Beijing Municipal People's Government issued a document!

On April 12, the Beijing Municipal People's Government issued the "Several Measures for Deepening the Reform of the Medical Security System", which mentioned that the reform of the centralized procurement system for medicines and medical consumables should be deepened
.
The centralized procurement of medicines and medical consumables was carried out smoothly
.
Promote the procurement of medicines and medical consumables in the Beijing-Tianjin-Hebei regional alliance, gradually form a cross-provincial regional procurement alliance, and explore the formation of a three-level procurement system of "national-regional alliance-province (city)"
.
Continue to expand the scope of centralized procurement of high-value medical consumables
.
Strengthen the construction of the city's centralized procurement platform for medicines and medical consumables, and optimize the functions of bidding, procurement, transaction and supervision on the existing platform
.
Improve the coding system for medicines and medical consumables, strengthen data connection, and realize the sharing of medical security data and business collaboration in this city
.
Implement the medical price and credit evaluation system for recruitment
.
The original text is as follows: Notice of the Beijing Municipal Committee of the Communist Party of China and the Beijing Municipal People's Government on Printing and Distributing Several Measures for Deepening the Reform of the Medical Security System Institutions of higher learning: The "Several Measures on Deepening the Reform of the Medical Security System" are hereby issued to you, please implement them according to the actual situation
.
On April 2, 2022, in order to implement the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System", the Beijing Municipal People's Government of the Beijing Municipal Committee of the Communist Party of Guarantee and improve people's livelihood at a higher level, accelerate the establishment of a more mature and stereotyped multi-level medical security system with the characteristics of the capital, and formulate the following measures in light of the city's actual conditions
.
1.
Improve the fair and appropriate treatment guarantee mechanism (1) Improve the basic medical insurance system
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Adhere to and improve the basic medical insurance system and policy system that covers the whole people and participates in accordance with the law, employees and urban and rural residents are guaranteed classified protection, benefits are linked to payment, and funds are separately established and accounted for separately
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Continue to strengthen and improve the basic medical insurance participation work, enhance the awareness of the whole people to participate in the insurance, and promote the full coverage of the insurance
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Adapt to the development of new business formats, and improve the way employees of new business formats participate in insurance and payment
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Steadily promote the reform of individual accounts of basic medical insurance for employees, standardize the scope of use of individual accounts, improve the accounting methods for individual accounts, realize the targeted use of individual accounts, and improve the efficiency of the use of funds in individual accounts
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(2) Strictly implement the medical security treatment list system
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Formulate and implement the implementation plan of the medical security treatment list system
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Strictly implement basic systems, basic policies, fund payment items and standards, and no policies beyond the scope of authorization of the list shall be issued without approval
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(3) Improve a unified and standardized medical assistance system
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Establish and improve the medical expense assistance mechanism for key aid recipients and a long-term mechanism for preventing and resolving poverty due to illness, improve the identification conditions for poverty relief due to illness, reasonably determine the proportion of out-of-pocket expenses within the policy scope of people in need, and enhance the accuracy and trustworthiness of medical assistance.
Bottom protection function
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Continue to implement the policy of fully subsidizing people in extreme poverty, family members with minimum living allowances, and members of low-income families to participate in the basic medical insurance policy for urban and rural residents
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Promote the "one-stop" settlement of basic medical insurance, critical illness insurance and medical assistance, and further reduce the burden of medical expenses for the poor
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Strengthen financial investment in medical aid, and broaden the financing channels for medical aid
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(4) Promote the development of a multi-level medical security system
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Strengthen the triple protection function of basic medical insurance, critical illness insurance and medical assistance, promote the complementary connection of various medical insurances, and improve the level of protection for major and serious diseases and diversified medical needs
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Improve and standardize resident critical illness insurance, employee critical illness medical insurance, civil servant medical subsidies and enterprise supplementary medical insurance
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Accelerate the development of commercial health insurance, enrich the supply of health insurance products, make full use of the personal income tax policy of commercial health insurance, support the development of inclusive commercial supplementary medical insurance and other products that meet the characteristics of the capital and are linked to basic medical insurance, so as to meet the needs of many people.
To meet the needs of different levels, build a multi-level medical security system in the capital
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Strengthen the supervision of market behavior, highlight the supervision of key links such as health insurance product design, sales, and compensation, and improve health security service capabilities
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On the premise of ensuring information security and protecting personal privacy, explore and establish a sharing mechanism for basic medical insurance and commercial health insurance information in accordance with laws and regulations
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Encourage social charitable donations, fully mobilize the enthusiasm of all parties, and coordinate the promotion of charitable medical assistance
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Promote the organic connection between trade union employees' medical mutual assistance and the basic medical insurance system, and support the orderly development of medical mutual assistance
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Explore the mechanism of drug protection for rare diseases
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(5) Steadily establish the city's long-term care insurance system
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Summarize and systematically evaluate the pilot work in Shijingshan District, and form a long-term care insurance system that can be replicated, promoted and sustainable
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Explore the establishment and improvement of a multi-channel financing mechanism for mutual assistance and shared responsibility, and a scientific and reasonable treatment payment policy
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Develop disability assessment criteria for long-term care insurance
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Standardize the supply of long-term care services, and support the integrated development of elderly care, nursing, rehabilitation, and medical-related industries
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Encourage social forces to participate in handling services
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Formulate the city's long-term care insurance pilot implementation plan and supporting policies, and roll it out across the city
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(6) Improve the guarantee mechanism for medical treatment expenses for major epidemics
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Improve the medical insurance payment policy for major epidemics.
In the event of an emergency such as a major epidemic, ensure that medical institutions provide treatment first and then charge, and medical insurance funds are prepaid and settled later
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Implement the exemption system for medical expenses for special groups and specific diseases, and exempt the medical insurance catalogue, payment limit, drug dosage and other restrictive clauses in a targeted manner, so as to alleviate the worries of the needy people seeking medical treatment
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Coordinate the use of medical security funds and public health service funds to achieve effective connection between public health services and medical services
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2.
Improve the stable and sustainable financing operation mechanism (7) Improve the financing sharing and adjustment mechanism
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Employers and individuals to participate in basic medical insurance jointly pay
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Non-employees participating in basic medical insurance are paid by individuals, and the government provides subsidies according to regulations.
The contributions are linked to the level of economic and social development and the per capita disposable income of residents
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According to the economic and social development of the capital and the individual affordability of enterprises, dynamically adjust the payment ratio of employees' basic medical insurance, and standardize the payment base policy
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Balance the responsibilities of individuals, employers, and the government for fundraising and payment, and continue to optimize the structure of individual payment and government subsidies
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(8) Strengthen fund budget management and risk early warning
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Resolutely keep the bottom line of no systemic risks, adhere to the principle of determining expenditures by revenue, balancing revenue and expenditure, and having a slight balance, and formulate revenue and expenditure budgets scientifically
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Strengthen budget execution supervision, fully implement budget performance management, strengthen medium and long-term actuarial and operational analysis, and improve operational risk assessment and early warning mechanisms to ensure a balance of revenue and expenditure
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3.
Establish an effective and efficient medical insurance payment mechanism (9) Improve the dynamic adjustment mechanism of the medical insurance catalogue
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Strictly implement the national medical insurance drug catalogue, clean up and standardize the non-national medical insurance drug catalogues in this city, and realize the unification of the medical insurance drug scope in this city and the national medical insurance drug scope
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Optimize and adjust the scope of payment for hospital preparations and Chinese herbal decoction pieces in this city, and formulate medical insurance drug management measures
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Adjust and optimize the catalog of diagnosis and treatment projects, standardize the scope of payment for medical service facilities, support the innovation and development of medical technology, and include innovative medical technologies and devices that meet the regulations into the scope of medical insurance payment
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(10) Optimizing and improving the management of medical insurance agreements
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Improve the management of basic medical insurance agreements, simplify the application conditions for designated medical institutions, optimize the evaluation process and negotiation mechanism, and provide the masses with more appropriate medical and pharmaceutical services
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Adapt to the needs of the masses for medical treatment, support the standardized development of new service models such as "Internet + medical care", and include qualified Internet hospitals and other medical institutions into agreement management
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Innovate the comprehensive performance evaluation mechanism for designated medical institutions, highlight the evaluation and evaluation of behavioral norms, service quality and cost control, and associate the evaluation results with budget management, audit inspection, designated agreement management, etc.
, to achieve dynamic management of designated medical institutions
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(11) Continue to deepen the reform of medical insurance payment methods
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Under the total budget, we will continue to improve the multi-modal medical insurance payment method that coexists in multiple ways such as group payment and fixed payment according to disease diagnosis
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Improve the hospital's negotiation and coordination mechanism, scientifically formulate a total budget, and link it with the quality of medical services, the implementation of agreements, and the efficiency of medical insurance expenses, so as to improve the quality and efficiency of total management
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Promote the payment of hospitalization by groups related to disease diagnosis, cooperate with the formulation of national technical standards for payment by groups related to disease diagnosis and the implementation in this city, expand the scope of disease implementation to all disease groups, and establish and improve it to control costs and standardize A payment management system based on disease diagnosis-related groups with the core of diagnosis and treatment and improving the enthusiasm of medical staff
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Accelerate the exploration of per capita payment for chronic diseases in outpatient clinics, study and explore the implementation of total payment for close medical complexes, strengthen supervision and assessment, retain surpluses, and reasonably share overspending, and guide the rational allocation of medical resources and patients to seek medical treatment in an orderly manner
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4.
Improve a strict and powerful fund supervision mechanism (12) Reform and improve the medical insurance fund supervision system
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Implement the relevant policies of this Municipality to promote the reform of the medical insurance fund supervision system, and comprehensively improve the medical insurance governance capacity
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Further rationalize the supervisory responsibilities of cities and districts, implement supervisory responsibilities, and establish and improve the fund supervision system
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Strengthen the construction of the internal control mechanism of medical security public service institutions, and implement the responsibility for agreement management, cost monitoring, and auditing
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Improve the social supervisor mechanism for medical insurance fund supervision, and make good use of social forces to supervise
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Strengthen the construction of medical insurance fund supervision capacity, and promote the professionalization, standardization and standardization of medical insurance supervision and law enforcement agencies
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(13) Improve innovation fund supervision methods
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Adhere to the "double random, one open" supervision mechanism, establish and improve the inspection system that combines daily inspections, special inspections, unannounced inspections, cross inspections, key inspections, and expert reviews
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Actively adopt emerging technologies such as big data and blockchain, continuously improve the intelligent monitoring function of medical insurance, dynamically optimize and adjust monitoring indicators, realize the tracking and linkage of abnormal data, and promote fund supervision from manual drawing and review to all-round, whole-process, and all-link intelligent monitoring transform
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Establish an information reporting system for designated medical institutions, and disclose information such as medical expenses and fee structures to the public in accordance with laws and regulations
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Strictly implement and continuously improve the reward system for reporting violations of laws and regulations in medical security, smooth the channels for complaints and reports, and encourage the masses and all parties in the society to actively participate in supervision
.
(14) Pursuing responsibility for fraudulent insurance fraud according to law
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Formulate and improve the relevant laws and regulations for the supervision of medical insurance funds, and standardize the supervision authority, procedures, and punishment standards
.
Establish a system for the management of medical insurance credit records, credit evaluation and points for designated medical institutions and insured persons, and strengthen incentives for keeping promises and punishments for dishonesty
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Strengthen the joint law enforcement of inter-departmental cooperation and coordinated supervision, comprehensively use agreements, administrative, judicial and other means to seriously investigate the responsibility of fraudulent insurance units and individuals, investigate criminal responsibility for suspected crimes according to law, and resolutely crack down on fraudulent insurance fraud and harm to insurance participation public rights behavior
.
V.
Promote the supply-side reform of medical services and the coordinated development of Beijing-Tianjin-Hebei medical insurance (15) Deepen the reform of the centralized procurement system for drugs and medical consumables
.
The centralized procurement of medicines and medical consumables was carried out smoothly
.
Promote the procurement of medicines and medical consumables in the Beijing-Tianjin-Hebei regional alliance, gradually form a cross-provincial regional procurement alliance, and explore the formation of a three-level procurement system of "national-regional alliance-province (city)"
.
Continue to expand the scope of centralized procurement of high-value medical consumables
.
Strengthen the construction of the city's centralized procurement platform for medicines and medical consumables, and optimize the existing platform's bidding, procurement, transaction, and supervision functions
.
Improve the coding system for medicines and medical consumables, strengthen data connection, and realize the sharing of medical security data and business collaboration in this city
.
Implement the medical price and credit evaluation system for recruitment
.
(16) Improve the pricing mechanism for medical services
.
In accordance with the idea of ​​"doing a good job in total control, strengthening regulation, clarifying adjustment rules, and focusing on balance and connection", scientifically balance the three parties of medical institutions, medical insurance departments, and patients, do a good job in standardizing the adjustment of medical service price items, continuously improve the adjustment rules, and promote Establish a standardized and normalized dynamic adjustment mechanism for medical service prices, and continue to optimize the structure of medical service prices
.
(17) Enhancing the accessibility of medical services
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Improve the modern medical service system with cooperation and division of labor for general and specialized medical services
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Strengthen the training and use of general practitioners, and strengthen general medical services at the grassroots level
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Make up for the shortage of medical services such as nursing, pediatrics, geriatrics, and psychiatry
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Strengthen the assessment of regional medical service capabilities, rationally plan the distribution of various medical resources, promote the sharing and utilization of resources, and accelerate the development of social medical services
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Improve the allocation and management of medical equipment in regional public hospitals, guide reasonable allocation, and strictly control excessive allocation
.
Promote the consistency evaluation of the quality and efficacy of generic drugs, support the research and development and use of high-quality generic drugs, and promote the substitution of generic drugs by improving the medical insurance payment standard and the drug bidding and procurement mechanism
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Improve the monitoring, early warning and graded response system for drug shortages
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(18) Promote the improvement of medical service capabilities
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Standardize the diagnosis and treatment behavior of medical institutions and medical staff, strengthen prescription review and comment, establish a publicity and interview system for irrational drug use, and promote rational drug use
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Strengthen the internal professional and refined management of medical institutions, classify and improve a scientific and reasonable assessment and evaluation system, and link the assessment results with the payment of medical insurance funds
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Reform the current accounting methods for departments and individuals, improve the personnel compensation system that is compatible with incentives, flexible and efficient, and in line with the characteristics of the medical industry, and improve the performance appraisal and distribution system to fully reflect the differences between different positions and the value of medical personnel’s technical labor services.

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(19) Deepen the coordinated development of Beijing-Tianjin-Hebei medical insurance
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We will thoroughly implement the Beijing-Tianjin-Hebei coordinated development strategy, continue to do a good job in the transfer and continuation of the medical insurance relationship between the Beijing-Tianjin-Hebei three regions, and safeguard the rights and interests of insured persons
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Continue to promote the direct settlement of medical expenses in three places across provinces to improve the convenience of medical treatment in different places
.
Strengthen supervision and mutual assistance and coordination, actively carry out cross-regional fee assistance investigations, cross-regional fraud and insurance fraud investigations, etc.
, to ensure the safety of medical insurance funds
.
Fully support the construction of the Xiongan New Area, the basic medical insurance relationship of the migrant workers in the two places can be transferred according to the regulations, and the payment period is mutually recognized according to the regulations
.
6.
Optimizing public services and handling management (20) Optimizing public services for medical security
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Optimize the list of medical security government services in the city, and realize the unification with the national medical security government service list
.
Explore the "one-stop" application for the payment of maternity allowances and the reimbursement of maternity medical expenses to facilitate the settlement of medical treatment for the masses
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Promote the handling of convenience for the people, focus on reducing materials, pressing time limits, implementing "informed commitments", and promoting "online" and "handheld" medical security government services throughout the process
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Continue to promote the smooth operation of direct settlement of inter-provincial and non-local medical treatment expenses, accelerate the direct settlement of inter-provincial and inter-provincial medical outpatient expenses, and continuously improve the convenience of cross-provincial and inter-provincial medical treatment settlement for insured persons
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(21) Build smart medical insurance with a high starting point and high standards
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According to unified standards, establish a unified, efficient, compatible, convenient and safe integrated medical security information system in the city, and realize interconnection and data sharing with the national medical security information platform
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Promote the integration and sharing of information such as electronic medical records, medical images, and inspections, and further improve the convenience of people seeking medical treatment between different medical institutions
.
Standardize data management and application permissions, and protect the basic information and data security of insured personnel in accordance with the law
.
(22) Strengthen the capacity building of medical insurance service management
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Explore the collection and payment of medical insurance funds, filing for medical treatment in other places and other businesses to sink to the grassroots level, and achieve full coverage of cities, districts, streets (townships), and communities (village)
.
Strengthen the construction of supervision and law enforcement teams and handling service teams, and improve the level of standardization, specialization and precision
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Strengthen the allocation of medical security public management service capabilities, and establish an incentive and restraint mechanism linked to management service performance
.
The government arranges the budget reasonably to ensure the normal operation of public service institutions for medical security
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(23) Continue to promote innovation in medical insurance governance
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Promote the corporate governance of medical security agencies, actively introduce social forces to participate in agency services, standardize and strengthen cooperation with commercial insurance agencies and social organizations, and improve incentive and restraint mechanisms
.
Explore the establishment of a cross-regional medical insurance management collaboration mechanism to achieve full-process, seamless public services and fund supervision
.
Give full play to the role of high-end think tanks and other professional institutions in decision support and technical support
.
7.
Effectively strengthen organizational security (24) Strengthen the leadership of the party
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Party committees and governments at all levels should take the reform of the medical security system as an important task, implement the Party's leadership in the entire process of medical security reform and development, and regularly study and solve major problems in medical security reform
.
Strictly follow the unified deployment, improve the working mechanism, consolidate work responsibilities, incorporate the implementation of the reform of the medical security system into the key task of ensuring and improving people's livelihood, and ensure that the reform goals are achieved as scheduled
.
(25) Promote legal protection
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Implement the requirements for the construction of a government governed by the rule of law, accelerate the legislative work in key areas of medical security, standardize administrative law enforcement, and further enhance the ability to make decisions, manage and act in accordance with the law
.
Research and formulate plans for law popularization in the field of medical security, strengthen publicity and education on law popularization, and guide the whole society to enhance the awareness of the rule of law in medical insurance
.
(26) Strengthen coordination and cooperation
.
Establish a departmental coordination mechanism to strengthen the coordination and comprehensive support between medical insurance, medical care, and pharmaceutical systems and policies
.
The Municipal Medical Insurance Bureau is responsible for coordinating and promoting the reform of the medical security system, and working with relevant departments to study and solve major cross-departmental, cross-regional, and cross-industry issues in the reform of the medical security system
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On important reform matters, opinions should be widely listened to, and risk assessment should be done in advance
.
In case of major situations, timely request and report to the Municipal Party Committee and Municipal Government to ensure the orderly progress of various reform tasks
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(27) Create a good atmosphere
.
All regions and departments should take the initiative to interpret medical security policies and publicize services, respond to social concerns in a timely manner, reasonably guide social expectations, fully mobilize the enthusiasm and initiative of all parties to support and cooperate with the reform and development of medical security, and build social consensus
.