速看！权威专家解读职工医保改革热点
<section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; caret-color: rgb(0, 0, 0); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; letter-spacing: 1px; text-align: justify; white-space: normal; text-size-adjust: auto; line-height: 2; visibility: visible; overflow-wrap: break-word !important;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px 10px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; visibility: visible; overflow-wrap: break-word !important; text-align: center;"></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; visibility: visible; overflow-wrap: break-word !important;"><br/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; visibility: visible; overflow-wrap: break-word !important;">近期，广东、湖北、四川等省份实施职工医保门诊共济保障改革，明确开展职工医保门诊统筹，按规定报销参保人普通门诊费用，并同步调整职工医保个人账户计入办法。围绕公众关心的焦点问题，权威专家和业内人士做出解答。</p></section><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; visibility: visible; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"/></p><section powered-by="xiumi.us" style="margin: 10px 0px 2px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; text-align: center; line-height: 0; visibility: visible;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; vertical-align: middle; display: inline-block; line-height: 0; visibility: visible;"></section></section><section powered-by="xiumi.us" style="margin: 0px 0px 5px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; text-align: right; font-size: 12px; color: rgb(160, 160, 160);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">（新华社记者 姜克红 摄）</p></section></section><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><section powered-by="xiumi.us" style="margin: 10px 0px 15px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: flex; flex-flow: row nowrap; justify-content: flex-start;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; min-width: 10%; flex: 0 0 auto; height: auto; align-self: flex-start;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; font-size: 19px; text-align: center;"><section style="margin: 0px auto; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; border: 1px solid rgb(116, 159, 238); background-color: rgb(116, 159, 238); width: 1.8em; height: 1.8em; border-radius: 100%; font-size: 16px; color: rgb(255, 255, 255);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">问</p></section></section></section><section style="margin: 0px 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; flex: 100 100 0%; align-self: flex-start; height: auto;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; color: rgb(51, 122, 183);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;">个人账户的“钱”少了会影响医保待遇吗？</strong></p></section></section></section><section powered-by="xiumi.us" style="margin: 0px; padding: 0px 10px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgba(253, 236, 122, 0.44);">答：</span></strong>随着多地政策落地，不少参保人发现自己医保账户的“钱”少了，担心会影响个人医保待遇。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">据了解，近期多地出台的医保改革方案有共同点：职工医保个人账户当期计入的金额有所变化。对在职职工而言，原本由单位缴费划入的部分不再划入，被纳入统筹基金；对退休人员而言，个人账户计入从过去的与本人养老金挂钩，过渡到定额划入，定额标准与统筹地区改革当年人均养老金挂钩。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">单从账面上看，个人账户新计入的“钱”的确变少了，而且有些人的降幅不小。这不禁让人疑惑，减少的“钱”去哪儿了？会影响个人医保待遇吗？</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">“医保个人账户上的‘钱’减少，并不意味着参保职工医保待遇的降低或损失。”中国社科院公共经济学研究室主任王震说，个人账户减少的“钱”将转化为统筹基金“大池子”的增量，用来承担以往个人账户“小池子”需要支付的普通门诊费用，且个人账户之前的累计结存仍归个人使用，实现保障“增量”。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">2021年4月，国务院办公厅印发《关于建立健全职工基本医疗保险门诊共济保障机制的指导意见》，明确调整统筹基金和个人账户结构后，增加的统筹基金主要用于门诊共济保障，提高参保人员门诊待遇。这也就是说，改革后，以前不能报销的普通门诊费用可以报销了。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">以武汉市退休参保职工周某为例。其年养老金收入5万元，改革前个人账户每年划入2400元。周某患有脑梗，但因当地没有门诊统筹政策，在门诊看病无法享受报销。改革后，他的个人账户年划入调整为996元，在某三级医院门诊就医发生门诊费用7150元后，按照新的门诊统筹政策报销，除去门槛费500元，按三级医院60%的报销比例，即可报销3990元。这也就是说，虽然周某改革后个人账户当年少划入1404元，但其享受待遇却增加了2586元。</p></section><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><section powered-by="xiumi.us" style="margin: 10px 0px 15px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: flex; flex-flow: row nowrap; justify-content: flex-start;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; min-width: 10%; flex: 0 0 auto; height: auto; align-self: flex-start;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; font-size: 19px; text-align: center;"><section style="margin: 0px auto; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; border: 1px solid rgb(116, 159, 238); background-color: rgb(116, 159, 238); width: 1.8em; height: 1.8em; border-radius: 100%; font-size: 16px; color: rgb(255, 255, 255);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">问</p></section></section></section><section style="margin: 0px 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; flex: 100 100 0%; align-self: flex-start; height: auto;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; color: rgb(51, 122, 183);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;">改革职工医保个人账户是因为统筹基金没钱了吗？</strong></p></section></section></section><section powered-by="xiumi.us" style="margin: 0px; padding: 0px 10px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgba(253, 236, 122, 0.44);">答：</span></strong>有质疑声认为，改革职工医保个人账户是因为统筹基金没钱了，要用个人账户“补窟窿”。对此，专家表示，这是由于对我国医保基金收支情况不清楚而产生的误解。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">数据显示，2021年职工医保统筹基金收入11864亿元，支出9321亿元。也就是说，统筹基金不仅收支平衡，而且略有结余，所以“统筹基金没钱了”并不成立。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">既然如此，有公众疑惑，为何把个人账户的“钱”转到统筹基金，用于门诊共济保障，让别人花自己的“钱”？</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">“医疗保险归根到底是一种社会保险，这就意味着它具有互助共济、责任共担、共建共享的性质。”王震说，参保人年轻时得病少，到年老时容易生病，看病吃药仅依靠个人账户积累是有限的，把大家的钱放在一起，可以实现用大数法则化解社会群体的风险，更大范围满足公众医疗需求。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">王震说，调整个人账户是调减当期计入，没有动个人的历史结存。要认识到，无论是个人账户还是统筹基金，都属于已经缴纳的医疗保险费用，是用于解决公众防病、治病问题而筹集、分配和使用的“钱”。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">改革前，个人账户无法给别人使用，“有病的不够用、没病的不能用”，这就逐渐出现了过度沉淀、共济性不够、欺诈骗保等弊端。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">“在医保战略性购买的框架下，优化门诊保障待遇是结构性调整。”国家卫健委卫生发展研究中心医疗保障研究室主任顾雪非介绍，这是在不另外筹资、不新增单位和个人缴费负担的前提下，提高门诊保障水平。</p></section><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><section powered-by="xiumi.us" style="margin: 10px 0px 15px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: flex; flex-flow: row nowrap; justify-content: flex-start;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; min-width: 10%; flex: 0 0 auto; height: auto; align-self: flex-start;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; font-size: 19px; text-align: center;"><section style="margin: 0px auto; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; border: 1px solid rgb(116, 159, 238); background-color: rgb(116, 159, 238); width: 1.8em; height: 1.8em; border-radius: 100%; font-size: 16px; color: rgb(255, 255, 255);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">问</p></section></section></section><section style="margin: 0px 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; flex: 100 100 0%; align-self: flex-start; height: auto;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; color: rgb(51, 122, 183);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;">个人账户改革对老年人有什么影响？</strong></p></section></section></section><section powered-by="xiumi.us" style="margin: 0px; padding: 0px 10px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgba(253, 236, 122, 0.44);">答：</span></strong>有一些老年人看到改革后个人账户“钱”少了，担心看病吃药使用受限。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">指导意见明确，普通门诊统筹保障水平以50%起步，并要求各地在此基础上对退休的老年人再给予倾斜支付。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">以呼和浩特市为例，在开通门诊统筹保障后，退休人员门诊支付比例提高，各级医疗机构在原办法的基础上提高5%，同时进一步提高门诊统筹年度最高支付限额，退休人员待遇支付由原来的4000元提高到6000元，高于在职职工。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">此外，在普通门诊保障健全之前，不少地区先行建立了门诊慢特病保障机制，用统筹基金支付常见于老年人的慢性病、特殊疾病在门诊发生的费用。近期，一些地方适当扩大门诊特殊病病种。如江苏南京在原4大类门特病种基础上，新增9类病种；武汉将高血压、糖尿病等慢性病特殊疾病病种由28类增加到37类，基本病种从32种增加到70种等。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">通过对多地职工医保个人账户改革方案的对比，还可以发现一个共同点——个人账户使用范围拓宽，使用主体从个人扩宽到配偶、父母、子女等，对象范围从药品支付到医疗器械、医用耗材等。这对老年人来说更是个利好。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">顾雪非表示，改革后，参保人可以把个人账户的“钱”用给老人等其他家庭成员，形成家庭内部“小共济”，提高家庭应对医疗风险能力。</p></section><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><section powered-by="xiumi.us" style="margin: 10px 0px 15px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: flex; flex-flow: row nowrap; justify-content: flex-start;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; min-width: 10%; flex: 0 0 auto; height: auto; align-self: flex-start;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; font-size: 19px; text-align: center;"><section style="margin: 0px auto; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; border: 1px solid rgb(116, 159, 238); background-color: rgb(116, 159, 238); width: 1.8em; height: 1.8em; border-radius: 100%; font-size: 16px; color: rgb(255, 255, 255);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">问</p></section></section></section><section style="margin: 0px 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; display: inline-block; vertical-align: top; width: auto; flex: 100 100 0%; align-self: flex-start; height: auto;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; color: rgb(51, 122, 183);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;">如何提高百姓对改革的获得感？</strong></p></section></section></section><section powered-by="xiumi.us" style="margin: 0px; padding: 0px 10px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgba(253, 236, 122, 0.44);">答：</span></strong>随着各地改革方案落地，也有人对改革提出意见：以前在家门口药店买药，现在为了报销还要跑到定点医疗机构门诊挂号；门诊统筹报销设置起付线、最高支付限额，保障力度不如住院报销等。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">“参保人对改革感受最为直观。”顾雪非说，为了让改革红利真正惠及最广大群众，需要充分考虑对老百姓、医药机构等利益相关方的影响，多方共同发力，方便老百姓就医购药。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">根据相关部署，职工医保门诊共济保障改革将通过3年完成。目前，大多数地区已经公布职工医保个人账户改革、门诊共济保障机制的实施细则，但各地经济发展水平、医保统筹力度等情况存在差异，相应的改革策略与举措不尽相同。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">受访专家与业内人士建议，要切实回应群众提出的合理诉求，在提高医疗保障服务的便捷性和可及性、加强政策解读等方面着手，切实破解群众求医问药难题。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">“改革过程中存在不同声音是正常的。”王震说，改革政策效益的显现也需要时间，要同步推进协同配套服务，如合理调整门诊报销的起付线与最高支付限额、尽快将符合条件的定点零售药店纳入门诊统筹、探索将符合条件的“互联网+”医疗服务纳入保障范围等。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">不少地区采取分步调整，促进政策平稳过渡。也有一些地区降低门诊报销起付线、提高报销限额等，如广州在门诊报销由月度限额调整为年度限额的基础上，提高了报销金额；北京不再设置医保门诊最高支付限额。</p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"/></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;">武汉市医保局发布公告，在前期已经公布的1000多家零售药店试点的基础上，将第三批4065家定点零售药店纳入职工医保门诊统筹保障范围。</p></section><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; clear: both; min-height: 1em; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></p></section><section style="overflow-wrap: break-word; max-width: 100%; color: rgb(67, 74, 84); font-family: -apple-system-font, Helvetica, PingFang SC, Hiragino Sans GB, Arial, Microsoft YaHei; font-size: 14px; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box; margin-bottom: 0px;"><section powered-by="xiumi.us" style="overflow-wrap: break-word; max-width: 100%; margin-top: 0.5em; margin-bottom: 0.5em; box-sizing: border-box;"><section style="overflow-wrap: break-word; max-width: 100%; height: 1px; background-color: rgb(160, 160, 160); box-sizing: border-box; line-height: 0;"><br style="overflow-wrap: break-word;"/></section></section></section><p style="overflow-wrap: break-word; margin-top: 0px; margin-bottom: 0px; padding: 0px; color: rgb(67, 74, 84); font-family: -apple-system-font, Helvetica, PingFang SC, Hiragino Sans GB, Arial, Microsoft YaHei; font-size: 14px; white-space: normal; background-color: rgb(255, 255, 255);"><span style="overflow-wrap: break-word; color: rgb(136, 136, 136); letter-spacing: 0.544px; font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;">来</span><span style="overflow-wrap: break-word; color: rgb(136, 136, 136); letter-spacing: 0.544px; font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;">源：新华社</span></p><p style="margin: 0cm 0cm 0.0001pt; padding: 0px; color: rgb(67, 74, 84); font-size: 14px; white-space: normal; background-color: rgb(255, 255, 255); max-width: 100%; min-height: 1em; font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; letter-spacing: 0.544px; line-height: 19.2pt; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="overflow-wrap: break-word !important; letter-spacing: 0.544px; max-width: 100%; color: rgb(136, 136, 136); box-sizing: border-box !important;">制作：吴梦 | </span><span style="overflow-wrap: break-word; color: rgb(136, 136, 136); letter-spacing: 0.544px;">编辑：方丹 熊霞 | </span><span style="overflow-wrap: break-word; letter-spacing: 0.544px; color: rgb(136, 136, 136);">责编：方军</span></p><p style="margin: 0cm 0cm 0.0001pt; padding: 0px; color: rgb(67, 74, 84); font-size: 14px; white-space: normal; background-color: rgb(255, 255, 255); max-width: 100%; min-height: 1em; font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; 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