A Study On The Operation Of The Remote Medical Settlement For The Basic Medical Insurance Of Shanxi Urban Employees

The coverage rate of the basic medical insurance system for urban employees in China has been increasing year by year.But because the system follows the principle of localized management,and the overall level of basic medical insurance is low at present,it is difficult for people to reimburse and for medical insurance agency to supervise.With the increasing demand of the personnel mobility and the remote medical treatment,settlement problems of remote medical treatment seem to be serious.The 13 th Five-year Plan pointed out that we must improve the medical insurance system,perfect the management of remote medical settlement,focus on the medical demand of retirees who live outside the insured place.Medical insurance is to make up a loss of medical expenses for the insured person after treatment.Remote medical settlement is based on the relevant provisions of the medical insurance system for the insured person in offsite to reimburse the medical expenses.To achieve direct settlement of the remote medical treatment,which would reduce the burden of the heavy advance payment and difficulty in reimbursement for insured person,is the main purpose at the present stage.Shanxi selects the mode of networking direct-settlement on the basis of the achievement of city-level overall medical insurance.By means of the construction of medical settlement information platform and unification of social security card,the management system covered 11 municipal co-ordination areas in 2014,which made direct settlement of the remote medical treatment and achieved “full provincial linkage and interoperability”.By the end of 2016,the Shanxi provincial remote medical settlement system served More than 32 million people,and made the total cost over 1.1 billion yuan.The remote medical settlement also appears some problems,such as the effectiveness of business coordination of the agency is low,the construction of the system platform needs to be improved,the development of the remote medical settlement is not balanced,medical insurance fund of some areas face more risks and the grating treatment system is affected.The specific performance is that there are fewer professionals but more difficult to coordinate,system compatibility is poor and lack of funds,quite different effects on the settlement operation of different places,the outflow risk of medical insurance fund has increased in some areas,Settlement convenience to increase the number of patients in large hospitals which is not conducive to the grading treatment system.Improve the overall level,select the mode of networking direct-settlement,make the good publicity and comprehensive technical transformation,stick to implement the work according to hierarchy,which are the revelation of the remote medical settlement in Shanxi province.The remote medical settlement in Shanxi province need to be further improved.It is proposed to improve the management system,improve management efficiency of remote medical settlement,and strengthen the effective connection with the grating treatment system.