Opinions of the General Office of the State Council on Improving the Medical Insurance and Relief System for Major and Serious Diseases

The people's governments of all provinces, autonomous regions, and municipalities directly under the Central Government, all ministries and commissions of the State Council, and all directly affiliated institutions:

Doing a good job in providing medical insurance for major and serious diseases is an important measure to further reduce the burden of medical expenses for the people in need and patients with serious illnesses, to prevent poverty from returning to poverty due to illness, and to strengthen the bottom line of people's livelihood protection
.

In order to thoroughly implement the decisions and deployments of the Party Central Committee and the State Council on deepening the reform of the medical security system and improving the social assistance system, consolidate and expand the achievements of medical security in poverty alleviation, and continuously enhance the people's sense of gain, happiness, and security, with the consent of the State Council, it is now complete The medical insurance and relief system for major diseases put forward the following opinions

1.
General requirements

1.
General requirements

Under the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the Communist Party of China and the 2nd, 3rd, 4th and 5th Plenary Sessions of the 19th National Congress of the Communist Party of China.
We will do our best to ensure the basics, do our best and do our best, and promote the improvement of people's livelihood to be more sustainable
.

Focus on reducing the burden of medical expenses for the people in need of serious and serious diseases, establish and improve a long-term mechanism to prevent and resolve poverty and return to poverty due to illness, strengthen the comprehensive protection of basic medical insurance, serious illness insurance, and medical assistance (hereinafter collectively referred to as the triple system), and seek truth from facts to determine the medical security treatment for the people in difficulty Standards to ensure that the basic medical care of the people in need is guaranteed, not to affect their basic life due to serious diseases, and to avoid excessive protection

2.
Scientifically determine the scope of medical assistance

2.
Scientifically determine the scope of medical assistance

(1) Determine the rescue target in a timely and accurate manner
.

Medical assistance fairly covers needy employees and urban and rural residents who have a heavier burden of medical expenses, and implements classified assistance according to the types of assistance recipients

(1) Determine the rescue target in a timely and accurate manner

3.

(2) To ensure that the people in difficulty should be fully protected

(3) Promote the complementary connection of triple systems

4.

(4) Clarify the scope of protection of rescue costs

(5) Reasonably determine the basic level of assistance

(6) Overall planning and perfecting the safeguard measures for underpinning

5.

(7) Strengthen early warning and monitoring of high medical expenses

(8) Implement comprehensive security policies upon application
.

6.
Actively guide charity and other social forces to participate in assistance and guarantee

6.
Actively guide charity and other social forces to participate in assistance and guarantee

(9) Develop and expand charity assistance
.
Encourage charitable organizations and other social organizations to set up critical illness relief projects to play a supplementary role in relief
.
Promote the development of Internet public fundraising information platforms and the sharing of charitable resources between platforms, regulate the release of information on the Internet personal critical illness help platform, and promote sunshine relief
.
Support the development of social work services and voluntary services in the field of medical assistance, and enrich the content of assistance services
.
According to the level of economic and social development and the endurance of all parties, explore the establishment of a rare disease drug protection mechanism, integrate medical security, social assistance, charity assistance and other resources, and implement comprehensive protection
.
Establish an incentive mechanism for charitable participation, and implement corresponding tax incentives, fee reductions and exemptions
.

(9) Develop and expand charity assistance
.

(10) Encourage the development of mutual medical assistance and commercial health insurance
.
Support the development of mutual medical assistance among employees, standardize mutual assistance on Internet platforms, strengthen risk management and control, and guide the healthy development of mutual medical assistance
.
Support the development of commercial health insurance to meet protection needs other than basic medical insurance
.
Encourage commercial insurance institutions to strengthen product innovation, and give proper preference to people in need in terms of product pricing, compensation conditions, and coverage
.

(10) Encourage the development of mutual medical assistance and commercial health insurance
.

Seven, standardize management services

Seven, standardize management services

(11) Accelerate the promotion of integrated management
.
Refine and improve the list of relief service items, introduce medical assistance management service procedures, and do a good job in handling services such as information sharing and mutual recognition of assistance recipients, subsidized insurance participation, and payment of benefits
.
Promote the integration of basic medical insurance and medical assistance services, rely on a unified national medical insurance information platform, and strengthen centralized data management in accordance with laws and regulations
.
Unified agreement management, and strengthen the main responsibility of designated medical institutions for cost management and control
.
Unify fund supervision, do a good job in cost monitoring, inspection and review, maintain a high-pressure situation in combating fraud and insurance, and implement key monitoring of designated medical institutions that provide medical assistance services to ensure the safe, efficient and reasonable use of funds
.
Promote the implementation of "one-stop" services and "one-window" processing to improve the convenience of settlement services
.

(11) Accelerate the promotion of integrated management
.

(12) Optimize the review procedures for aid applications
.
Simplify the application, review, and assistance payment procedures, and directly include the subsistence allowance recipients and extremely poor people into the “one-stop” settlement method, and explore and improve the direct settlement methods for other assistance recipients
.
Strengthen the coordination of departmental work, fully connect with social assistance management services, and do a good job in the acceptance of medical assistance applications for the people in need, branch transfers, and result feedback in accordance with the division of responsibilities
.
Mobilize grassroots cadres, rely on grassroots medical and health institutions, do a good job in policy publicity and assistance application entrusted agency, etc.
, and proactively help people in need in a timely manner
.

(12) Optimize the review procedures for aid applications
.

(13) Improve the level of comprehensive service management
.
Strengthen the guidance of medical treatment behavior of rescued objects, promote the first consultation at the grassroots level, standardize referrals, and promote reasonable medical treatment
.
Improve the content of medical assistance services in designated medical institutions, improve service quality, and settle basic medical insurance and medical assistance expenses in accordance with regulations
.
In accordance with the basic principles of safety, effectiveness, economic suitability, and assistance, guide medical assistance recipients and designated medical institutions to preferentially select medicines, medical consumables, and diagnosis and treatment items that are included in the scope of basic medical insurance payment, and strictly control unreasonable expenditures
.
Subsistence allowance recipients and extremely poor people who have been referred for the first consultation at the grassroots level are hospitalized in designated medical institutions within the city.
The implementation of "first diagnosis and treatment, then payment" is implemented, and their hospitalization deposits are completely exempted
.
We will do a good job in the registration and filing of aid recipients in different places and different places for referrals, and settlement of medical treatment.
The aid recipients who are referred in accordance with regulations shall implement the aid standards of the overall planning area where their household registration is located
.
In principle, the medical expenses incurred by the recipients who are not referred in accordance with the regulations are not included in the scope of medical assistance
.

(13) Improve the level of comprehensive service management
.

8.
Strengthen organizational guarantees

8.
Strengthen organizational guarantees

(14) Strengthen organization and leadership
.
Strengthen the protection of major diseases with party committee leadership, government leadership, departmental coordination, and social participation
.
The implementation of the underpinning guarantee policy for medical assistance for severe and serious diseases of the needy people is taken as an important indicator for strengthening and improving people’s livelihood and included in the performance evaluation of medical assistance
.
All provinces (autonomous regions and municipalities directly under the Central Government) should implement their main responsibilities, refine policies and measures, strengthen supervision and inspection, and ensure that policies are implemented, benefits are implemented, and the people receive benefits
.
It is necessary to combine the implementation of the medical security treatment list system, formulate detailed measures, effectively standardize the scope of medical assistance, and adhere to the basic security standards to ensure the sustainable development of the system
.
Strengthen policy publicity and interpretation, respond to social concerns in a timely manner, and create a good atmosphere of public opinion
.
The implementation of policies in various regions shall be reported to the National Medical Insurance Bureau in a timely manner
.

(14) Strengthen organization and leadership
.

(15) Strengthen departmental coordination
.
Establish and improve the departmental coordination mechanism, and strengthen the overall coordination of medical security, social assistance, medical and health system policies, and handling services
.
The medical security department must coordinate the advancement of the reform and management of medical insurance and medical assistance systems, and implement medical security policies
.
The civil affairs department should do a good job in identifying the recipients of the subsistence allowance, the extremely poor, and the marginal family members of the subsistence allowance, and work with relevant departments to identify and share relevant information for patients who are poor and severely ill, and support the development of charity assistance
.
The financial department shall provide financial support in accordance with regulations
.
The health department should strengthen the industry management of medical institutions, standardize the path of diagnosis and treatment, and promote hierarchical diagnosis and treatment
.
The taxation department must do a good job in the collection and payment of basic medical insurance premiums
.
Banking and insurance supervision departments should strengthen the industry supervision of commercial insurance institutions undertaking serious illness insurance, and regulate the development of commercial health insurance
.
The rural revitalization department must do a good job in monitoring and information sharing of the rural population prone to return to poverty
.
The trade union shall provide mutual medical assistance to employees and help employees suffering from serious illnesses and difficulties
.

(15) Strengthen departmental coordination
.

(16) Strengthen fund budget management
.
On the basis of ensuring the safe operation of the medical aid fund, coordinate the fund budget and policy formulation as a whole, and implement the responsibility of guaranteeing medical aid investment
.
Broaden funding channels, mobilize social forces, raise funds through multiple channels such as charity and social donations, and coordinate the use of medical assistance funds
.
Strengthen budget implementation supervision and comprehensively implement budget performance management
.
Promote the coordination between the overall level of medical assistance and the overall level of basic medical insurance, and improve the efficiency of the use of assistance funds
.

(16) Strengthen fund budget management
.

(17) Strengthen capacity building at the grassroots level
.
Strengthen the construction of the grassroots medical security handling team, coordinate the needs of medical security public services and the allocation of service capabilities, and make corresponding guarantees
.
Actively introduce social forces to participate in handling services, vigorously promote the sinking of medical assistance handling services, and focus on improving informatization and handling service levels
.
Strengthen medical assistance policies and professional ability training, and strive to build a grassroots management team with high comprehensive quality, good work >
.

(17) Strengthen capacity building at the grassroots level
.

Office of the State Council

October 28, 2021

(This piece is publicly released)