The Secretary interviewed | Making the reform of the health care system "law-based"

Wen| Chongqing Municipal Medical Security Bureau Director, but Yan Yanxuan in-depth promotion of the rule of law medical insurance construction, deepening the reform of the medical security system, is to comprehensively promote the rule of law and the implementation of the "Healthy China" strategy in the context of medical security work to achieve a higher level of security and promote high-quality development of the firm direction and the only way.
To push forward any reform, we must closely focus on the overall goal of comprehensively advancing the rule of law, starting from the actual situation of our country, adapting to the modernization of the national governance system and governance capacity, and ensuring that the reform always operates within the framework of the rule of law, and finally achieve good law and good governance.
Guided by Xi Jinping's thought of socialism with Chinese characteristics in the new era, the comprehensive establishment of a "medical security system with Chinese characteristics" deeply understands the essence of Xi Jinping's new era of socialist thought with Chinese characteristics on the theory of ruling the country by law, the strategic discourse of healthy China and the key issues adopted by the Fourth Plenary Session of the 18th Central Committee of the Communist Party of China.
General Secretary Xi Jinping made it clear at the second meeting of the Fourth Plenary Session of the 18th CENTRAL Committee of the Communist Party of China that the implementation of the plenary session must speed up the formation of a complete legal norm system, an efficient system of implementation of the rule of law, a strict system of supervision of the rule of law, a strong system of guarantee of the rule of law, and a sound system of intra-Party laws and regulations.
19th National Congress of the Communist Party of China made a great judgment on "socialism with Chinese characteristics into a new era" and pointed out that the main contradictions in our society have been transformed into contradictions between the people's growing need for a better life and unbalanced and inadequate development.
After steadily solving the problem of feeding more than a billion people and building a well-off society in an all-round way, the people's need for a better life is growing, not only for material and cultural life, but also for democracy, the rule of law, fairness, justice, security and the environment.
The Fifth Plenary Session of the 18th Central Committee of the Communist Party of China clearly proposed to promote the construction of a "healthy China" and, starting from the overall layout of the "five-in-one" and the coordinated promotion of the "four comprehensive" strategic layout, made institutional arrangements for better safeguarding people's health in the current and future period.
the report of the 19th National Congress of the Communist Party of China stressed the "implementation of the 'Healthy China' strategy" and the provision of a full range of full-cycle health services to the people.
all these need to be followed up by the rule of law construction, all need to be guaranteed by the rule of law.
to accurately grasp the requirements of establishing a comprehensive medical security system with Chinese characteristics, and to clarify that the goal and direction of medical security reform system are fundamental, global, stable and long-term characteristics.
Xi Jinping has repeatedly stressed that universal health care is the foundation of the basic medical and health system with Chinese characteristics, and that a medical security system with Chinese characteristics should be fully established.
The reform of the medical security system is an important support system for realizing the strategy of "Healthy China", and since its establishment, the State Medical Security Administration has been carrying out the spirit of the 19th National Congress of the Communist Party of China on "comprehensively establishing a medical security system with Chinese characteristics", and has firmly promoted the top-level design and overall planning of the medical security system.
On November 26, 2019, the Opinions on Deepening the Reform of China's Medical Security System (hereinafter referred to as opinions) adopted by the 11th meeting of the Central Committee for Comprehensive And Deepening Reform is the first reform document ever issued in the field of medical security in the name of the CPC Central Committee and the State Council.
It is of great significance and far-reaching significance to speed up the deployment of a multi-level medical security system covering the whole people, urban and rural areas, with clear rights and responsibilities, and to ensure a moderate and sustainable multi-level medical security system, and to establish the overall goal of the reform of the national health care system in the next 10 years.
On April 27, 2020, the 13th meeting of the Central Committee for Comprehensive And Deepening Reform considered and adopted the Guidance on Promoting the Reform of the Regulatory System of the Medical Security Fund, stressing the need to adhere to the improvement of the rule of law, supervision in accordance with the law, discipline and trust, encourage good faith, build a whole-field, whole-process fund safety prevention and control mechanism, safeguard social equity and justice, and promote the healthy and sustainable development of the medical security system.
June 30, 2020, the 14th meeting of the Central Committee for Comprehensive and Deepening Reform pointed out that the people's life safety and health should be put first and the concept of health should be strengthened.
we should speed up the key tasks of improving the hierarchical diagnosis and treatment system, deepening the reform of the payment method of medical insurance, strengthening the supervision of the medical insurance fund and perfecting the drug supply guarantee system, perfect the relevant supporting policies, and make a good reform combination.
the introduction of these reform measures have laid a solid foundation for furthering the reform of the health care system, and clear the direction path.
firmly establish the thinking of the rule of law, adhere to the concept of governance according to law, improve the system, improve the ability to govern "to establish good law in the world, then the world to rule;
"Medical security work as an important area of people's livelihood, involving a wide range of circumstances, complex circumstances, many interests, high expectations of the masses, reform is difficult, only a national chess game, in accordance with the "top-level design, overall layout, overall coordination, overall promotion" thinking, firmly rely on accelerating the construction of the medical insurance legal system, and strive to achieve law-based, law enforcement must be strict, illegal, and actively create a law-based, law-seeking, problem-solving and law-based law-based environment.
In concrete practice, thinking work establishes the concept of rule of law, planning work adheres to the rule of law thinking, handles work using the rule of law method, actively thinks about problems under the rule of law, makes decisions and do things, so as to continuously improve the level of medical insurance rule of law, and gradually promote the realization of health insurance governance capacity and modernization of the governance system.
The medical insurance system established by the Social Insurance Law on the Rule of Law of Medical Security and the Dilemma it faces has not been able to adapt to the reform needs of the Social Insurance Law of the People's Republic of China promulgated in 2010 (hereinafter referred to as the Social Insurance Law) for nearly a decade, and its legislative background is that the legal level of the system for obtaining social insurance benefits in accordance with the law has been solidified from the period of planned economy when enterprises provide labor welfare protection for workers to citizens and employers who fulfill their obligations to pay social insurance.
In the legislative case of "five risks in one", corresponding to medical insurance, only ten provisions provide for the basic medical insurance system framework in principle: basic medical insurance for urban workers covers urban workers, basic medical insurance for urban residents covers urban non-employed persons, and new rural cooperative medical insurance covers non-urban residents.
characteristics of "binary governance" of urban-rural division are more prominent.
With the overall development of urban and rural areas, the new rural cooperative medical care and basic medical insurance system for urban residents has become anachronistic, in January 2016 "on the integration of urban and rural residents of the basic medical insurance system" issued, "new agricultural joint" and "urban housing insurance" system in the country in line with the implementation of the social insurance law established by the medical insurance system has been broken.
with the establishment of the "Healthy China" strategy at the 19th National Congress of the Communist Party of China, the Social Insurance Law has not kept pace with the rapid development of the reform of the "three medical associations" of medical care, medicine and medical insurance.
Although the Social Security Act was amended on 29 December 2018, its amendments are limited to two aspects: one reflects the accounting and budget management following the merger of the two major types of health care and maternity insurance;
It still can't meet the needs of medical security reform, its system design can't cover the connotation and extension of medical security, and the power design of social insurance administrative departments, social insurance agencies and social insurance premium collection agencies can't meet the needs of the transformation of the duties of medical security, human social security, taxation and other departments after the institutional reform.
The Basic Medical and Health Promotion Law still cannot meet the real needs of the reform of the medical security system The Basic Medical and Health Promotion Law, which was implemented in June 2020, covers basic medical and health services, medical and health institutions and personnel, drug supply guarantee, health promotion, financial security, etc., and establishes the basic systems of basic medical and health care, graded diagnosis and treatment, modern hospital management, basic medical insurance for all, drug supply guarantee, comprehensive supervision of medical and health care, etc., which embodies the concept of "basic, strong grass-roots, health promotion and development".
The Law clearly states that "the State shall establish a multi-level medical security system supplemented by basic medical insurance, commercial health insurance, medical assistance, mutual medical assistance for employees and medical charitable services" (Article 83) "The competent departments of medical security of the people's governments at or above the county level shall improve the capacity and level of medical security supervision, strengthen supervision and management of medical services and medical expenses included in the scope of payment of the basic medical insurance fund, and ensure the rational use and safe control of the basic medical insurance funds (Article 87)" "The people's governments at or above the county level shall organize the departments of health and health, medical security, drug supervision and management, development reform, finance and other departments to establish communication and consultation mechanisms, strengthen system convergence and coordination, improve the efficiency and level of security of the use of medical and health resources (Article 88)" "The competent departments of health and health care and medical security of the people's governments at or above the county level shall establish credit records systems for medical and health institutions, personnel, etc., and incorporate them into the national credit information sharing platform and implement joint disciplinary measures in accordance with the provisions of the State." Compared with the design of the medical insurance system of the Social Insurance Law, the principled provisions of medical security, although there are great progress and no shortage of legislative highlights, but only some of the requirements of the central government to deepen the reform of the medical security system into the law, to solve the problem of "yes and no" in the law, but did not systematically design the establishment of the medical security system with Chinese characteristics.
in the legal liability section, only the illegal circumstances of drug procurement bidding (not involving the purchase of medical supplies) designed penalties, to combat fraud to cheat health insurance funds and other health insurance focus areas did not make specific provisions.
as a whole, the act embodies the legislative thrust of the health sector to guarantee the level of basic public health services, in which medical security is subordinate.
In addition to the Social Insurance Law and the Basic Medical and Health Promotion Law, laws such as the Military Insurance Law of the People's Republic of China, the Law of the People's Republic of China on the Protection of the Rights and Interests of Persons with Disabilities, the Law of the People's Republic of China on the Protection of the Rights and Interests of The Elderly, and other laws provide for medical insurance for veterans and social security for spouses, disabled persons, women and the elderly who are not employed in the military.
On December 28, 2016, the Standing Committee of the National People's Congress (NPC) issued the Decision authorizing the State Council to temporarily adjust the application of the relevant provisions of the Social Insurance Law of the People's Republic of China in 12 pilot cities, including Yancheng, Hebei Province, providing a legal basis for the implementation of the merger of maternity insurance and basic medical insurance in 12 pilot cities throughout the country.
Administrative regulations, such as the Interim Measures for Social Assistance, the Special Provisions for the Protection of Workers' Labour, and the Interim Regulations on the Collection and Payment of Social Insurance Premiums, provide for the collection and payment of social insurance premiums, including medical assistance, maternity insurance and basic medical insurance.
, Hainan Province, Inner Mongolia Autonomous Region, Tianjin, Guangzhou and other provinces and cities have issued local laws and regulations on basic medical insurance, maternity insurance.
the regulations of the ministry, only the human and social security department in 2011 formulated the "Implementation of the Social Insurance Law of the People's Republic of China" a number of provisions.
followed up with some provinces and issued local government regulations related to medical insurance and maternity insurance.
these laws, regulations, regulations, etc., there are no clear provisions on whether maternity insurance set a waiting period, resulting in a large difference in the specific provisions of maternity insurance treatment throughout the country.
the reform of medical institutions, the health care sector fulfilled its responsibility of setting and adjusting the prices of medical services, and issued guidance on negotiations and collection in some countries, with remarkable results.
However, the specific implementation of the recruitment work should also follow the Price Law of the People's Republic of China, the Rules of Government-made Price Behavior, the Measures for the Government to Set Price Cost Supervision, the Government Pricing Directory, the National Development and Reform Commission Pricing Cost Supervision Directory, and the function of price discovery and value realization of drug supplies has yet to be incorporated into the track of the rule of law and market economy.
Overall, because there is no systemic legislation on medical security, the relevant provisions are scattered in different fields of law, the content is too principled, the legislative level is low, the quality of legislation is not high, lack of scientific, unified, authoritative and mandatory.
In particular, the administrative regulations of the key areas of medical security (e.g., centralized recruitment of pharmaceutical supplies, treatment guarantee) are in a blank state, resulting in the non-operationality of the rules that can be directly applied by the medical security management departments, some of which are no longer in line with the current actual and reform needs.
The legal system of medical security with basic medical insurance as the main body is not suitable for the requirements of "promoting reform on the track of the rule of law and perfecting the rule of law in the process of reform", whether compared with legislation in the fields of education, health, labor and employment, civil affairs, etc., or in the field of mature legal system such as work injury insurance, unemployment insurance and civil assistance.
Policy fragmentation brought about by the institutional dilemma due to the lag in the construction of the legal system, as the core of the medical insurance system for many years by the relevant departments of the State Council and local governments issued normative documents to explore and promote, in view of the problems exposed in the operation of the health insurance system, "point-to-point" way to regulate, where there are omissions.
accumulated over the years, leading to the current national health care policy is not unified, unsymard, fragmented phenomenon is serious.
Secretary Hu Jinglin made it clear that the current health care policy has "complementary up and down, under the rescue there is a bottom" of the reality of the problem.
provinces have different degrees of existence of normative documents bloated, some documents are old, the same problem is constantly patch-type norms.
Taking Chongqing as an example, Chongqing's health insurance department cleaned up the city's stock of normative documents in 2019, and finally there were 26 valid normative documents, which belong to the departments of human social security, health, reform and development, civil affairs and other departments as assured to the responsibilities of the Health Insurance Bureau or have a guiding significance for a certain work of health insurance, a total of 241 normative documents.
a large number of documents "to patch patch", some documents are no longer adapted to the needs of reality, some provisions have deviated from the current requirements of health care reform, policy fragmentation can be seen.
thinking about the construction of medical insurance rule of law is an important part of the "four comprehensive" strategic layout.
to face the new era, new challenges and new missions, and comprehensively promote the administration of medical insurance in accordance with the law, is an important task for the medical security system to carry out the "four comprehensive" and comprehensively promote the rule of law.