When we talk about the health insurance payment system, we often mention the terms "pooled payment" and "individual account payment". Both are important components of the health insurance system, but there are distinct differences between them. In this article, we'll break down the differences between these two payment methods.
1. Conceptual differences.
Co-ordinated payment: refers to the medical insurance co-ordination ** to pay the medical expenses of the insured. Pooling** is formed by the insurance premiums paid jointly by all insured persons, and is used to pay the medical expenses of the insured persons in a mutual aid manner.
Personal account payment: refers to the use of funds in the personal account of the insured person to pay for medical expenses. The funds in the personal account are mainly used for the medical insurance premiums paid by the individual, as well as possible interest income.
Second, the difference in funds.
The overall fund is mainly paid by all insured persons, so it embodies a spirit of "mutual aid", that is, everyone works together to prepare for the possible risk of medical expenses.
The funds in the personal account are mainly used for personal contributions and possible interest income, which more reflects the individual's reserve and protection for his future medical expenses.
Third, the scope of use is different.
Co-ordination**It is mainly used to pay for large medical expenses such as inpatient medical expenses and outpatient medical expenses for special diseases of insured persons. This is because these costs are often high, too much for individuals to bear, and require mutual support.
The personal account is mainly used to pay for small medical expenses such as outpatient medical expenses and drug purchase expenses of designated retail pharmacies. These costs are relatively low and can usually be afforded by individuals.
Fourth, the difference in management methods.
Co-ordination ** by the medical insurance agency unified management, in accordance with the provisions of the payment standards and payment methods for payment. When co-ordinating** payments, there are usually certain conditions and procedures that need to be met.
The personal account is managed by the insured person and can be used to pay for eligible medical expenses. The use of personal accounts is relatively flexible, but there are also rules and restrictions that need to be followed.
5. Differences in risk-taking.
Since the pooling** is paid jointly by all insured persons, it embodies a risk-sharing mechanism. When an insured person incurs a large amount of medical expenses, the co-ordinator** can provide mutual aid support for him/her.
The personal account is more reflective of the individual's reserve and protection for his future medical expenses. When the funds in the personal account are insufficient, the insured person needs to bear the remaining medical expenses by himself.
To sum up, there are obvious differences between overall payment and personal account payment in terms of concept, funds, scope of use, management methods and risk taking. Understanding these differences can help us better understand how the health insurance system works and choose the right health insurance product for yourself and your family.