Research On Implementation Difficulties And Countermeasures Of Employee Medical Insurance Outpatient Mutual Aid Policy In Baotou City

With the deepening of the reform of the national medical security system and the increasing demand of the people for outpatient medical treatment,the personal account system of basic medical insurance which used to be "unified account" has been unable to meet the needs of social development,and the reform of employee medical insurance personal account is imminent.In April 2021,The General Office of the State Council issued the Guiding Opinions on Establishing and improving the Mutual Assistance Mechanism for Employees’ Basic Medical Insurance Outpatient Service.Then,in December 2021,the General Office of the Inner Mongolia Autonomous Region People’s Government issued the Opinions on Establishing and Improving the Mechanism of Mutual Assistance for Employees’ Basic Medical Insurance Outpatient Service,which defined the goals and directions and made specific arrangements for the reform of employees’ individual medical insurance accounts and the establishment and improvement of the mutual assistance mechanism for employees’ outpatient service in Inner Mongolia.In accordance with the document spirit of The State Council and the People’s Government of Inner Mongolia Autonomous Region,the Office of Baotou People’s Government formulated and issued the Implementation Rules of Baotou City on Establishing and Improving the Mechanism of Mutual Support for Employees’ Basic Medical Insurance Outpatient Service on August 4,2022.On October 1,2022,Baotou began to implement the mutual assistance policy for the basic medical insurance outpatient service,which is of great significance for solving the problem of outpatient protection for the employees of Baotou medical insurance and reducing the medical burden.In this paper,the difficulties and countermeasures in the implementation of the mutual aid policy of employee medical insurance outpatient service in Baotou City are taken as the research object.Three research methods,including literature research,questionnaire survey and interview,are used to conduct in-depth analysis and research with the policy implementation theory,good governance theory and health equity theory.Analyze the problems and reasons existing in the implementation process of employee medical insurance outpatient mutual aid policy,and put forward the specific solution path.First of all,under the background of the people’s urgent desire for medical insurance reform and the national release of outpatient mutual assistance guarantee mechanism,this paper clarifies the research significance from the aspects of improving the medical security network,reducing the pressure of seeing a doctor and promoting social equity and justice.The research results of foreign medical security system research,domestic outpatient mutual aid necessity research,outpatient mutual aid operation problem research,outpatient mutual aid optimization path research were reviewed.The related concepts of employee medical insurance outpatient mutual aid were defined.Secondly,combined with the reality of Baotou City,according to the implementation of the outpatient mutual aid policy in Baotou City,Inner Mongolia,through sorting out the official data,questionnaire survey and interviews with the insured personnel,the existing difficult problems are carefully summarized and in-depth analysis.The problems are mainly as follows: first,the awareness of the policy is not enough;Second,low policy participation;Third,the existence of fund security risks;Fourth,the outpatient mutual aid guarantee is insufficient.The main reasons for these problems are that the policy interpretation and publicity is not in place,the policy content design is not perfect,the supervision system and mechanism is not sound,the overall treatment standard of outpatient is low.Finally,after a series of textual research and research,four suggestions are put forward: first,to strengthen the policy publicity and guidance,to ensure the smooth development of reform;The second is to improve the details of policy design and give full consideration to the needs of the insured;Third,we should simultaneously dredge and strengthen the supervision of medical insurance funds.Fourth,improve the overall treatment of outpatients.