How to establish a medical insurance fund loan

The problem of “difficult to see a doctor and expensive to see a doctor” has always been a prominent problem. Although the government's investment in medical insurance funds is gradually increasing, the high medical expenses for major diseases, and the urgent need for these costs have not been solved. So how to establish a personal medical insurance fund loan?

In recent years, the government's financial investment increased and the medical insurance funds continue to increase to solve some of the medical expenses, but the social medical care fund's protection for participating medical insurance personnel is "guarantee and not package", hospitalization expenses The proportion and amount of out-of-pocket medical care are still relatively high, especially for high medical expenses for major diseases, which are urgently needed to be solved by consumer loans.

However, the social reality is that on the one hand, the demand for personal medical funds is strong, and social medical insurance cannot fully meet the needs of residents' medical funds; on the other hand, personal medical consumption loans are difficult to provide, and personal medical funds cannot be provided. In the face of this situation, the author through research, looking for new ways to promote financial security, in order to effectively reduce the pressure on residents to pay for medical expenses, and effectively alleviate "difficult to see a doctor, expensive to see a doctor."

The necessity of starting a personal medical loan with the nature of social public services

The most direct manifestation of "difficult to see a doctor and expensive to see a doctor" is that the absolute expenditure of the residents is higher, from the "outpatient special disease policy" of the Social Insurance Administration. See, the self-pay for the patient is the sum of the “payment threshold (ie threshold fee)” and the personal burden portion of the medical insurance payment and the cost of the self-funded medicine and medical project. According to a survey data from Northeast China in 2011, the proportion of hospitalization expenses for medical insurance is about 52%, and the proportion of self-sufficiency is about 48%. If drugs and services other than medical insurance are used, the proportion of individuals will be higher. The author actually visited six patients with special diseases, the self-contained proportion is about 50%, such as patient A, suffering from myocardial infarction, coronary artery bypass surgery, a total of 35,620 medical expenses, unified fund payment 20713, self-negative ratio of 58.15%. In addition to medical insurance reimbursement, a large part of the expenses need to be borne by the patients themselves. The patients use the savings to save, and other parts can only be solved by private lending.

For a family, medical loans are a way to urgently solve medical expenses in the current consumption of residents, and also an important supplement to medical insurance, which can greatly reduce the burden on families and society. Many commercial banks have tried to develop “medical loans”, but they have not been able to promote this business. Therefore, the development of medical loans is a social system project. It is not the issue of financial products launched by a financial institution. It requires multi-sectoral attention and cooperation to establish and improve. According to the above situation, a “personal medical insurance fund loan” should be established by relying on the existing medical security system to explore a new way of financial services.

Feasibility analysis of personal medical insurance fund loan source

City Basic medical insurance fund. With the continuous improvement of the medical security system, the coverage of the medical security system has increased, and the medical insurance fund has also increased. At the end of 2010, the number of people participating in the city's basic medical insurance was 432.63 million, an increase of 31.16 million over the end of the previous year. Among them, the number of people participating in urban basic medical insurance was 237.35 million, and the number of people participating in basic medical insurance for urban residents was 19.528 million. At the end of the year, the number of workers participating in medical insurance was 45.83 million, an increase of 2.49 million from the end of the previous year. In 2010, the city's basic medical insurance fund totaled 430.9 billion yuan and expenditure was 353.8 billion yuan, up 17.3% and 26.5% respectively over the previous year. At the end of the year, the basic medical care fund had a total balance of 331.3 billion yuan (including a total of 30.6 billion yuan in the basic medical insurance fund of urban residents), and the personal account accumulated 173.4 billion. It is beneficial to preserve and increase the value of the city's basic medical insurance fund by setting a certain percentage of the fund within a certain limit to be included in the personal medical insurance fund loan source.

Personal medical insurance fund loan interest. The city's basic medical insurance fund balance increased, and the fund was used rationally to establish a personal medical insurance fund for loans, which provided loans to individuals who were short of funds at the time of medical treatment, and the loan interest was used to supplement the personal medical insurance fund.

Personal medical insurance fund loan risk protection compensation. It can be shared by the central, government, and other levels of finance, and through the financial allocation to form a personal medical insurance fund loan risk protection compensation, used to make up for the deficiencies and risks of the individual medical insurance loan fund.

City Basic pension insurance fund balance. According to the statistical bulletin on the development of human resources and social security in 2010, the total urban pension insurance fund for the whole year of 2010 was 1.342 billion, an increase of 16.8% over the previous year; the total expenditure of the fund for the year was 105.55 billion, an increase of 18.7% over the previous year. At the end of the year, the basic endowment insurance fund accumulated a total of 1,536.5 billion. At present, the balance of the social insurance fund is limited to the two types of investment: the purchase of national debt and the deposit into the bank account. The pension fund is deposited into the demand deposits of various commercial banks, and the interest rate is calculated based on the three-month fixed deposit rate. The deposit interest rate is lower than the inflation rate, and the pension insurance fund is facing the hidden risk of depreciation. The fund is drawn as a source of funds for the “Personal Medical Insurance Fund Loan”, which is beneficial to the smooth development of the “Personal Medical Insurance Fund Loan”. Conducive to the preservation and appreciation of social pension funds.

Financing with policy banks. When the personal medical insurance fund loan fund is temporarily insufficient, it can be injected into the personal medical loan insurance fund through the quasi-national credit resource financing of the policy bank to maintain the normal operation of the fund loan.

Personal medical insurance fund loan operationSystem Design

Design Principles - The basic principle of issuing "Personal Medical Insurance Fund Loan" must be based on social mutual aid, focus on major illnesses, and the principle of safe deposit of funds, and participate in social medical insurance with full civil behavior. The ability of individuals to issue major illness medical loans. Personal medical insurance fund loans use “channel integration”—the integration of medical insurance and financial services and the “integration of models”—the integration of public management and business services. It is proposed to set up a leading group composed of the government, the bank, the financial department, the social security department, the health department, etc., and set up a special management agency to guarantee the operation of the personal medical insurance fund loan, and be responsible for formulating policies and measures for personal medical insurance fund loans. Coordinate the settlement of problems in the loan.

Anyone who has a normal social insurance coverage and has full civil capacity can apply for a loan for the person (or immediate family member) when paying for hospitalization. The loan method is to apply for loan credit line in various ways such as joint guarantee, guarantee, mortgage, pledge, etc., and the joint-guarantee and guarantor are jointly and severally liable. The loan amount directly enters the personal medical account and is earmarked for special purposes. The loan is only applicable to the hospitalization expenses and is used to solve the problem of insufficient funds when seeking medical treatment for major diseases. The loan is for a different period of time, up to a maximum of five years, and the interest rate does not exceed the housing provident fund loan interest rate.

Loan process - First, loan application. The borrower first applies for the loan credit line. When the funds are used, the actual loan issuance date. The overdraft amount is the actual loan amount. The second is the pre-lending investigation. The investigation, evaluation of the authenticity, legality, completeness, feasibility, and the conduct, reputation, repayment ability, guarantee, and mortgage of the borrower's documents and materials. The third is the determination of the loan amount. The social insurance fund loan management institution determines the credit line of credit according to the applicant's personal illness, credit status, repayment ability and guarantee. The fourth is the issuance of loans. When the loan applicant needs to pay medical expenses for the hospitalization of a major illness in the person or immediate family member, the actual overdraft payment within the loan credit line is the amount of the hospitalization fee. Loan interest is determined based on the loan term and the corresponding interest rate at the time of loan application. The fifth is loan repayment. Loan funds can be repaid in the future after the medical insurance personal account deposit fund deduction, personal counter deposit, and medical reimbursement amount are directly transferred to the loan account. When the borrower applies for the credit line, he chooses to repay it in one lump sum, repay it in installments, or partially repay it in a lump sum, and repay the other instalments. After the loan, the borrower can apply for the loan term, the installment repayment amount, and the change of the repayment method.

Risk control: First, establish various ways of mortgage guarantee. The borrower may use a loan of several people in the form of a joint guarantee or other person's guarantee when applying for a loan. In addition, it may also use real estate such as real estate and depository, forestry and other movable property, and mortgage and pledge to ensure the security of the loan. Second, the loan information enters the bank credit information system. It records the borrower's handling of loans, guarantees for loans to others, etc., forms a customer's credit report, and promptly intercepts refinancing of bad customers. The third is to determine the loan credit limit. According to the personal credit status, illness, repayment ability, guarantee, and mortgage situation of the loan applicant, the loan amount is determined, and the loan cap is put on the line. Fourth, when the loan funds are used, they will directly enter the designated account of the hospital, and the funds will be earmarked. Loan funds are not transferred by individuals, preventing loan fraud and eliminating the occurrence of misappropriation or misappropriation of loan funds. The fifth is to bundle with the salary card and make a direct transfer deduction to repay the loan. The loan applicant and the guarantor may agree to use the loan applicant or the guarantor's salary card to transfer the deduction within a certain period of time according to the specific circumstances, or deduct the full amount within a certain period of time or deduct a certain amount to guarantee the loan repayment. . The sixth is to establish financial risk compensation. Through the financial allocation to establish a personal medical insurance fund loan risk reserve (risk compensation), it can be shared by the central government, and other levels of finance, the loan risk reserve ratio is not less than 10% of the total loan balance, when the loan is lost Make a compensation. The seventh is to establish a risk control system. Set up a special agency management to develop a non-performing loan control line. When the loan line is overtaken by the police line, the loan will be settled and the payment will continue after the settlement is resumed.