医保门诊共济是自己的“钱”给别人用了吗？权威解读来了
<section data-role="outer" class="article135" label="edit by 135editor"><section style="box-sizing: border-box;" class=""><section style="box-sizing: border-box;" class="_135editor"><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><span style="caret-color: red;">近日，关于职工医保个人账户改革的消息引发社会关注。其中，不少涉及人民群众切身利益的改革举措，引发社会热议。</span><br/></p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">门诊共济是自己的“钱”给别人用了吗，是年轻人的钱给老年人用了吗？调整个人账户使用范围是否会影响零售药店的发展？就这些热点问题，记者采访了医保专家和业内人士。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="text-align:center; line-height: 2em;"></p></section><section data-role="paragraph" class="_135editor"><p><br/></p></section><section style="margin: 10px 0%; box-sizing: border-box;" class="_135editor"><section style="display: inline-block;min-width: 10%;max-width: 100%;vertical-align: top;padding-left: 30px;box-sizing: border-box;" class=""><section style=";margin-right: 0%;margin-bottom: -30px;margin-left: 0%;box-sizing: border-box;transform: translate3d(-30px, 0px, 0px);-webkit-transform: translate3d(-30px, 0px, 0px);-moz-transform: translate3d(-30px, 0px, 0px);-ms-transform: translate3d(-30px, 0px, 0px);-o-transform: translate3d(-30px, 0px, 0px);"><section style="box-sizing:border-box;display: inline-block;width: 30px;height: 30px;vertical-align: top;overflow: hidden;border-width: 0px;border-radius: 100%;border-style: none;border-color: rgba(118, 178, 124, 0);background-color: rgba(71, 193, 168, 0.3);"><section style="text-align: justify;box-sizing: border-box;"><p style="white-space: normal;box-sizing: border-box;"><br/></p></section></section></section><section style=";box-sizing: border-box;transform: translate3d(-15px, 0px, 0px);-webkit-transform: translate3d(-15px, 0px, 0px);-moz-transform: translate3d(-15px, 0px, 0px);-ms-transform: translate3d(-15px, 0px, 0px);-o-transform: translate3d(-15px, 0px, 0px);"><section style="display: inline-block;min-width: 10%;max-width: 100%;vertical-align: top;padding-top: 3px;padding-bottom: 3px;box-sizing: border-box;" class=""><section style="color: rgb(55, 80, 114);text-align: justify;box-sizing: border-box;" class=""><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><strong style="box-sizing: border-box;">热点问题一：改革是因为统筹基金没钱了？</strong></p></section></section></section></section></section><section data-role="paragraph" class="_135editor"><p><br/></p></section><section style="box-sizing: border-box;" class="_135editor"><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">职工医保门诊共济保障改革简单地说，就是<strong style="box-sizing: border-box;"><span style="color: #47c1a8;box-sizing: border-box;">职工医保参保人的门诊费用以前主要通过“个人账户”的方式来保障，现在是通过“共济保障”，也就是统筹来报销。</span></strong></p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">有观点认为，改革是因为统筹基金没钱了，所以用个人账户的钱“补窟窿”。对此，中国社会科学院经济研究所研究员王震说，这个观点是对我国职工医保基金的收支状况不清楚所致。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">数据显示，2021年我国职工医保基金当年收入19003.10亿元，当年支出14746.73亿元。其中，统筹基金当年收入为11864.04亿元，支出为9321.27亿元，<strong><span style="color: #47c1a8;">统筹基金当期结存2542.77亿元。</span></strong>也就是说，在不动用累计结余的情况下，统筹基金完全可以实现当年的收支平衡。所以，补统筹基金的“窟窿”这一点并不成立。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">王震说，<span style="color: #47c1a8;"><strong>将门诊保障的方式改为互助共济、统筹报销为主的模式，最主要的考虑是通过提高医保基金的使用效率，从而提高参保人的门诊待遇水平。</strong></span></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><br/></p><p style="text-align:center; line-height: 2em;"></p></section><section data-role="paragraph" class="_135editor"><p><br/></p></section><section style="margin: 10px 0%; box-sizing: border-box;" class="_135editor"><section style="display: inline-block;min-width: 10%;max-width: 100%;vertical-align: top;padding-left: 30px;box-sizing: border-box;" class=""><section style=";margin-right: 0%;margin-bottom: -30px;margin-left: 0%;box-sizing: border-box;transform: translate3d(-30px, 0px, 0px);-webkit-transform: translate3d(-30px, 0px, 0px);-moz-transform: translate3d(-30px, 0px, 0px);-ms-transform: translate3d(-30px, 0px, 0px);-o-transform: translate3d(-30px, 0px, 0px);"><section style="box-sizing:border-box;display: inline-block;width: 30px;height: 30px;vertical-align: top;overflow: hidden;border-width: 0px;border-radius: 100%;border-style: none;border-color: rgba(118, 178, 124, 0);background-color: rgba(71, 193, 168, 0.3);"><section style="text-align: justify;box-sizing: border-box;" class=""><p style="white-space: normal;box-sizing: border-box;"><br/></p></section></section></section><section style=";box-sizing: border-box;transform: translate3d(-15px, 0px, 0px);-webkit-transform: translate3d(-15px, 0px, 0px);-moz-transform: translate3d(-15px, 0px, 0px);-ms-transform: translate3d(-15px, 0px, 0px);-o-transform: translate3d(-15px, 0px, 0px);"><section style="display: inline-block;min-width: 10%;max-width: 100%;vertical-align: top;padding-top: 3px;padding-bottom: 3px;box-sizing: border-box;" class=""><section style="color: rgb(55, 80, 114);text-align: justify;box-sizing: border-box;" class=""><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><strong style="box-sizing: border-box;">热点问题二：为啥要动个人账户的“钱”？</strong></p></section></section></section></section></section><section style="box-sizing: border-box;" class="_135editor"><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">变成统筹保障之后，一个明显的变化是原来从统筹基金划入个人账户的一部分资金不再划入，而是留在统筹基金共济使用。由此，一些观点认为这是“自己的钱给别人用、年轻人的钱给老年人用”。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">这里需要了解“共济”的含义。它是保险的本质，也叫“大数法则”，意思是把大家的钱放在一起，给发生风险事件（疾病）的人用，共同抵御疾病风险。试想一下，当人们发生大病，但个人账户不足支付时，谁来帮你？谁又能保证年轻时就一定不发生大病，年老多病时积存的个人账户资金一定能够支付得起大病费用？</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">王震说，<strong style="box-sizing: border-box;"><span style="color: #47c1a8;box-sizing: border-box;">从保险的角度，不能说自己缴了费但用不上就是“吃亏”。</span></strong>因为保险本就是应对不确定性带来的风险。当然，个人完全可以用自己的收入和积蓄来支付疾病费用，那也就没有“医疗保险”一说了。但不论是历史还是现实，我们看到的是完全依靠个人应对疾病风险是不靠谱的，所以才有了“老吾老以及人之老、幼吾幼以及人之幼”，才有了“互助共济”的制度化保障。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="text-align:center; line-height: 2em;"></p></section><section data-role="paragraph" class="_135editor"><p><br/></p></section><section style="margin: 10px 0%; box-sizing: border-box;" class="_135editor"><section style="display: inline-block;min-width: 10%;max-width: 100%;vertical-align: top;padding-left: 30px;box-sizing: border-box;"><section style=";margin-right: 0%;margin-bottom: -30px;margin-left: 0%;box-sizing: border-box;transform: translate3d(-30px, 0px, 0px);-webkit-transform: translate3d(-30px, 0px, 0px);-moz-transform: translate3d(-30px, 0px, 0px);-ms-transform: translate3d(-30px, 0px, 0px);-o-transform: translate3d(-30px, 0px, 0px);" class=""><section style="box-sizing:border-box;display: inline-block;width: 30px;height: 30px;vertical-align: top;overflow: hidden;border-width: 0px;border-radius: 100%;border-style: none;border-color: rgba(118, 178, 124, 0);background-color: rgba(71, 193, 168, 0.3);"><section style="text-align: justify;box-sizing: border-box;" class=""><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal;box-sizing: border-box;"><br/></p></section></section></section><section style=";box-sizing: border-box;transform: translate3d(-15px, 0px, 0px);-webkit-transform: translate3d(-15px, 0px, 0px);-moz-transform: translate3d(-15px, 0px, 0px);-ms-transform: translate3d(-15px, 0px, 0px);-o-transform: translate3d(-15px, 0px, 0px);"><section style="display: inline-block;min-width: 10%;max-width: 100%;vertical-align: top;padding-top: 3px;padding-bottom: 3px;box-sizing: border-box;" class=""><section style="color: #375072;text-align: justify;box-sizing: border-box;" class=""><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><strong style="box-sizing: border-box;">热点问题三：门诊统筹能否真正减轻个人负担？</strong></p></section></section></section></section></section><section style="box-sizing: border-box;" class="_135editor"><p style="white-space: normal; box-sizing: border-box; line-height: 2em;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">作为参保人，<strong style="box-sizing: border-box;"><span style="color: #47c1a8;box-sizing: border-box;">门诊就医拟纳入统筹保障后，最直接的好处是待遇提升了</span></strong><strong><span style="color: #47c1a8;"><span style="box-sizing: border-box;">，</span>原来不能报销的现在能报销了。</span></strong>但也有一种担心的声音，门诊统筹后，一些药品需要到医院开具才能报销，从而导致原来大量在药店就可以解决问题集中到医院，增加医院负担和个人医疗费用的支出。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">王震解释说，且不说门诊待遇的提升能否抵消这种所谓“医疗费用的增加”，就从临床安全性以及患者的就医行为来看，在没有改革之前该去医院的也得去医院，在改革之后不该去医院的也没有必要去。</p><p style="white-space: normal;box-sizing: border-box;"><br/></p><p style="white-space: normal; box-sizing: border-box; line-height: 2em;">更何况，改革并没有取消个人账户。“原来在药店可以购买的药品仍然可以在药店购买，原来个人账户该怎么用还是可以怎么用。所以说，个人负担不会增加。”王震表示。</p></section></section></section><p> </p><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: 17px; letter-spacing: 1px; text-align: justify; 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; 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