Medical insurance patients in Ji'nan have been prevarication in large hospitals.
source: Xinhua net authors: Wang Haiying, Li Yahong, Cheng Shihua
, some patients with medical insurance cards have been in a number of large hospitals for medical treatment, and sometimes they encounter the embarrassment of "buck passing" and "discrimination". What is the cause of the hospital suit Do you have such a bad attitude?
Medical Insurance Funds: on the one hand, "tight" on the one hand, on the one hand, "tight eating"
hospital prevarication cases of medical insurance patients have occurred, some hospitals even mobilize half of the treatment of patients in advance discharge, "and then have a medical insurance amount to live in."
statistics from Ji'nan Social Security Bureau showed that in 2011, 270 medical insurance patients in Ji'nan were rejected by hospitals. According to the person in charge of the Social Security Bureau of the city, the medical insurance patients with high medical cost or serious condition are easily rejected, because the medical insurance department examines the cost of each hospital doctor. If the per capita cost index is 10 thousand yuan, and the patient needs to spend 20 thousand yuan, the hospital will not be willing to receive it, preferring to receive a few small A patient with a disease.
Xu Dongmei, director of the Department of Nephrology at Qianfo Hill hospital in Shandong, said that a uremia patient was reimbursed only 55 thousand yuan per year, while the actual cost of medical treatment was about 100 thousand yuan a year, which meant that the hospital should attach more than 40 thousand yuan to the hospital for every uremia.
hospital reflects that because public finances are inadequately invested in hospitals and are more concentrated in infrastructure and equipment, hospitals are forced to make up for insufficient operating costs through income creation. "And who will not be able to earn much money from medical care patients, who would like to receive it?"
on the one hand, the medical insurance fund is not enough, on the other hand, the limited medical insurance fund is wasted. Reporters in Shandong and other places of interviews found that some patients only for physical examination to be hospitalized, because the urban residents medical insurance only reimbursement of hospitalization costs, not reimbursed out-patient costs; and the medical insurance patients a large number of prescriptions, it is said that "medical insurance money do not use white, because do not have what benefits do not have to do."
small fund overall, alternative function "discounted"
Zhu Hengpeng, director of the public policy research center of the Institute of economic research, Chinese Academy of Social Sciences, believes that the greater the pool, the lower the risk. And the total amount prepaid system is equal to the each designated hospital into a small pool, the hospital also divided the medical insurance funds into each department, the section of the Department to assign the amount to the doctor, "the more small the pool, once used, the doctor in addition to the prevarication in addition to other ways?"
on the one hand, the health insurance funds of the state workers and urban workers have not been used as a whole, and the alternative function of medical insurance is difficult to give full play; on the other hand, the supervision of the medical insurance institutions to the hospital is not enough, leading to the waste of some social security funds.
take Shangdong Province-owned Hospital as an example, the medical insurance cost in Ji'nan only accounts for less than 10% of its business income. "The hospital doesn't care about that money. For the hospital, the most willing to receive medical insurance patients, such as self paid patients, public medical patients, and monopolistic industries such as finance and electricity, have low average age, low medical rate and strong ability to pay for funds, and do not want to receive local medical insurance patients.
in order to prevent hospital refusal of medical care patients, the Ji'nan Social Security Bureau set a 10% quality margin in the total pre payment system. If the hospital refuses to accept medical insurance, the quality margin will be punished.
however, for some large hospitals, the profit margin is generally between 30% and 40%, even if the 10% premium is deducted, it will not affect much revenue.
it is understood that medical insurance institutions lack "the right to speak" in front of the hospital, one of the main reasons is that the growth of medical insurance funds can not keep up with the increase of medical expenses.
experts point out that only by expanding the overall coverage of medical insurance can the "bargaining power" of medical insurance institutions and hospitals be enhanced and the actual medical insurance level for ordinary patients can be improved.
administrative division does not break down, medical insurance "bonus" is shrinking
the current medical insurance system of our country is huge, such as the basic medical insurance of medical insurance of urban workers, medical insurance of urban residents and NCMS, which is managed by the Department of human society and the health department; and the public health care of the state staff is returned to the financial department. Management; for medical assistance for low-income urban and rural residents, the civil affairs department is responsible for management.
in the "fragmented" medical insurance system, different members of different social status have different protection strength, and easy to form unfair distribution. Hui Hui, a researcher at the Institute of industrial economics of the Chinese Academy of Social Sciences, believes that the social medical insurance system should be shifted from decentralization to centralization and integration, and the same cost will eventually be paid by the insured, and the same guarantee treatment will be obtained.
at the same time, the medical insurance of urban and urban residents in our country is being promoted to the city level city, while the new rural cooperation is mostly at the county level, so the ability to prevent risk is weak. Experts suggest expanding the overall coverage and implementing provincial co-ordination as soon as possible.