-funded patients will be the main service group for a long time.
In this case, not only is it difficult to promote the reform of "seeing a doctor before paying" to large hospitals, but the intention of the reform of medical insurance payment method to incite the reform of public hospitals will also fail.
Zhu Hengpeng, director of the Center for Public Policy Research, Institute of Economics, Chinese Academy of Social Sciences, pointed out.
Under the situation that public hospitals monopolize the supply of medical services, it is difficult for the new medical insurance payment mechanism to play its role effectively. The reform of medical insurance payment method is largely a technical problem, and the reform of medical service supply system is the key to the success or failure of medical reform.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.