Home » In the next five years, medical insurance reform will benefit the people. The National Medical Insurance Bureau explains in detail the “Fourteenth Five-Year” National Medical Insurance Plan_Sina News

In the next five years, medical insurance reform will benefit the people. The National Medical Insurance Bureau explains in detail the “Fourteenth Five-Year” National Medical Insurance Plan_Sina News

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Original Title: The National Medical Insurance Administration Explains the “Fourteenth Five-Year Plan for Universal Medical Security” in the next five years

According to Xinhua News Agency, Beijing, September 29 (Reporters Peng Yunjia and Mu Tiecheng) According to the “14th Five-Year Plan for National Medical Insurance” issued by the State Council on the 29th, how will the medical insurance reform go in the next five years? In what ways will the masses benefit? The National Medical Insurance Bureau gave detailed answers at the State Council’s regular policy briefing on the 29th.

  Meet the multi-level medical insurance needs of the masses

“By the end of 2020, the number of people participating in basic medical insurance nationwide will reach 1.36 billion, and the participation rate has stabilized at more than 95%.” Shi Zihai, deputy director of the National Medical Insurance Bureau, introduced that my country has established the world‘s largest basic medical insurance covering all people. net.

At present, the development of my country’s medical security is still unbalanced and insufficient, and the multi-level medical security system is not yet complete. The coordination of medical insurance, medical care, and pharmaceutical reforms needs to be further enhanced.

Shi Zihai introduced that in the future, based on basic insurance, consolidate the basic medical security system, improve the medical insurance and rescue system for major diseases, strengthen the complementary connection of basic medical insurance, supplementary medical insurance and medical assistance, enhance basic and comprehensive protection functions, and encourage commercial health The orderly development of insurance development and medical mutual assistance meets the multi-level medical security needs of the masses.

“Through the implementation of a triple system of basic medical insurance, critical illness insurance, and medical assistance, medical insurance for poverty alleviation will benefit 530 million poor people in total from 2018 to 2020.” Shi Zihai said that the protection of major diseases in the next five years will be more effective, and the core is to establish a sound prevention and control system. A long-term mechanism for resolving poverty and returning to poverty due to illness. Including the establishment of a timely and accurate identification mechanism for medical assistance objects, and the implementation of hierarchical and classified assistance for different types of difficulties.

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He said that the level of inpatient and outpatient coverage will be more balanced, which will further benefit the public. On the basis of the level of economic and social development and the affordability of medical insurance funds, the comprehensive protection function of the “triple system” shall be fully coordinated, including the establishment and improvement of a mutual assistance guarantee mechanism for outpatient medical insurance for employees.

  Improve the efficiency of the use of medical insurance funds

“We need to make new and good medicines more accessible, and benefit the people more.” Shi Zihai said that since the establishment of the National Medical Insurance Agency, the medical insurance drug catalogue has been adjusted for three consecutive years. At present, 2,800 drugs have been included in the medical insurance drug catalogue.

During the “14th Five-Year Plan” period, the National Medical Insurance Administration will continue to base itself on the fund’s affordability, adapt to basic medical needs and the needs of clinical technology advancement, dynamically adjust and optimize the list of medical insurance drugs, and timely collect those with high clinical value, obvious benefits for patients, and excellent economic evaluation. Medicines and qualified Chinese medicines are included in the scope of payment.

“Since 2018, the state has organized centralized procurement of more than 200 varieties of drugs, and the average price of selected products has fallen by 54%.” A province must purchase more than 500 types of drugs through national and provincial centralized purchases, and the number of high-value medical consumables must reach more than 5 categories.

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In order to ensure that limited medical resources are spent on the “knife edge”, the “Regulations on the Supervision and Administration of the Use of Medical Insurance Funds” implemented on May 1 this year have clarified the “untouchable red line” for the use of medical insurance funds, and have initially formed a fight against fraud. Long-term mechanism for fraudulent insurance.

“From January to August this year, 211,500 institutions across the country have dealt with violations of laws and regulations, and medical insurance funds and liquidated damages of 8.884 billion yuan have been recovered.” Supervision, adhere to zero tolerance, full coverage, and no dead ends, and strive to build a long-term mechanism for fund supervision.

  Provide more convenient medical insurance public services

The plan proposes to provide more convenient, high-quality, efficient and sophisticated services to the insured people and units. Among them, the direct settlement service for medical treatment in other places has attracted much attention.

“At present, all provinces, all insured persons in all coordinating regions, major migrants, and key medical institutions have been included in the direct settlement system for medical and hospitalization expenses across provinces and other places.” Shi Zihai introduced, as of the end of August this year, all provinces and Xinjiang in the country The Production and Construction Corps has launched a direct settlement service for ordinary outpatient expenses across provinces. It has networked 395 coordinating areas, and 2231 counties have realized that each county has at least one designated medical institution that can carry out outpatient settlement across provinces.

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A few days ago, the National Medical Insurance Administration has issued the “Notice on the Pilot Work for Direct Settlement of Outpatient Chronic Special Diseases Related Treatment Expenses”, and launched outpatient radiotherapy and chemotherapy for hypertension, diabetes, and malignant tumors, uremic dialysis, and anti-rejection treatment after organ transplantation. Wait for the pilot work of direct settlement of related treatment costs for five main outpatients with chronic diseases to further meet the medical settlement needs of insured persons.

In the next step, the National Medical Insurance Administration will strengthen the construction of the direct settlement system and mechanism for medical treatment in different places across provinces. It also optimizes cross-provincial off-site medical settlement management services, perfects the national off-site medical management service platform, expands the coverage of cross-provincial direct settlement, etc., and provides online and offline integrated off-site medical settlement services for hospitalization, general outpatient clinics, and outpatient chronic diseases.

Shi Zihai introduced that during the “14th Five-Year Plan” period, a five-level medical insurance service network will be established. While actively promoting the on-site one-stop service in the handling hall, speed up the construction of intelligent medical insurance public service platforms such as the Internet and medical insurance electronic vouchers, and promote the “online management”, “code-based management” and “video management” of medical insurance public services.

Editor in charge: Wang Shumiao SN242

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