Core Points - The recent notification from the New Xiang City Medical Insurance Bureau suspends outpatient comprehensive services for urban and rural residents at tertiary medical institutions, meaning non-employment insured individuals can only use personal accounts for reimbursement at large hospitals [1][4] - This policy aligns with a national trend to promote hierarchical medical care and control medical insurance fund expenditures, as seen in various provinces like Hainan and Jiangxi [2][3] Summary by Sections Policy Changes - The New Xiang City policy is part of a broader initiative to enhance the efficiency of medical insurance fund usage and ensure fund security, particularly in light of declining fund balances [3][4] - The policy does not eliminate all reimbursement for outpatient services but specifically targets the outpatient comprehensive reimbursement at tertiary hospitals, preserving it for primary and secondary healthcare institutions [4] National Trends - The move to limit outpatient services at tertiary hospitals is becoming a nationwide trend, with various provinces implementing similar measures to promote hierarchical diagnosis and treatment [2][3] - The national medical insurance system has previously implemented several beneficial measures due to a surplus in funds, but recent data indicates a decline in fund balances, prompting a tightening of policies [3] Impact on Healthcare System - The policy aims to encourage insured individuals to seek initial treatment at primary healthcare facilities, thereby reducing overcrowding at large hospitals [5][6] - The push for hierarchical medical care has been ongoing since the 2009 healthcare reform, with various guidelines emphasizing the need for a tiered healthcare system [6][8] Challenges and Considerations - Despite the push for primary care, many patients still prefer tertiary hospitals due to a lack of trust in primary care providers, highlighting the need for improvements in primary healthcare services [8][9] - The implementation of this policy raises questions about balancing access to care for patients with legitimate needs for tertiary services while discouraging unnecessary visits [9][10]