Recently, some friends have expressed concern about whether the personal accounts of employee medical insurance will be abolished. There have been concerns about a decrease in the amount of money recorded in the medical insurance accounts. What is the situation here?

This mainly stems from the establishment of the outpatient joint aid security mechanism for employee basic medical insurance by the state in 2021.

Changes brought by the employee medical insurance outpatient joint aid mechanism.

At that time, we established a three-year transition period, and from 2024, the employee medical insurance outpatient joint aid mechanism will be fully established. The main purpose of the employee medical insurance outpatient joint aid mechanism is to implement reimbursable outpatient visits, with a starting reimbursement ratio of 50%, and retired personnel can further increase this ratio.

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Implementing reimbursable outpatient visits does not mean the abolition of employee medical insurance personal accounts; it merely changes the proportion of money recorded in the personal accounts. The National Medical Insurance Administration has also made a special clarification statement, the main content of which includes: ① The money in the past medical insurance personal accounts can still be used by individuals; ② The part of the personal payment by employees is still fully recorded in the personal account. ③ Retired personnel still do not need to pay, and there is still money recorded in the personal account every month.

The development history of employee medical insurance personal accounts.

The personal account system of our country's employee basic medical insurance was established in 1998, along with the establishment of employee medical insurance, mainly to replace the personal payment reimbursement of the original public medical care. For outpatient visits at that time, due to the small amount involved, complex review, and the lack of the current electronic information system, a model of establishing medical insurance personal accounts and individual burden was adopted.

With the development and progress of the times, our country first established a reimbursement system for serious outpatient diseases, and now it also has the conditions for reimbursing ordinary outpatient visits. The starting reimbursement ratio set by the state for outpatient visits is 50%, and the lower the level of the designated medical institution, the higher the reimbursement ratio. Some primary hospitals and grassroots health institutions in some places even have a zero deductible line, and the reimbursement ratio even reaches 70% to 80%, with retired personnel being able to additionally increase the reimbursement ratio by 5 to 10 percentage points.Changes in the Proportion of Individual Medical Insurance Accounts.

The initial establishment of the individual medical insurance account mechanism stipulated that the basic medical insurance premiums paid by employees would be fully credited to their individual accounts. A portion of the employer's contribution would also be allocated to the individual account. Generally, the crediting ratio is designed to favor older individuals and retirees. For example, in the previous Shenzhen medical insurance system, the crediting ratio for employed workers was 5% or 5.6% of the contribution base, with those over 45 years old receiving 5.6%. In Qingdao, the crediting ratios for insured employees aged under 35, between 35 and 45, and over 45 were 2.0%, 2.2%, and 3.0%, respectively. After the implementation of the outpatient cost-sharing mechanism, the crediting ratio will be unified to 2% of the individual's contribution base. To be honest, as people age, the probability of illness increases, and when it comes to using the insurance, they may not necessarily be at a disadvantage.

For retired workers, there have been various rules for the amount credited to the individual medical insurance accounts across the country. For instance, Beijing and Shanghai have a fixed amount crediting system. In Beijing, the fixed monthly credit is 100 yuan for those under 70 years old and 110 yuan for those over 70. Shanghai, on the other hand, has an annual fixed crediting, with 1680 yuan for those under 75 and 1890 yuan for those over 75. Other cities like Guangzhou and Shenzhen link the crediting amount to a certain percentage of the social average wage or the lower limit of the social security payment base. Shenzhen credits 8.05% of 60% of the payment base. In most areas of Shandong Province, the crediting amount is increased according to a certain percentage of the individual's basic pension. Qingdao sets this at 4.5%, but not less than 80 or 90 yuan at a minimum.

After the implementation of the medical insurance outpatient cost-sharing mechanism, the crediting ratio for retirees' individual accounts is determined at around 2% of the average monthly pension of retirees from the previous year when the mechanism is implemented, and like in Beijing and Shanghai, it generally does not change. This is a process of national unification, with Shandong Province setting a unified amount of 100 yuan for those under 70 and 125 yuan for those over 70. Many retired workers have seen an increase in their credited amounts.

Overall, the implementation of the medical insurance outpatient cost-sharing mechanism better reflects the purpose of the medical insurance system to concentrate funds for the treatment of serious illnesses, improves the scope of use of individual medical insurance accounts, enhances the efficiency of medical insurance funds, and is very beneficial to society as a whole. #Top Headline Creation Challenge# #Top Headline Rumor Refutation#​