Medical insurance "Zhanjiang model" won the attention of the medical reform office of the State Council

Source: from April 13, 2015 to April 11, 2015, Yao Jianhong, deputy director of the medical reform office of the State Council and his delegation conducted a two-day research on the "Zhanjiang model" of medical insurance It is understood that in 2009, on the basis of making full use of the original medical insurance management service system, Zhanjiang City improved the service mode, improved the management efficiency, integrated the new rural cooperative medical system and the basic medical insurance system for urban residents, established a unified medical insurance system for urban and rural residents in the city, and introduced commercial insurance to participate in the management In 2012, it took the lead in developing urban and rural serious illness insurance, and gradually developed a new way of medical insurance in underdeveloped areas, which is "urban and rural integration, city level overall planning, commercial insurance participation, diagnosis and treatment standards, serious illness insurance" Liang Zhipeng, deputy mayor of Zhanjiang City, said that Zhanjiang City has constantly innovated the "Zhanjiang model" of medical insurance, especially the establishment of the serious illness insurance system, and through the linkage of medical treatment, medical insurance and medicine, let urban and rural medical insurance play a better leverage role Actively guide the masses to seek medical treatment reasonably according to the needs of diagnosis and treatment, gradually improve the hierarchical diagnosis and treatment system of "primary diagnosis at the grassroots level, two-way referral, acute and slow treatment, upper and lower linkage", so that the insured can get cheaper, convenient, timely and safe medical services, and effectively promote the further deepening of medical reform In terms of the management of medical insurance fund for urban and rural residents, the practice of Zhanjiang city is to strictly follow the principle of "determining expenditure by income, balancing income and expenditure, and having a slight balance", and at the same time establish the information notification system of serious disease medical insurance and incentive and restraint mechanism of insurance undertaking According to Feng Zhiqiang, director of Zhanjiang Social Insurance Fund Management Bureau, the payment system of "total amount control, disease type plus quota, monthly prepayment, year-end liquidation and reasonable compensation" has been established and improved based on the reform of payment mode and the bearing capacity of medical insurance fund and the distribution of medical and health resources It has reversed the situation of large loss of medical insurance fund payment, initially achieved the overall goal of medical insurance fund balance, promoted the harmonious coexistence of hospitals, agencies, insured patients and the sustainable development of medical insurance Feng Zhiqiang said that the serious illness medical insurance system, which is led by the government and combined with the market mechanism, has achieved tangible results in expanding and extending the basic medical insurance function and effectively alleviating the "poverty caused by illness" of the insured residents At present, the coverage rate of medical insurance in Zhanjiang City is 98% The reimbursement rates of township hospitals, class I, II and III hospitals are 85%, 80%, 70% and 50% respectively The maximum payment limit of serious illness insurance is increased to 300000 yuan for class I and 500000 yuan for class II Township hospitals and community health service centers implement the general outpatient co-ordination.