人民日报发文：怎样看待门诊共济保障改革
<p style="text-align: center;"></p><p><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.6em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section powered-by="xiumi.us" style="margin: 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: left; justify-content: flex-start; display: flex; flex-flow: row nowrap; visibility: visible;"><section style="margin: 0px; padding: 16px 20px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: inline-block; width: 578px; vertical-align: top; background-color: rgba(199, 230, 255, 0.33); align-self: flex-start; flex: 0 0 auto; visibility: visible;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.8em; text-align: justify; text-indent: 0em; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; letter-spacing: 1px; text-decoration-style: solid; text-decoration-color: rgb(94, 94, 94); color: rgb(0, 0, 0); visibility: visible;">今年元旦，一些省份的地级市职工基本医保门诊共济保障机制落地实施。当地职工医保参保人发现，去医院看门诊就医购药能报销了。提升医疗保障待遇，这本是大家都期待的好事。但与此同时，自己个人医保账户里的资金减少了，也让一些人有点疑惑。</span></section><p style="margin-top: 16px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 1.8em; text-align: justify; text-indent: 0em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; letter-spacing: 1px; text-indent: 0em; color: rgb(0, 0, 0); visibility: visible;">职工医保门诊共济保障机制改革意义何在，参保人的权益是否受到影响？对此，有关专家进行了解答。</span></p></section></section></section><p><br/></p><section powered-by="xiumi.us" style="margin: 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); justify-content: flex-start; display: flex; flex-flow: row nowrap; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 24px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: inline-block; width: 578px; vertical-align: top; border-style: solid; border-width: 1px 1px 7px; border-color: rgb(178, 219, 239); align-self: flex-start; flex: 0 0 auto; visibility: visible;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; letter-spacing: 1px; line-height: 1.8; color: rgb(0, 0, 0); text-align: justify; visibility: visible;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(61, 170, 214); visibility: visible;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; letter-spacing: 2px; visibility: visible;">“个人账户保门诊小病”局限日益凸显，共济保障改革势在必行</span></strong></span></p></section></section></section></section><p><br/></p><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); visibility: visible; box-sizing: border-box !important; 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; visibility: visible;"/></p><p><br/></p><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; visibility: visible;">“职工个人医保账户的资金减少，是因为实施门诊共济保障改革后的门诊保障机制发生了变化，将单位缴费全部计入医保统筹基金，不再将其中一部分划入个人账户，同时参保人个人门诊费用纳入医保统筹基金的保障范围，从而在整体上提高广大职工的门诊保障水平。”浙江大学国家制度研究院副院长金维刚表示，我国现行职工医保制度已有20多年历史，实行社会统筹与个人账户相结合的制度模式。其中，统筹基金来源于用人单位缴费，主要提供住院、门诊大病和部分慢性病的医疗保障；个人账户来源于个人缴费和单位缴费的一部分划拨，主要用于一般的门诊医疗费用支出。这种“统账结合”的制度模式是特定历史时期的产物，有其特殊的历史作用，但这种制度模式也存在着不足之处。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; visibility: visible;">金维刚表示，由于职工医保个人账户缺乏社会互济性，个人账户在门诊保障方面的功能具有局限性，出现了参保职工“有病的不够花，没病的用不了”的状况。一方面，在医保基金累计结余中有将近40%是个人账户结余资金，其中80%以上的个人账户累计结余资金主要集中在健康状况较好的青壮年参保人员的个人账户中，有些收入高的参保人员个人账户累计结余达数万元；另一方面，不少参保患者特别是广大退休人员个人账户资金在支付门诊费用方面不够用，门诊个人负担较重。在这种情况下，迫切需要通过建立职工门诊共济保障机制来提高医保在门诊保障方面的能力，以减轻个人在门诊医疗保障方面的负担。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">国家医保局公布数据显示，2021年，全国参保职工在医疗机构中发生的费用中，在职职工平均花费2097元，退休职工花费8002元，后者是前者的3.82倍。在职职工住院率为9.90%，退休职工为39.50%，后者是前者的3.99倍。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">“很明显，老年人生病多、花费多。”华中师范大学劳动与社会保障系副教授王超群表示，调取某个城市约500万人参保职工个人账户数据发现，在60岁以上、70岁以上和80岁以上的参保职工中，50%以上参保人的个人账户余额分别低于730元、325元和162元。也就是说，年龄越大，个人账户的结余金额越低，看一两次病就用完了。依靠个人账户完全无法解决老年人尤其是高龄老年人的门诊就医和购药需求。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">“建立健全职工门诊共济保障机制是深化医保改革、提高参保职工门诊保障水平的客观需要。”金维刚表示，职工医保中的统筹基金是全体参保职工之间实现互助共济的基础，体现了医疗保险作为一种社会保障制度的再分配功能。从发展趋势来看，医保统筹基金需要承担更多的医疗保险责任。通过推行职工医保门诊共济保障机制改革，强化职工医保统筹基金，将职工门诊医疗费用全面纳入职工医保统筹基金的保障范围，有利于增强职工医保在门诊方面的保障功能，有利于完善医保筹资机制，有利于提高医保基金的使用效率，有利于职工医保更加公平可持续发展。</span></section><section powered-by="xiumi.us" style="margin: 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); justify-content: flex-start; display: flex; flex-flow: row nowrap; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 24px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: inline-block; width: 578px; vertical-align: top; border-style: solid; border-width: 1px 1px 7px; border-color: rgb(178, 219, 239); align-self: flex-start; flex: 0 0 auto;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; letter-spacing: 1px; line-height: 1.8; color: rgb(0, 0, 0); text-align: justify;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; letter-spacing: 2px; color: rgb(61, 170, 214);">改革就是让最有需要的人受益，要算大账、长远账</span></strong></p></section></section></section></section><p><br/></p><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; 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><p><br/></p><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">“一些人认为个人账户里的钱就是个人自己的，这是概念上的误解。”王超群介绍，个人账户里的钱在法律性质上是医保基金，由政府管理。只不过，医保基金按照每个参保职工的工资或者退休金水平，给每个人分别设置了一个可以使用的资金额度。这个资金额度划到个人账户户头上，就成了个人账户里的钱。既然属于医保基金，这些个人账户里的钱必须遵照社会保险法的规定，只能用于支付医药费用。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">“个人账户里钱少了，我就吃亏了！”事实果真如此吗？</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">从全国看，实施普通门诊统筹后，互助共济功能显著提高，门诊需求多、患病多的参保职工明显获益。之前不报销的门诊常见病、多发病医疗费纳入统筹基金支付范围，将有效减轻普通门诊就诊费用负担。特别是患病多和罹患慢病的参保职工，获益远超个人账户减计额，仅仅减计数百元，就能报销千余元甚至数千元。2022年，全国职工医保普通门诊统筹待遇惠及11.8亿就诊人次，参保人政策范围内报销比例在50%左右。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">当然，也有部分身体健康的职工，很少去医院就诊，个人账户资金减少，对他们来说确实有损失。对此，金维刚表示，改革本身就是利益调整的过程，让最有需要的人受益是基本原则。改革后，大部分参保人个人账户当期计入会减少，但改革后门诊待遇更好，真正患病的群众和老年人更受益。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">有关专家详解了“待遇更好”：一是调减个人账户当期计入的同时建立了共济保障，通过权益置换提升普通门诊保障水平，增加的普通门诊统筹报销待遇比个人账户减少要高，随着制度健全完善还将逐步提高门诊报销水平，让老百姓充分享受改革红利。二是保留了个人账户这一制度设置，且历史上的结存仍然由个人支配使用，可继续用于个人在门诊就医、在药店购药，原来能保障的改革后仍然可以保障，还拓展了使用范围。三是计入办法更加公平，在职职工个人缴费继续计入个人账户，退休人员个人账户由统筹基金统一按定额划入，不再与本人养老金水平或者退休前工资一定比例挂钩，实现了同一地区内公平统一，同一人群内基本一致。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">专家表示，在社会医疗保险的大框架下，个人账户的资金是“看病钱”，不是工资收入，也不是福利。年轻健康的，虽然现在看病不多，但疾病带来的经济风险是长期存在的。年老多病的时候，个人账户和个人积累有限，需要有坚实可持续的医疗保险实现社会互助共济来化解疾病风险。长远来看，每个人都会在改革中获益。“大家既要算小账，也要算大账；既要算眼前账，又要算长远账。”</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; 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;"/></section><section powered-by="xiumi.us" style="margin: 0px 0px 10px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); justify-content: flex-start; display: flex; flex-flow: row nowrap; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 24px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: inline-block; width: 578px; vertical-align: top; border-style: solid; border-width: 1px 1px 7px; border-color: rgb(178, 219, 239); align-self: flex-start; flex: 0 0 auto;"><section powered-by="xiumi.us" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; letter-spacing: 1px; line-height: 1.8; color: rgb(0, 0, 0); text-align: justify;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px; letter-spacing: 2px; color: rgb(61, 170, 214);">门诊共济保障改革将细化配套措施，促参保职工获得感提升</span></strong></p></section></section></section></section><p><br/></p><p powered-by="xiumi.us" style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; 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><p><br/></p><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">除了对个人账户资金减少不理解，也有一些职工提出：因为附近药店没有自己需要的常用药，要享受报销待遇还得常跑医院，耽误时间，还搭上了门诊费交通费。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">“医保改革关系到人民群众的切身利益，各地经济发展水平、职工收入水平、医保基金统筹层次和收支状况以及参保人员对医保的理解认识等方面都存在着显著差异。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">因此，在目前职工医保以市级统筹为主的条件下，这项改革还需要由各统筹地区政府根据国家要求，结合本地实际情况制定出台具体政策和实施细则。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">”金维刚认为，目前，有的地方参保人对当地职工医保门诊共济保障的具体政策措施有不理解，不仅反映了当地有关政策宣传解读工作做得不到位，而且也提醒地方政府有关部门，要把制定和实施上述改革的具体政策措施以及经办服务工作做得更细更扎实。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">为确保各地改革顺利推进，国家医保局早前已出台相关规定，包括职工医保个人账户家庭共济、适当拓展个人账户使用范围等等。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">针对群众提出的药店购药难享受医保待遇的问题，国家医保局明确回应，改革后，参保患者在定点零售药店购药既可以使用个人账户，也可以凭外配处方享受统筹基金报销。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">为更好方便参保群众待遇享受，还将实施支付方面的创新。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">一是支持患者持外配处方在定点零售药店结算和配药，享受与在就诊医疗机构同等的报销待遇。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">二是探索将符合条件的“互联网+”医疗服务纳入保障范围，提高享受待遇的便捷性。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">三是探索推进电子处方流转，更好解决购药结算的需要。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">此外，还将协同相关部门在家庭医生签约服务、基层医疗卫生机构和定点药店配药联动上，进一步完善支持措施。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">职工医保门诊共济保障制度建立之后，武汉等地也相继出台了一系列医疗机构便民服务政策。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">目前，武汉市682家定点医疗机构、1029家定点零售药店已纳入门诊统筹保障范围。</span></section><section style="margin: 0px 8px 16px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">“后续，医保、卫健、市场监管、财政等部门将不断深化职工医保门诊共济保障机制改革配套措施，比如增加职工医保门诊统筹定点医疗机构数量，增加医保门诊慢性病特殊疾病保障病种，完善日间手术医保报销政策，推行电子处方流转等等，在定点医疗机构设立便民门诊，免收便民门诊的挂号费、诊疗费，确保参保职工看病购药更方便、医疗费用保障更充分、获得感更强。</span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 16px;">”武汉市政府相关人士表示。</span></section><p><br/></p><p><br/></p><section style="max-width: 100%; color: rgb(67, 74, 84); font-family: -apple-system-font, Helvetica, PingFang SC, Hiragino Sans GB, Arial, Microsoft YaHei; white-space: normal; background-color: rgb(255, 255, 255); margin: 0px; padding: 0px; outline: 0px; box-sizing: border-box; visibility: visible; overflow-wrap: break-word !important;"><section powered-by="xiumi.us" style="overflow-wrap: break-word !important; max-width: 100%; margin: 0.5em 0px; padding: 0px; outline: 0px; box-sizing: border-box; visibility: visible;"><section style="overflow-wrap: break-word !important; max-width: 100%; margin: 0px; padding: 0px; outline: 0px; box-sizing: border-box; height: 1px; background-color: rgb(160, 160, 160); line-height: 0; visibility: visible;"><br style="overflow-wrap: break-word !important; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;"/></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="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; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(136, 136, 136); visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="overflow-wrap: break-word !important; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; visibility: visible; box-sizing: border-box !important;">来</span><span style="overflow-wrap: break-word !important; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; visibility: visible; box-sizing: border-box !important;">源：人民日报</span></span><br style="overflow-wrap: break-word;"/></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); outline: 0px; max-width: 100%; clear: both; 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; visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; color: rgb(136, 136, 136); visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;">制作：方筱玥 | </span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(136, 136, 136); letter-spacing: 0.544px; visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;">编辑：方丹 熊霞 | </span><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; color: rgb(136, 136, 136); visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;">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); outline: 0px; max-width: 100%; clear: both; 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; visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(136, 136, 136); visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="overflow-wrap: break-word !important; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; line-height: 19.2pt; visibility: visible; box-sizing: border-box !important;"><span style="overflow-wrap: break-word !important; font-weight: 700; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; visibility: visible; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; visibility: visible; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="overflow-wrap: break-word !important; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;">出品：</span></span>蔡甸区融媒体中心</span></span></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); outline: 0px; max-width: 100%; clear: both; 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;"><br style="overflow-wrap: break-word !important; margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important;"/></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); outline: 0px; max-width: 100%; clear: both; 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; text-align: center; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; color: rgb(136, 136, 136); overflow-wrap: break-word !important; box-sizing: border-box !important;">您有新闻线索，请联系我们：</span></p><p style="margin: 0cm 0cm 0.0001pt; 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letter-spacing: 0.544px; line-height: 19.2pt; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; letter-spacing: 0.544px; color: rgb(136, 136, 136); overflow-wrap: break-word !important; box-sizing: border-box !important;">投稿邮箱：2187431778@qq.com</span></p><p><br/></p><link rel="stylesheet" href="//bbs.whcdrm.com/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_g3y" id="wcn_editor_css"/>
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