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Better ensure the people's basic medical protection rights and interests.
Keeping close to the basic national conditions, we will do our best and do what we can to improve people's livelihood, promote common prosperity, and prevent welfarism in development.
Establish a medical security benefit list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations.
Improve the basic medical insurance financing and benefit adjustment mechanism, and gradually include outpatient medical expenses into the payment scope of the basic medical insurance overall planning fund.
Realize the effective connection with the rural revitalization strategy, and consolidate and expand the effectiveness of medical insurance to fight poverty.
Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic uniformity of the national medical insurance drug coverage.
Establish a national medical insurance consumables access catalog system.
Keeping close to the basic national conditions, we will do our best and do what we can to improve people's livelihood, promote common prosperity, and prevent welfarism in development.
Establish a medical security benefit list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations.
Improve the basic medical insurance financing and benefit adjustment mechanism, and gradually include outpatient medical expenses into the payment scope of the basic medical insurance overall planning fund.
Realize the effective connection with the rural revitalization strategy, and consolidate and expand the effectiveness of medical insurance to fight poverty.
Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic uniformity of the national medical insurance drug coverage.
Establish a national medical insurance consumables access catalog system.
To better meet the diverse security needs of the people.
Improve the critical illness medical insurance and assistance system, optimize the basic medical insurance, critical illness insurance and medical assistance triple security system, unify and standardize the medical assistance system, promote the complementary connection of various medical insurance systems, and establish a sound long-term mechanism for preventing and resolving poverty and returning to poverty due to illness.
Coordinate and mobilize the assistance of charity medical assistance, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to guarantees.
Improve the critical illness medical insurance and assistance system, optimize the basic medical insurance, critical illness insurance and medical assistance triple security system, unify and standardize the medical assistance system, promote the complementary connection of various medical insurance systems, and establish a sound long-term mechanism for preventing and resolving poverty and returning to poverty due to illness.
Coordinate and mobilize the assistance of charity medical assistance, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to guarantees.
Better protect the people's "life-saving money".
Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraudulent insurance with a zero tolerance attitude.
Strengthen the medium and long-term actuarial calculation of the fund, and improve the operation risk assessment and early warning mechanism.
Strengthen fund budget management and risk early warning, and fully implement budget performance management.
We will implement the overall planning of basic medical insurance at the municipal and prefecture level, promote the overall planning at the provincial level, and promote the integration of basic medical insurance and medical assistance at the overall level.
Require benefits from management, strengthen refined management, and steadily improve the level of medical insurance governance.
Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraudulent insurance with a zero tolerance attitude.
Strengthen the medium and long-term actuarial calculation of the fund, and improve the operation risk assessment and early warning mechanism.
Strengthen fund budget management and risk early warning, and fully implement budget performance management.
We will implement the overall planning of basic medical insurance at the municipal and prefecture level, promote the overall planning at the provincial level, and promote the integration of basic medical insurance and medical assistance at the overall level.
Require benefits from management, strengthen refined management, and steadily improve the level of medical insurance governance.
Better guarantee the people's access to high-quality and affordable medical services.
Insist on system integration and give full play to the basic role of medical insurance in the reform of "three-medicine linkage".
Promote the institutionalization and normalization of centralized drug purchases, and in-depth exploration of the reform of the centralized procurement system for high-value medical consumables.
Improve the incentive mechanism and promote the implementation of policies for centralized procurement of medicines and medical consumables by medical institutions.
Standardize the transaction rules of the provincial-level pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system.
Continue to promote the reform of payment methods, implement a diversified compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical consortia.
Innovate agreement management, establish and improve the negotiation and negotiation mechanism between handling agencies and designated institutions, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management coordination mechanisms.
Improve the price formation mechanism of medical services, establish a scientific pricing and dynamic adjustment mechanism, and continue to optimize the price structure of medical services.
Insist on system integration and give full play to the basic role of medical insurance in the reform of "three-medicine linkage".
Promote the institutionalization and normalization of centralized drug purchases, and in-depth exploration of the reform of the centralized procurement system for high-value medical consumables.
Improve the incentive mechanism and promote the implementation of policies for centralized procurement of medicines and medical consumables by medical institutions.
Standardize the transaction rules of the provincial-level pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system.
Continue to promote the reform of payment methods, implement a diversified compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical consortia.
Innovate agreement management, establish and improve the negotiation and negotiation mechanism between handling agencies and designated institutions, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management coordination mechanisms.
Improve the price formation mechanism of medical services, establish a scientific pricing and dynamic adjustment mechanism, and continue to optimize the price structure of medical services.
Better provide the people with convenient and efficient medical insurance public services.
Strengthen the construction of handling capacity and vigorously promote the sinking of services.
Improve the insurance services that adapt to the new business model and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance is fully covered.
Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places.
Continue to promote the construction of systematic business style, strictly implement the list of handling government services, fully implement the "good and bad review" system, and strive to achieve "immediate, online, nearby, and one-off" service items.
Speed up the construction of a unified national medical insurance information system, and promote the standardization and informatization of medical insurance.
Adhere to the parallel of traditional service and intelligent service innovation, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels.
Improve the level of legalization of medical insurance, and implement the concepts and methods of the rule of law in all aspects of medical insurance management.
Strengthen the construction of handling capacity and vigorously promote the sinking of services.
Improve the insurance services that adapt to the new business model and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance is fully covered.
Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places.
Continue to promote the construction of systematic business style, strictly implement the list of handling government services, fully implement the "good and bad review" system, and strive to achieve "immediate, online, nearby, and one-off" service items.
Speed up the construction of a unified national medical insurance information system, and promote the standardization and informatization of medical insurance.
Adhere to the parallel of traditional service and intelligent service innovation, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels.
Improve the level of legalization of medical insurance, and implement the concepts and methods of the rule of law in all aspects of medical insurance management.
Medical Network News, March 12, medical insurance is related to the vital interests of the people.
On March 9th, China Government Network published the article "Promoting the High-quality Development of Medical Security" published by Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Medical Security Administration on the "Learning Times".
The article proposes that during the "14th Five-Year Plan" period, medical security work should adapt to the requirements of entering a new stage of development, implementing new development concepts, and building a new development pattern, centering on people's health, and achieving high-quality development.
The following key points are worth paying attention to:
On March 9th, China Government Network published the article "Promoting the High-quality Development of Medical Security" published by Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Medical Security Administration on the "Learning Times".
The article proposes that during the "14th Five-Year Plan" period, medical security work should adapt to the requirements of entering a new stage of development, implementing new development concepts, and building a new development pattern, centering on people's health, and achieving high-quality development.
The following key points are worth paying attention to:
"Thirteenth Five-Year Plan" Achievements:
In the past three years, 433 new drugs have been included , and eligible "Internet +" medical services have been included in medical insurance
At present, the world’s largest basic medical insurance network has been established, with basic medical insurance covering more than 1.
36 billion people, with an insured rate stabilizing above 95%, and the poor population’s enrolling rate above 99.
9%.
The reimbursement rates for hospitalization expenses of employee medical insurance and resident medical insurance policies reached about 80% and 70%, respectively.
The actual reimbursement rate for hospitalization and outpatient chronic diseases of the poor population stabilized at 80% after being guaranteed by the triple system of basic medical insurance, critical illness insurance, and medical assistance.
about.
36 billion people, with an insured rate stabilizing above 95%, and the poor population’s enrolling rate above 99.
9%.
The reimbursement rates for hospitalization expenses of employee medical insurance and resident medical insurance policies reached about 80% and 70%, respectively.
The actual reimbursement rate for hospitalization and outpatient chronic diseases of the poor population stabilized at 80% after being guaranteed by the triple system of basic medical insurance, critical illness insurance, and medical assistance.
about.
Make up for shortcomings, eliminate blind spots, and establish and improve a medical security system with Chinese characteristics.
To strengthen the top-level design, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", drawing a blueprint for the reform of medical insurance in the next 5 to 10 years.
At present, a unified basic medical insurance and critical illness insurance system for urban and rural residents has been established.
Comprehensively promote the combined implementation of maternity insurance and basic medical insurance for employees.
A multi-level medical security system with basic medical insurance as the main body, medical assistance as the foundation, and other security measures are gradually being formed.
The comprehensive protection of the triple system of basic medical insurance, critical illness insurance, and medical assistance has played an important role in satisfying the basic medical insurance of the people.
To strengthen the top-level design, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", drawing a blueprint for the reform of medical insurance in the next 5 to 10 years.
At present, a unified basic medical insurance and critical illness insurance system for urban and rural residents has been established.
Comprehensively promote the combined implementation of maternity insurance and basic medical insurance for employees.
A multi-level medical security system with basic medical insurance as the main body, medical assistance as the foundation, and other security measures are gradually being formed.
The comprehensive protection of the triple system of basic medical insurance, critical illness insurance, and medical assistance has played an important role in satisfying the basic medical insurance of the people.
Relieve pain points, remove blockage points, and effectively improve the people's sense of access to, happiness, and security.
The first is to initially establish a dynamic adjustment mechanism for the drug catalog, include more new and good drugs, significantly improve the drug security capabilities for cancer, chronic diseases, and pediatric diseases, and implement innovative negotiation access, and the average price of 233 negotiated drugs has dropped by more than 50%.
, Many "noble drugs" offer "civilian prices.
" The 114 medicines negotiated in 2018 and 2019 alone will reduce the patient's burden by 72.
19 billion yuan from January to November 2020.
In the past three years, a total of 433 new drugs have been included, and there are 2,800 drugs in the catalog, which basically meets the needs of clinical medication.
The second is to effectively improve the quality of guarantees.
Improved outpatient protection policies and measures, and established and improved the outpatient medication protection mechanism for hypertension and diabetes in urban and rural residents.
More than 72 million patients with "two diseases" have benefited, and the cumulative burden has been reduced by 25 billion yuan.
To adapt to changes in medical service models, include eligible "Internet +" medical services into the scope of medical insurance payment, and vigorously support the development of "Internet +" medical services.
The third is to strengthen public services for medical insurance.
Standardize the handling of service behaviors, make it convenient for the masses to seek medical treatment in different places, improve the accessibility of high-quality medical services, support the free flow of labor, and basically solve the problem of "advance" and reimbursement for hospitalization of patients in different places across provinces, benefiting 7.
25 million hospitalizations; steadily The pilot program for direct settlement of outpatient expenses across provinces has been promoted, benefiting 3.
02 million people in total outpatient visits.
The fourth is to consolidate the foundation of medical insurance management, continuously improve the level of informatization, standardization, refinement, and rule of law, and continuously improve the standardization, convenience, and ageing of medical insurance management services, and establish the main body of the national medical insurance information platform.
All provinces have opened the medical insurance code activation service , The total number of users exceeds 450 million.
The first is to initially establish a dynamic adjustment mechanism for the drug catalog, include more new and good drugs, significantly improve the drug security capabilities for cancer, chronic diseases, and pediatric diseases, and implement innovative negotiation access, and the average price of 233 negotiated drugs has dropped by more than 50%.
, Many "noble drugs" offer "civilian prices.
" The 114 medicines negotiated in 2018 and 2019 alone will reduce the patient's burden by 72.
19 billion yuan from January to November 2020.
In the past three years, a total of 433 new drugs have been included, and there are 2,800 drugs in the catalog, which basically meets the needs of clinical medication.
The second is to effectively improve the quality of guarantees.
Improved outpatient protection policies and measures, and established and improved the outpatient medication protection mechanism for hypertension and diabetes in urban and rural residents.
More than 72 million patients with "two diseases" have benefited, and the cumulative burden has been reduced by 25 billion yuan.
To adapt to changes in medical service models, include eligible "Internet +" medical services into the scope of medical insurance payment, and vigorously support the development of "Internet +" medical services.
The third is to strengthen public services for medical insurance.
Standardize the handling of service behaviors, make it convenient for the masses to seek medical treatment in different places, improve the accessibility of high-quality medical services, support the free flow of labor, and basically solve the problem of "advance" and reimbursement for hospitalization of patients in different places across provinces, benefiting 7.
25 million hospitalizations; steadily The pilot program for direct settlement of outpatient expenses across provinces has been promoted, benefiting 3.
02 million people in total outpatient visits.
The fourth is to consolidate the foundation of medical insurance management, continuously improve the level of informatization, standardization, refinement, and rule of law, and continuously improve the standardization, convenience, and ageing of medical insurance management services, and establish the main body of the national medical insurance information platform.
All provinces have opened the medical insurance code activation service , The total number of users exceeds 450 million.
Break through the difficulties, find the fulcrum, and lead the medical reform to deepen with the "small incision and big reform" of medical insurance.
One is the gradual normalization of centralized and volume procurement, effectively squeezing the water consumption of medicines, reducing the burden on the masses, purifying the ecology of the industry, and standardizing medical behavior.
The three batches of state-organized centralized drug procurement cover a total of 112 varieties, with an average price reduction of 54%, and annual cost savings of 53.
9 billion yuan.
For the first time the state organized the centralized procurement of high-value medical consumables, the price of selected coronary stents dropped by more than 90%, and it is estimated that the annual medical cost will be saved by 11.
7 billion yuan.
The reform of high-value medical consumables was governed, and the bonus of medical consumables was cancelled.
The second is to continue to consolidate the high-pressure situation of fund supervision.
Since 2018, a total of 730,000 medical institutions have been investigated and dealt with illegally and illegally , and 34.
87 billion yuan of medical insurance funds have been recovered, which has effectively promoted the standardized diagnosis and treatment behavior of medical institutions.
The third is to continue to deepen the reform of payment methods, and orderly advance the national pilots of disease diagnosis-related group (DRG) payment, the total budget of regional points method and the pilot of payment by disease points (DIP), and promote the reform of the compact county medical community payment method.
Guide medical institutions to actively regulate diagnosis and treatment behaviors, and initially form a diversified compound payment method based on the total budget.
One is the gradual normalization of centralized and volume procurement, effectively squeezing the water consumption of medicines, reducing the burden on the masses, purifying the ecology of the industry, and standardizing medical behavior.
The three batches of state-organized centralized drug procurement cover a total of 112 varieties, with an average price reduction of 54%, and annual cost savings of 53.
9 billion yuan.
For the first time the state organized the centralized procurement of high-value medical consumables, the price of selected coronary stents dropped by more than 90%, and it is estimated that the annual medical cost will be saved by 11.
7 billion yuan.
The reform of high-value medical consumables was governed, and the bonus of medical consumables was cancelled.
The second is to continue to consolidate the high-pressure situation of fund supervision.
Since 2018, a total of 730,000 medical institutions have been investigated and dealt with illegally and illegally , and 34.
87 billion yuan of medical insurance funds have been recovered, which has effectively promoted the standardized diagnosis and treatment behavior of medical institutions.
The third is to continue to deepen the reform of payment methods, and orderly advance the national pilots of disease diagnosis-related group (DRG) payment, the total budget of regional points method and the pilot of payment by disease points (DIP), and promote the reform of the compact county medical community payment method.
Guide medical institutions to actively regulate diagnosis and treatment behaviors, and initially form a diversified compound payment method based on the total budget.
Fight the epidemic, stabilize employment, and innovatively respond to major public health emergencies.
The first is to introduce “two guarantees” as soon as possible to ensure that patients will not be affected by cost issues, ensure that hospitals do not affect treatment due to payment policies, and promote the realization of “early detection, early reporting, early isolation, and early treatment”, and accumulative settlement of patients The cost is 2.
84 billion yuan, medical insurance payment is 1.
63 billion yuan, and 19.
4 billion yuan of special funds for designated treatment institutions are pre-allocated.
The second is to guide all regions to carry out centralized procurement of new coronavirus detection reagents, and the prices of nucleic acid and antibody detection reagents have dropped by 70% and 40% respectively.
The third is to optimize the handling services during the epidemic, and propose the "five offices" to optimize handling services to facilitate the masses to handle medical insurance services.
Support long-term prescriptions and "Internet +" medical insurance services, and make every effort to ensure that the masses seek medical treatment and purchase medicines.
Focus on guiding Wuhan to develop "Internet +" medical insurance to solve the problem of taking medicine for patients with chronic diseases during the epidemic.
The fourth is to fully support the resumption of work and production.
The nationwide phased reduction of the payment of employee medical insurance units by half has reduced the levy by more than 165 billion yuan for 9.
75 million insured units, providing a strong policy guarantee for maintaining employment stability.
The first is to introduce “two guarantees” as soon as possible to ensure that patients will not be affected by cost issues, ensure that hospitals do not affect treatment due to payment policies, and promote the realization of “early detection, early reporting, early isolation, and early treatment”, and accumulative settlement of patients The cost is 2.
84 billion yuan, medical insurance payment is 1.
63 billion yuan, and 19.
4 billion yuan of special funds for designated treatment institutions are pre-allocated.
The second is to guide all regions to carry out centralized procurement of new coronavirus detection reagents, and the prices of nucleic acid and antibody detection reagents have dropped by 70% and 40% respectively.
The third is to optimize the handling services during the epidemic, and propose the "five offices" to optimize handling services to facilitate the masses to handle medical insurance services.
Support long-term prescriptions and "Internet +" medical insurance services, and make every effort to ensure that the masses seek medical treatment and purchase medicines.
Focus on guiding Wuhan to develop "Internet +" medical insurance to solve the problem of taking medicine for patients with chronic diseases during the epidemic.
The fourth is to fully support the resumption of work and production.
The nationwide phased reduction of the payment of employee medical insurance units by half has reduced the levy by more than 165 billion yuan for 9.
75 million insured units, providing a strong policy guarantee for maintaining employment stability.
Key words:
Promote the high-quality development of medical insurance and do a good job in the "five changes"
During the "14th Five-Year Plan" period, economic and social development must be based on the promotion of high-quality development.
Promoting the high-quality development of medical insurance is an inevitable requirement for the medical insurance industry to adapt to changes, to create new opportunities, and to cultivate opportunities.
Promoting the high-quality development of medical insurance is an inevitable requirement for the medical insurance industry to adapt to changes, to create new opportunities, and to cultivate opportunities.
Promoting the high-quality development of medical insurance is a process of shifting from extensive development to quality and benefit development.
The basic connotation can be summarized as "five more".
The first is more fairness, emphasizing the promotion of common prosperity, so that all people can share the fruits of development, everyone has medical insurance, the basic systems and policies between urban and rural areas, and regions are unified, treatment and public services are balanced, rights and obligations are equal, and it is implemented for the people in need.
Appropriately tilt the protection, and prevent welfarism.
The second is to be more efficient, emphasizing on improving the efficiency of fund use, focusing on the input-output ratio, and purchasing better and higher-quality medical services with the same capital investment, making the purchased services more cost-effective, more economical and more appropriate.
The third is more sustainable, emphasizing continuous and stable protection of the basic health rights and interests of the people , the system and funds can maintain their own balance in the medium and long term, there is no obvious shortcoming, the coordinated development of medical insurance and the economy and society, the government, enterprises , and individuals have balanced responsibilities, reasonable financing and appropriate treatment match.
The fourth is to be more secure, emphasizing the basic system positioning of social security, safeguarding the fundamental interests of the broadest masses of the people, coordinating the advancement of medical insurance and medical development, ensuring the safe operation of funds, timely payment of benefits, and avoiding systemic and overall risks or occurrences.
Events that hit the bottom line of social morality.
Fifth, it is more convenient, emphasizing the reduction of waiting time and cost for mass business processing, simple service process, convenient access and non-probation of handling, integration of traditional services and intelligent services, more humane, and more suitable for the needs of special populations such as the elderly.
The basic connotation can be summarized as "five more".
The first is more fairness, emphasizing the promotion of common prosperity, so that all people can share the fruits of development, everyone has medical insurance, the basic systems and policies between urban and rural areas, and regions are unified, treatment and public services are balanced, rights and obligations are equal, and it is implemented for the people in need.
Appropriately tilt the protection, and prevent welfarism.
The second is to be more efficient, emphasizing on improving the efficiency of fund use, focusing on the input-output ratio, and purchasing better and higher-quality medical services with the same capital investment, making the purchased services more cost-effective, more economical and more appropriate.
The third is more sustainable, emphasizing continuous and stable protection of the basic health rights and interests of the people , the system and funds can maintain their own balance in the medium and long term, there is no obvious shortcoming, the coordinated development of medical insurance and the economy and society, the government, enterprises , and individuals have balanced responsibilities, reasonable financing and appropriate treatment match.
The fourth is to be more secure, emphasizing the basic system positioning of social security, safeguarding the fundamental interests of the broadest masses of the people, coordinating the advancement of medical insurance and medical development, ensuring the safe operation of funds, timely payment of benefits, and avoiding systemic and overall risks or occurrences.
Events that hit the bottom line of social morality.
Fifth, it is more convenient, emphasizing the reduction of waiting time and cost for mass business processing, simple service process, convenient access and non-probation of handling, integration of traditional services and intelligent services, more humane, and more suitable for the needs of special populations such as the elderly.
Key points of the "14th Five-Year Plan":
Gradually realize the basic uniformity of the scope of national medical insurance and standardize the transaction rules of provincial centralized procurement platforms
The "14th Five-Year Plan" period is the initial period for starting a new journey of building a socialist modern country in an all-round way, as well as an opportunity period for the reform and development of medical security.
Better ensure the people's basic medical protection rights and interests.
Keeping close to the basic national conditions, we will do our best and do what we can to improve people's livelihood, promote common prosperity, and prevent welfarism in development.
Establish a medical security benefit list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations.
Improve the basic medical insurance financing and benefit adjustment mechanism, and gradually include outpatient medical expenses into the payment scope of the basic medical insurance overall planning fund.
Realize the effective connection with the rural revitalization strategy, and consolidate and expand the effectiveness of medical insurance to fight poverty.
Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic uniformity of the national medical insurance drug coverage.
Establish a national medical insurance consumables access catalog system.
Keeping close to the basic national conditions, we will do our best and do what we can to improve people's livelihood, promote common prosperity, and prevent welfarism in development.
Establish a medical security benefit list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations.
Improve the basic medical insurance financing and benefit adjustment mechanism, and gradually include outpatient medical expenses into the payment scope of the basic medical insurance overall planning fund.
Realize the effective connection with the rural revitalization strategy, and consolidate and expand the effectiveness of medical insurance to fight poverty.
Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic uniformity of the national medical insurance drug coverage.
Establish a national medical insurance consumables access catalog system.
To better meet the diverse security needs of the people.
Improve the critical illness medical insurance and assistance system, optimize the basic medical insurance, critical illness insurance and medical assistance triple security system, unify and standardize the medical assistance system, promote the complementary connection of various medical insurance systems, and establish a sound long-term mechanism for preventing and resolving poverty and returning to poverty due to illness.
Coordinate and mobilize the assistance of charity medical assistance, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to guarantees.
Improve the critical illness medical insurance and assistance system, optimize the basic medical insurance, critical illness insurance and medical assistance triple security system, unify and standardize the medical assistance system, promote the complementary connection of various medical insurance systems, and establish a sound long-term mechanism for preventing and resolving poverty and returning to poverty due to illness.
Coordinate and mobilize the assistance of charity medical assistance, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to guarantees.
Better protect the people's "life-saving money".
Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraudulent insurance with a zero tolerance attitude.
Strengthen the medium and long-term actuarial calculation of the fund, and improve the operation risk assessment and early warning mechanism.
Strengthen fund budget management and risk early warning, and fully implement budget performance management.
We will implement the overall planning of basic medical insurance at the municipal and prefecture level, promote the overall planning at the provincial level, and promote the integration of basic medical insurance and medical assistance at the overall level.
Require benefits from management, strengthen refined management, and steadily improve the level of medical insurance governance.
Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraudulent insurance with a zero tolerance attitude.
Strengthen the medium and long-term actuarial calculation of the fund, and improve the operation risk assessment and early warning mechanism.
Strengthen fund budget management and risk early warning, and fully implement budget performance management.
We will implement the overall planning of basic medical insurance at the municipal and prefecture level, promote the overall planning at the provincial level, and promote the integration of basic medical insurance and medical assistance at the overall level.
Require benefits from management, strengthen refined management, and steadily improve the level of medical insurance governance.
Better guarantee the people's access to high-quality and affordable medical services.
Insist on system integration and give full play to the basic role of medical insurance in the reform of "three-medicine linkage".
Promote the institutionalization and normalization of centralized drug purchases, and in-depth exploration of the reform of the centralized procurement system for high-value medical consumables.
Improve the incentive mechanism and promote the implementation of policies for centralized procurement of medicines and medical consumables by medical institutions.
Standardize the transaction rules of the provincial-level pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system.
Continue to promote the reform of payment methods, implement a diversified compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical consortia.
Innovate agreement management, establish and improve the negotiation and negotiation mechanism between handling agencies and designated institutions, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management coordination mechanisms.
Improve the price formation mechanism of medical services, establish a scientific pricing and dynamic adjustment mechanism, and continue to optimize the price structure of medical services.
Insist on system integration and give full play to the basic role of medical insurance in the reform of "three-medicine linkage".
Promote the institutionalization and normalization of centralized drug purchases, and in-depth exploration of the reform of the centralized procurement system for high-value medical consumables.
Improve the incentive mechanism and promote the implementation of policies for centralized procurement of medicines and medical consumables by medical institutions.
Standardize the transaction rules of the provincial-level pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system.
Continue to promote the reform of payment methods, implement a diversified compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical consortia.
Innovate agreement management, establish and improve the negotiation and negotiation mechanism between handling agencies and designated institutions, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management coordination mechanisms.
Improve the price formation mechanism of medical services, establish a scientific pricing and dynamic adjustment mechanism, and continue to optimize the price structure of medical services.
Better provide the people with convenient and efficient medical insurance public services.
Strengthen the construction of handling capacity and vigorously promote the sinking of services.
Improve the insurance services that adapt to the new business model and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance is fully covered.
Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places.
Continue to promote the construction of systematic business style, strictly implement the list of handling government services, fully implement the "good and bad review" system, and strive to achieve "immediate, online, nearby, and one-off" service items.
Speed up the construction of a unified national medical insurance information system, and promote the standardization and informatization of medical insurance.
Adhere to the parallel of traditional service and intelligent service innovation, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels.
Improve the level of legalization of medical insurance, and implement the concepts and methods of the rule of law in all aspects of medical insurance management.
Strengthen the construction of handling capacity and vigorously promote the sinking of services.
Improve the insurance services that adapt to the new business model and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance is fully covered.
Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places.
Continue to promote the construction of systematic business style, strictly implement the list of handling government services, fully implement the "good and bad review" system, and strive to achieve "immediate, online, nearby, and one-off" service items.
Speed up the construction of a unified national medical insurance information system, and promote the standardization and informatization of medical insurance.
Adhere to the parallel of traditional service and intelligent service innovation, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels.
Improve the level of legalization of medical insurance, and implement the concepts and methods of the rule of law in all aspects of medical insurance management.
Medical Network News, March 12, medical insurance is related to the vital interests of the people.
On March 9th, China Government Network published the article "Promoting the High-quality Development of Medical Security" published by Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Medical Security Administration on the "Learning Times".
The article proposes that during the "14th Five-Year Plan" period, medical security work should adapt to the requirements of entering a new stage of development, implementing new development concepts, and building a new development pattern, centering on people's health, and achieving high-quality development.
The following key points are worth paying attention to:
On March 9th, China Government Network published the article "Promoting the High-quality Development of Medical Security" published by Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Medical Security Administration on the "Learning Times".
The article proposes that during the "14th Five-Year Plan" period, medical security work should adapt to the requirements of entering a new stage of development, implementing new development concepts, and building a new development pattern, centering on people's health, and achieving high-quality development.
The following key points are worth paying attention to:
"Thirteenth Five-Year Plan" Achievements:
"Thirteenth Five-Year Plan" Achievements: In the past three years, 433 new drugs have been included , and eligible "Internet +" medical services have been included in medical insurance
In the past three years, 433 new drugs have been included , and eligible "Internet +" medical services have been included in medical insurance drugs and drugs At present, the world’s largest basic medical insurance network has been established, with basic medical insurance covering more than 1.
36 billion people, with an insured rate stabilizing above 95%, and the poor population’s enrolling rate above 99.
9%.
The reimbursement rates for hospitalization expenses of employee medical insurance and resident medical insurance policies reached about 80% and 70%, respectively.
The actual reimbursement rate for hospitalization and outpatient chronic diseases of the poor population stabilized at 80% after being guaranteed by the triple system of basic medical insurance, critical illness insurance, and medical assistance.
about.
36 billion people, with an insured rate stabilizing above 95%, and the poor population’s enrolling rate above 99.
9%.
The reimbursement rates for hospitalization expenses of employee medical insurance and resident medical insurance policies reached about 80% and 70%, respectively.
The actual reimbursement rate for hospitalization and outpatient chronic diseases of the poor population stabilized at 80% after being guaranteed by the triple system of basic medical insurance, critical illness insurance, and medical assistance.
about.
Make up for shortcomings, eliminate blind spots, and establish and improve a medical security system with Chinese characteristics.
To strengthen the top-level design, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", drawing a blueprint for the reform of medical insurance in the next 5 to 10 years.
At present, a unified basic medical insurance and critical illness insurance system for urban and rural residents has been established.
Comprehensively promote the combined implementation of maternity insurance and basic medical insurance for employees.
A multi-level medical security system with basic medical insurance as the main body, medical assistance as the foundation, and other security measures are gradually being formed.
The comprehensive protection of the triple system of basic medical insurance, critical illness insurance, and medical assistance has played an important role in satisfying the basic medical insurance of the people.
To strengthen the top-level design, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", drawing a blueprint for the reform of medical insurance in the next 5 to 10 years.
At present, a unified basic medical insurance and critical illness insurance system for urban and rural residents has been established.
Comprehensively promote the combined implementation of maternity insurance and basic medical insurance for employees.
A multi-level medical security system with basic medical insurance as the main body, medical assistance as the foundation, and other security measures are gradually being formed.
The comprehensive protection of the triple system of basic medical insurance, critical illness insurance, and medical assistance has played an important role in satisfying the basic medical insurance of the people.
Relieve pain points, remove blockage points, and effectively improve the people's sense of access to, happiness, and security.
The first is to initially establish a dynamic adjustment mechanism for the drug catalog, include more new and good drugs, significantly improve the drug security capabilities for cancer, chronic diseases, and pediatric diseases, and implement innovative negotiation access, and the average price of 233 negotiated drugs has dropped by more than 50%.
, Many "noble drugs" offer "civilian prices.
" The 114 medicines negotiated in 2018 and 2019 alone will reduce the patient's burden by 72.
19 billion yuan from January to November 2020.
In the past three years, a total of 433 new drugs have been included, and there are 2,800 drugs in the catalog, which basically meets the needs of clinical medication.
The second is to effectively improve the quality of guarantees.
Improved outpatient protection policies and measures, and established and improved the outpatient medication protection mechanism for hypertension and diabetes in urban and rural residents.
More than 72 million patients with "two diseases" have benefited, and the cumulative burden has been reduced by 25 billion yuan.
To adapt to changes in medical service models, include eligible "Internet +" medical services into the scope of medical insurance payment, and vigorously support the development of "Internet +" medical services.
The third is to strengthen public services for medical insurance.
Standardize the handling of service behaviors, make it convenient for the masses to seek medical treatment in different places, improve the accessibility of high-quality medical services, support the free flow of labor, and basically solve the problem of "advance" and reimbursement for hospitalization of patients in different places across provinces, benefiting 7.
25 million hospitalizations; steadily The pilot program for direct settlement of outpatient expenses across provinces has been promoted, benefiting 3.
02 million people in total outpatient visits.
The fourth is to consolidate the foundation of medical insurance management, continuously improve the level of informatization, standardization, refinement, and rule of law, and continuously improve the standardization, convenience, and ageing of medical insurance management services, and establish the main body of the national medical insurance information platform.
All provinces have opened the medical insurance code activation service , The total number of users exceeds 450 million.
The first is to initially establish a dynamic adjustment mechanism for the drug catalog, include more new and good drugs, significantly improve the drug security capabilities for cancer, chronic diseases, and pediatric diseases, and implement innovative negotiation access, and the average price of 233 negotiated drugs has dropped by more than 50%.
, Many "noble drugs" offer "civilian prices.
" The 114 medicines negotiated in 2018 and 2019 alone will reduce the patient's burden by 72.
19 billion yuan from January to November 2020.
In the past three years, a total of 433 new drugs have been included, and there are 2,800 drugs in the catalog, which basically meets the needs of clinical medication.
The second is to effectively improve the quality of guarantees.
Improved outpatient protection policies and measures, and established and improved the outpatient medication protection mechanism for hypertension and diabetes in urban and rural residents.
More than 72 million patients with "two diseases" have benefited, and the cumulative burden has been reduced by 25 billion yuan.
To adapt to changes in medical service models, include eligible "Internet +" medical services into the scope of medical insurance payment, and vigorously support the development of "Internet +" medical services.
The third is to strengthen public services for medical insurance.
Standardize the handling of service behaviors, make it convenient for the masses to seek medical treatment in different places, improve the accessibility of high-quality medical services, support the free flow of labor, and basically solve the problem of "advance" and reimbursement for hospitalization of patients in different places across provinces, benefiting 7.
25 million hospitalizations; steadily The pilot program for direct settlement of outpatient expenses across provinces has been promoted, benefiting 3.
02 million people in total outpatient visits.
The fourth is to consolidate the foundation of medical insurance management, continuously improve the level of informatization, standardization, refinement, and rule of law, and continuously improve the standardization, convenience, and ageing of medical insurance management services, and establish the main body of the national medical insurance information platform.
All provinces have opened the medical insurance code activation service , The total number of users exceeds 450 million.
Break through the difficulties, find the fulcrum, and lead the medical reform to deepen with the "small incision and big reform" of medical insurance.
One is the gradual normalization of centralized and volume procurement, effectively squeezing the water consumption of medicines, reducing the burden on the masses, purifying the ecology of the industry, and standardizing medical behavior.
The three batches of state-organized centralized drug procurement cover a total of 112 varieties, with an average price reduction of 54%, and annual cost savings of 53.
9 billion yuan.
For the first time the state organized the centralized procurement of high-value medical consumables, the price of selected coronary stents dropped by more than 90%, and it is estimated that the annual medical cost will be saved by 11.
7 billion yuan.
The reform of high-value medical consumables was governed, and the bonus of medical consumables was cancelled.
The second is to continue to consolidate the high-pressure situation of fund supervision.
Since 2018, a total of 730,000 medical institutions have been investigated and dealt with illegally and illegally , and 34.
87 billion yuan of medical insurance funds have been recovered, which has effectively promoted the standardized diagnosis and treatment behavior of medical institutions.
The third is to continue to deepen the reform of payment methods, and orderly advance the national pilots of disease diagnosis-related group (DRG) payment, the total budget of regional points method and the pilot of payment by disease points (DIP), and promote the reform of the compact county medical community payment method.
Guide medical institutions to actively regulate diagnosis and treatment behaviors, and initially form a diversified compound payment method based on the total budget.
Medicine Medicine MedicineOne is the gradual normalization of centralized and volume procurement, effectively squeezing the water consumption of medicines, reducing the burden on the masses, purifying the ecology of the industry, and standardizing medical behavior.
The three batches of state-organized centralized drug procurement cover a total of 112 varieties, with an average price reduction of 54%, and annual cost savings of 53.
9 billion yuan.
For the first time the state organized the centralized procurement of high-value medical consumables, the price of selected coronary stents dropped by more than 90%, and it is estimated that the annual medical cost will be saved by 11.
7 billion yuan.
The reform of high-value medical consumables was governed, and the bonus of medical consumables was cancelled.
The second is to continue to consolidate the high-pressure situation of fund supervision.
Since 2018, a total of 730,000 medical institutions have been investigated and dealt with illegally and illegally , and 34.
87 billion yuan of medical insurance funds have been recovered, which has effectively promoted the standardized diagnosis and treatment behavior of medical institutions.
The third is to continue to deepen the reform of payment methods, and orderly advance the national pilots of disease diagnosis-related group (DRG) payment, the total budget of regional points method and the pilot of payment by disease points (DIP), and promote the reform of the compact county medical community payment method.
Guide medical institutions to actively regulate diagnosis and treatment behaviors, and initially form a diversified compound payment method based on the total budget.
Fight the epidemic, stabilize employment, and innovatively respond to major public health emergencies.
The first is to introduce “two guarantees” as soon as possible to ensure that patients will not be affected by cost issues, ensure that hospitals do not affect treatment due to payment policies, and promote the realization of “early detection, early reporting, early isolation, and early treatment”, and accumulative settlement of patients The cost is 2.
84 billion yuan, medical insurance payment is 1.
63 billion yuan, and 19.
4 billion yuan of special funds for designated treatment institutions are pre-allocated.
The second is to guide all regions to carry out centralized procurement of new coronavirus detection reagents, and the prices of nucleic acid and antibody detection reagents have dropped by 70% and 40% respectively.
The third is to optimize the handling services during the epidemic, and propose the "five offices" to optimize handling services to facilitate the masses to handle medical insurance services.
Support long-term prescriptions and "Internet +" medical insurance services, and make every effort to ensure that the masses seek medical treatment and purchase medicines.
Focus on guiding Wuhan to develop "Internet +" medical insurance to solve the problem of taking medicine for patients with chronic diseases during the epidemic.
The fourth is to fully support the resumption of work and production.
The nationwide phased reduction of the payment of employee medical insurance units by half has reduced the levy by more than 165 billion yuan for 9.
75 million insured units, providing a strong policy guarantee for maintaining employment stability.
Hospital hospital hospitalThe first is to introduce “two guarantees” as soon as possible to ensure that patients will not be affected by cost issues, ensure that hospitals do not affect treatment due to payment policies, and promote the realization of “early detection, early reporting, early isolation, and early treatment”, and accumulative settlement of patients The cost is 2.
84 billion yuan, medical insurance payment is 1.
63 billion yuan, and 19.
4 billion yuan of special funds for designated treatment institutions are pre-allocated.
The second is to guide all regions to carry out centralized procurement of new coronavirus detection reagents, and the prices of nucleic acid and antibody detection reagents have dropped by 70% and 40% respectively.
The third is to optimize the handling services during the epidemic, and propose the "five offices" to optimize handling services to facilitate the masses to handle medical insurance services.
Support long-term prescriptions and "Internet +" medical insurance services, and make every effort to ensure that the masses seek medical treatment and purchase medicines.
Focus on guiding Wuhan to develop "Internet +" medical insurance to solve the problem of taking medicine for patients with chronic diseases during the epidemic.
The fourth is to fully support the resumption of work and production.
The nationwide phased reduction of the payment of employee medical insurance units by half has reduced the levy by more than 165 billion yuan for 9.
75 million insured units, providing a strong policy guarantee for maintaining employment stability.
Key words:
Key words: Promote the high-quality development of medical insurance and do a good job in the "five changes"
Promote the high-quality development of medical insurance and do a good job in the "five changes" During the "14th Five-Year Plan" period, economic and social development must be based on the promotion of high-quality development.
Promoting the high-quality development of medical insurance is an inevitable requirement for the medical insurance industry to adapt to changes, to create new opportunities, and to cultivate opportunities.
Promoting the high-quality development of medical insurance is an inevitable requirement for the medical insurance industry to adapt to changes, to create new opportunities, and to cultivate opportunities.
Promoting the high-quality development of medical insurance is a process of shifting from extensive development to quality and benefit development.
The basic connotation can be summarized as "five more".
The first is more fairness, emphasizing the promotion of common prosperity, so that all people can share the fruits of development, everyone has medical insurance, the basic systems and policies between urban and rural areas, and regions are unified, treatment and public services are balanced, rights and obligations are equal, and it is implemented for the people in need.
Appropriately tilt the protection, and prevent welfarism.
The second is to be more efficient, emphasizing on improving the efficiency of fund use, focusing on the input-output ratio, and purchasing better and higher-quality medical services with the same capital investment, making the purchased services more cost-effective, more economical and more appropriate.
The third is more sustainable, emphasizing continuous and stable protection of the basic health rights and interests of the people , the system and funds can maintain their own balance in the medium and long term, there is no obvious shortcoming, the coordinated development of medical insurance and the economy and society, the government, enterprises , and individuals have balanced responsibilities, reasonable financing and appropriate treatment match.
The fourth is to be more secure, emphasizing the basic system positioning of social security, safeguarding the fundamental interests of the broadest masses of the people, coordinating the advancement of medical insurance and medical development, ensuring the safe operation of funds, timely payment of benefits, and avoiding systemic and overall risks or occurrences.
Events that hit the bottom line of social morality.
Fifth, it is more convenient, emphasizing the reduction of waiting time and cost for mass business processing, simple service process, convenient access and non-probation of handling, integration of traditional services and intelligent services, more humane, and more suitable for the needs of special populations such as the elderly.
Health and Health Enterprise Enterprise EnterpriseThe basic connotation can be summarized as "five more".
The first is more fairness, emphasizing the promotion of common prosperity, so that all people can share the fruits of development, everyone has medical insurance, the basic systems and policies between urban and rural areas, and regions are unified, treatment and public services are balanced, rights and obligations are equal, and it is implemented for the people in need.
Appropriately tilt the protection, and prevent welfarism.
The second is to be more efficient, emphasizing on improving the efficiency of fund use, focusing on the input-output ratio, and purchasing better and higher-quality medical services with the same capital investment, making the purchased services more cost-effective, more economical and more appropriate.
The third is more sustainable, emphasizing continuous and stable protection of the basic health rights and interests of the people , the system and funds can maintain their own balance in the medium and long term, there is no obvious shortcoming, the coordinated development of medical insurance and the economy and society, the government, enterprises , and individuals have balanced responsibilities, reasonable financing and appropriate treatment match.
The fourth is to be more secure, emphasizing the basic system positioning of social security, safeguarding the fundamental interests of the broadest masses of the people, coordinating the advancement of medical insurance and medical development, ensuring the safe operation of funds, timely payment of benefits, and avoiding systemic and overall risks or occurrences.
Events that hit the bottom line of social morality.
Fifth, it is more convenient, emphasizing the reduction of waiting time and cost for mass business processing, simple service process, convenient access and non-probation of handling, integration of traditional services and intelligent services, more humane, and more suitable for the needs of special populations such as the elderly.
Key points of the "14th Five-Year Plan":
Key points of the "14th Five-Year Plan": Gradually realize the basic uniformity of the scope of national medical insurance and standardize the transaction rules of provincial centralized procurement platforms
Gradually realize the basic uniformity of the scope of national medical insurance and standardize the transaction rules of provincial centralized procurement platforms The "14th Five-Year Plan" period is the initial period for starting a new journey of building a socialist modern country in an all-round way, as well as an opportunity period for the reform and development of medical security.
Better ensure the people's basic medical protection rights and interests.
Keeping close to the basic national conditions, we will do our best and do what we can to improve people's livelihood, promote common prosperity, and prevent welfarism in development.
Establish a medical security benefit list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations.
Improve the basic medical insurance financing and benefit adjustment mechanism, and gradually include outpatient medical expenses into the payment scope of the basic medical insurance overall planning fund.
Realize the effective connection with the rural revitalization strategy, and consolidate and expand the effectiveness of medical insurance to fight poverty.
Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic uniformity of the national medical insurance drug coverage.
Establish a national medical insurance consumables access catalog system.
Keeping close to the basic national conditions, we will do our best and do what we can to improve people's livelihood, promote common prosperity, and prevent welfarism in development.
Establish a medical security benefit list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations.
Improve the basic medical insurance financing and benefit adjustment mechanism, and gradually include outpatient medical expenses into the payment scope of the basic medical insurance overall planning fund.
Realize the effective connection with the rural revitalization strategy, and consolidate and expand the effectiveness of medical insurance to fight poverty.
Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic uniformity of the national medical insurance drug coverage.
Establish a national medical insurance consumables access catalog system.
To better meet the diverse security needs of the people.
Improve the critical illness medical insurance and assistance system, optimize the basic medical insurance, critical illness insurance and medical assistance triple security system, unify and standardize the medical assistance system, promote the complementary connection of various medical insurance systems, and establish a sound long-term mechanism for preventing and resolving poverty and returning to poverty due to illness.
Coordinate and mobilize the assistance of charity medical assistance, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to guarantees.
Improve the critical illness medical insurance and assistance system, optimize the basic medical insurance, critical illness insurance and medical assistance triple security system, unify and standardize the medical assistance system, promote the complementary connection of various medical insurance systems, and establish a sound long-term mechanism for preventing and resolving poverty and returning to poverty due to illness.
Coordinate and mobilize the assistance of charity medical assistance, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to guarantees.
Better protect the people's "life-saving money".
Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraudulent insurance with a zero tolerance attitude.
Strengthen the medium and long-term actuarial calculation of the fund, and improve the operation risk assessment and early warning mechanism.
Strengthen fund budget management and risk early warning, and fully implement budget performance management.
We will implement the overall planning of basic medical insurance at the municipal and prefecture level, promote the overall planning at the provincial level, and promote the integration of basic medical insurance and medical assistance at the overall level.
Require benefits from management, strengthen refined management, and steadily improve the level of medical insurance governance.
Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraudulent insurance with a zero tolerance attitude.
Strengthen the medium and long-term actuarial calculation of the fund, and improve the operation risk assessment and early warning mechanism.
Strengthen fund budget management and risk early warning, and fully implement budget performance management.
We will implement the overall planning of basic medical insurance at the municipal and prefecture level, promote the overall planning at the provincial level, and promote the integration of basic medical insurance and medical assistance at the overall level.
Require benefits from management, strengthen refined management, and steadily improve the level of medical insurance governance.
Better guarantee the people's access to high-quality and affordable medical services.
Insist on system integration and give full play to the basic role of medical insurance in the reform of "three-medicine linkage".
Promote the institutionalization and normalization of centralized drug purchases, and in-depth exploration of the reform of the centralized procurement system for high-value medical consumables.
Improve the incentive mechanism and promote the implementation of policies for centralized procurement of medicines and medical consumables by medical institutions.
Standardize the transaction rules of the provincial-level pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system.
Continue to promote the reform of payment methods, implement a diversified compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical consortia.
Innovate agreement management, establish and improve the negotiation and negotiation mechanism between handling agencies and designated institutions, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management coordination mechanisms.
Improve the price formation mechanism of medical services, establish a scientific pricing and dynamic adjustment mechanism, and continue to optimize the price structure of medical services.
Insist on system integration and give full play to the basic role of medical insurance in the reform of "three-medicine linkage".
Promote the institutionalization and normalization of centralized drug purchases, and in-depth exploration of the reform of the centralized procurement system for high-value medical consumables.
Improve the incentive mechanism and promote the implementation of policies for centralized procurement of medicines and medical consumables by medical institutions.
Standardize the transaction rules of the provincial-level pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system.
Continue to promote the reform of payment methods, implement a diversified compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical consortia.
Innovate agreement management, establish and improve the negotiation and negotiation mechanism between handling agencies and designated institutions, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management coordination mechanisms.
Improve the price formation mechanism of medical services, establish a scientific pricing and dynamic adjustment mechanism, and continue to optimize the price structure of medical services.
Better provide the people with convenient and efficient medical insurance public services.
Strengthen the construction of handling capacity and vigorously promote the sinking of services.
Improve the insurance services that adapt to the new business model and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance is fully covered.
Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places.
Continue to promote the construction of systematic business style, strictly implement the list of handling government services, fully implement the "good and bad review" system, and strive to achieve "immediate, online, nearby, and one-off" service items.
Speed up the construction of a unified national medical insurance information system, and promote the standardization and informatization of medical insurance.
Adhere to the parallel of traditional service and intelligent service innovation, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels.
Improve the level of legalization of medical insurance, and implement the concepts and methods of the rule of law in all aspects of medical insurance management.
Strengthen the construction of handling capacity and vigorously promote the sinking of services.
Improve the insurance services that adapt to the new business model and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance is fully covered.
Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places.
Continue to promote the construction of systematic business style, strictly implement the list of handling government services, fully implement the "good and bad review" system, and strive to achieve "immediate, online, nearby, and one-off" service items.
Speed up the construction of a unified national medical insurance information system, and promote the standardization and informatization of medical insurance.
Adhere to the parallel of traditional service and intelligent service innovation, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels.
Improve the level of legalization of medical insurance, and implement the concepts and methods of the rule of law in all aspects of medical insurance management.
