Three departments jointly promote the implementation of medical insurance payment reform

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A few days ago, the Ministry of Finance, the Ministry of Human Resources and Social Security, and the National Health and Family Planning Commission jointly issued the "Opinions on Strengthening the Budget Management of Basic Medical Insurance Funds and Giving Play to the Role of Medical Insurance Funds in Controlling Fees" (hereinafter referred to as the "Opinions") to strengthen basic medical insurance funds Budget management of revenue and expenditure to control unreasonable growth of medical expenses.

The "Opinions" clarified that it is necessary to scientifically prepare revenue and expenditure budgets, and all coordinated regions must strictly follow the principle of "revenue and expenditure, balance of revenue and expenditure, and slight balance" to prepare revenue and expenditure budgets; premiums must be collected in full in accordance with the law, and all coordinated regions must further Expand the coverage of basic medical insurance to ensure that the insurance should be fully insured; standardize personal account expenditures, strengthen the management of personal account expenditures of basic medical insurance for employees; to improve the payment policy, the basic medical insurance treatment standard should be adapted to the level of financing and the level of local economic development, and the level of basic medical security should not exceed the affordability of the basic medical insurance fund. we should reasonably widen the gap in reimbursement levels among grass-roots, county-level and urban large hospitals, guide insured patients to seek medical treatment in an orderly manner, and adhere to the actuarial balance of the fund.

The Opinions emphasize the strict implementation of the budget of the basic medical insurance fund. It is necessary to strictly implement the budget of revenue and expenditure, and the budget of the basic medical insurance fund should be carried out in strict accordance with the approved budget and prescribed procedures, and shall not be adjusted at will; implement real-time monitoring of the whole process, improve the medical insurance information system, and implement real-time supervision of the medical expenses of designated medical institutions in advance, in-process monitoring and post-audit, focusing on the tracking, monitoring and evaluation of medical behaviors such as the use of drugs, promote the standard of diagnosis and treatment behavior, prevent unreasonable medical expenses, do a good job in the disclosure of relevant information, and promote the disclosure of the budget and implementation of the basic medical insurance fund to the public.

The "opinion" requires that the reform of the payment method of basic medical insurance should be implemented, and all overall planning areas should be combined with local reality, based on the total budget, outpatient fees per head, hospitalization by disease, disease diagnosis related groups (DRGs), bed-day payment and other ways to adapt to the compound payment methods of different groups of people, different diseases and medical service characteristics, and gradually reduce project-based payment, the reform of payment methods will cover all medical institutions and medical services; establish a quality control mechanism, establish and improve the assessment and evaluation mechanism for the quantity and quality of services of designated medical institutions; establish an incentive and restraint mechanism of "balance retention and reasonable overspending sharing" to encourage medical institutions Improve service efficiency and quality; establish a negotiation and consultation mechanism to ensure that medical insurance funds are affordable, the burden on the masses does not increase overall, and medical institutions have incentives; simultaneously promote supporting reforms, in accordance with the unified deployment of the State Council, vigorously promote the joint reform of medical insurance, medical care, and medicine, accelerate the reform of the system and mechanism of public hospitals and primary medical and health institutions, reform the medical service price formation mechanism, and formulate medical insurance drug payment standards, Vigorously rectify the order of drug production and circulation, and take comprehensive measures to effectively control the unreasonable growth of medical expenses. (Zhang Miaoting)