Clarify the focus of the "14th Five-Year Plan" medical insurance work.


Release time:

2021-03-12

Medical network March 12th hearing medical security related to the vital interests of the people. On March 9, the Chinese government website published the article "Promoting the High-quality Development of Medical Security" published by Hu Jinglin, Secretary of the Party Leadership Group and Director of the National Medical Security Administration in the "Learning Times. The article proposes that during the "14th Five-Year Plan" period, medical security work must adapt to the requirements of entering a new development stage, implementing new development concepts, and building a new development pattern, centering on people's health, and achieving high-quality development. The following key points are worth paying attention:
 
   "Thirteen five" results:
 
  433 new species in 3 yearsDrugsWill meet the conditions of the "Internet" medical services into the health insurance
 
At present, the world's largest basic medical insurance network has been established. Basic medical insurance covers more than 1.36 billion people, the participation rate is stable at more than 95%, and the participation rate of the poor is stable at more than 99.9. The reimbursement ratio within the scope of the employee medical insurance and resident medical insurance hospitalization expenses policy reached about 80% and 70% respectively, and the actual reimbursement ratio of hospitalization and outpatient expenses for the poor was stable at about 80% after being guaranteed by the triple system of basic medical insurance, serious illness insurance and medical assistance.
 
To make up for shortcomings, eliminate blind spots, and establish and improve the medical security system with Chinese characteristics. To strengthen the top-level design, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", which drew a blueprint for medical insurance reform in the next 5 to 10 years. At present, a unified basic medical insurance and serious illness insurance system for urban and rural residents has been established. We will comprehensively promote the combined implementation of maternity insurance and basic medical insurance for employees. It is gradually forming a multi-level medical security system with basic medical insurance as the main body, medical assistance as the foundation, and other security measures developing together. The comprehensive guarantee of the three systems of basic medical insurance, serious illness insurance and medical assistance has played an important role in meeting the basic medical security of the people.
 
Solve the pain points, dredge the blocking points, and effectively improve the people's sense of access to medical insurance, happiness and security. First, a dynamic adjustment mechanism for the drug catalogue has been initially established, including more new and good drugs, significantly improving the drug security capability for cancer, chronic diseases, pediatric diseases, etc., and innovatively implementing negotiated access. The average price of 233 negotiated access drugs has dropped by more than 50%, and many "noble drugs" offer "civilian prices". The 114 drugs negotiated for access in 2018 and 2019 alone will reduce the burden on patients by 72.19 billion yuan from January to November 2020. In the past three years, a total of 433 new drugs have been included, and the list of drugs has reached 2800, basically meeting the needs of clinical medication. The second is to effectively improve the quality of security. We have improved the outpatient security policies and measures, and established and improved the drug use guarantee mechanism for urban and rural residents with hypertension and diabetes. More than 7200 million patients with "two diseases" have benefited, with a cumulative burden reduction of 25 billion billion yuan. Adapt to changes in medical service models, include eligible "Internet" medical services into the scope of medical insurance payment, and vigorously support the development of "Internet" medical services. The third is to strengthen health insurance public services. Standardize the handling service behavior, facilitate people to seek medical treatment in different places, improve the accessibility of high-quality medical services, support the free flow of labor force, basically solve the problems of "advance payment" and reimbursement for running errands for patients seeking medical treatment in different places across provinces, and benefit 7.25 million people in total. We have steadily pushed forward the pilot of direct settlement of outpatient expenses across provinces, benefiting 3.02 million people in outpatient clinics. The fourth is to consolidate the foundation of medical insurance management, continuously improve the level of informatization, standardization, refinement, and rule of law, continuously improve the standardization, convenience, and aging of medical insurance management services, and build the main body of the national medical insurance information platform, and all provinces have opened medical insurance code activation services, The total number of users exceeds 0.45 billion.
 
Break the difficulties, find the fulcrum, to health insurance "small incision big reform" to lead the medical reform to deepen. First, the centralized belt procurement gradually normalized, effectively squeeze the drug water consumption, reduce the burden of the masses, purify the industry ecology, standardize medical behavior. The three batches of state-organized drug collection covered a total of 112 varieties, with an average price reduction of 54%, saving 53.9 billion yuan per year. For the first time, the state organized the collection of high-value medical consumables, and the price of the selected coronary stent decreased by more than 90%, which is expected to save 11.7 billion yuan in medical expenses every year. Governance of high-value medical supplies reform, the abolition of medical supplies plus. Second, continue to consolidate the high pressure of fund supervision, since 2018, a total of illegal and illegal fixed-point investigation and punishment.Medicine730000 institutions recovered 34.87 billion yuan of medical insurance funds, which effectively promoted the standardized diagnosis and treatment behavior of medical institutions. Third, we will continue to deepen the reform of payment methods, push forward the national pilot of disease diagnosis related group (DRG) payment, the regional point number method total budget and the disease score (DIP) payment pilot in an orderly manner, push forward the reform of the payment method of the close county medical community, guide medical institutions to actively standardize diagnosis and treatment behavior, and initially form a diversified compound payment method based on the total budget.
 
War epidemic, stable employment, innovative response to major public health emergencies. First, the "two guarantees" were introduced at the first time to ensure that patients would not be affected by cost problems and that they would be admitted to hospital.HospitalThe treatment will not be affected by the payment policy, and the realization of "early detection, early report, early isolation and early treatment" will be promoted. The accumulated settlement of patient expenses will be 2.84 billion yuan, medical insurance will be 1.63 billion yuan, and special funds for designated treatment institutions will be 19.4 billion yuan. Second, to guide all localities to carry out the centralized procurement of new coronavirus testing reagents, nucleic acid and antibody testing reagents prices fell by 70% and 40% respectively. The third is to optimize the handling services during the epidemic, and propose to optimize the handling services "five offices" to facilitate the public to handle medical insurance business. Support the strengths and "Internet" medical insurance services, and make every effort to ensure that the public medical treatment and purchase drugs. Focus on guiding Wuhan to carry out "Internet" medical insurance to solve the problem of taking medicine for patients with chronic diseases during the epidemic. Fourth, to fully support the resumption of work and production, the national phase of halving the collection of employee medical insurance unit contributions, a total of 9.75 million insured units to reduce the collection of more than 165 billion yuan, in order to maintain employment stability to provide a strong policy guarantee.
 
Key words:
 
  Promote the high-quality development of medical insurance and do a good job of "five more"
 
The theme of economic and social development during the 14th Five-Year Plan period should be to promote high-quality development. Promoting the high-quality development of medical insurance is an inevitable requirement for the medical insurance industry to meet the change, open a new bureau and educate the first opportunity.
 
Promoting the high-quality development of medical insurance is a process from extensive and expansionary development to quality-benefit development. The basic connotation can be summarized as "five more". The first is to be fairer, emphasizing the promotion of common prosperity, allowing all people to share the fruits of development, the masses to have medical insurance, the basic systems and policies between urban and rural areas and regions are unified, treatment and public services are balanced, and rights and obligations are equal. Appropriate tilt protection, and guard against welfarism. The second is to be more efficient, emphasizing the improvement of the efficiency of the use of the fund, paying attention to the input-output ratio, and investing the same funds to purchase better and higher-quality medical services, so that the purchased services are more cost-effective, more economical and more suitable. Third, it is more sustainable, emphasizing continuous stability and ensuring the basic needs of the masses.HealthRights and interests, systems and funds can maintain their own balance in the medium and long term, there is no obvious short board, medical insurance and economic and social coordinated development, the government,EnterprisePersonal responsibility is balanced, and reasonable financing is matched with appropriate treatment. The fourth is to be safer, emphasize the basic system positioning of social security, safeguard the fundamental interests of the overwhelming majority of the people, coordinate the promotion of medical insurance and medical development, ensure the safe operation of the fund, timely payment of benefits, no systemic and overall risks, and no incidents that impact the bottom line of social morality. Fifth, it is more convenient, emphasizing the reduction of waiting time and cost for mass business handling, the service process is simple, convenient and accessible, and the handling is non-sensitive. The integration of traditional services and intelligent services is more humanized and more suitable for the needs of special groups such as the elderly.
 
   The "14th Five-Year Plan" focuses on:
 
  Gradually realize the basic unification of the scope of medical insurance drugs nationwide, and standardize the trading rules of the provincial collection platform.
 
The "14th Five-Year Plan" period is the starting period for the new journey of building a modern socialist country in an all-round way, and it is also a period of opportunity for the reform and development of medical security.
 
To better ensure the people's basic medical security rights and interests. We should pay close attention to the basic national conditions, do our best and do what we can, improve people's livelihood, promote common prosperity and guard against welfarism in the course of development. Establish a medical security treatment list system, standardize the government's decision-making authority, and guide the formation of reasonable and stable expectations. Improve the basic medical insurance financing and treatment adjustment mechanism, and gradually bring outpatient medical expenses into the scope of payment of the basic medical insurance co-ordination fund. To achieve effective convergence with the rural revitalization strategy, and to consolidate and expand the effectiveness of medical insurance in poverty alleviation. Improve the dynamic adjustment mechanism of the medical insurance drug catalog, improve the drug access negotiation system, and gradually realize the basic unification of the national medical insurance drug use scope. Establish a national medical insurance consumables access catalog system.
 
To better meet the diverse security needs of the people. We will improve the medical insurance and assistance system for major diseases, optimize the triple security system of basic medical insurance, serious illness insurance and medical assistance, unify and standardize the medical assistance system, promote the complementary convergence of various medical insurance systems, and establish and improve a long-term mechanism to prevent and resolve poverty caused by illness. Coordinate the mobilization of charitable medical assistance forces, support the orderly development of medical mutual assistance, encourage and guide the development of commercial medical insurance, and give full play to the security synergy.
 
Better protect the people's "life-saving money". Reform and improve the fund supervision system and mechanism, innovate supervision methods, establish and improve the medical insurance credit management system, and continue to combat fraud and insurance fraud with a zero tolerance attitude. Strengthen the fund's medium-and long-term actuarial, improve operational risk assessment, early warning mechanism. Strengthen fund budget management and risk early warning, and fully implement budget performance management. To do a solid basic medical insurance city-level co-ordination, promote provincial-level co-ordination, and promote the basic medical insurance and medical assistance co-ordination level convergence. To benefit from management, strengthen fine management, and steadily improve the level of medical insurance governance.
 
Better guarantee the people's access to quality and affordable medical services. Adhere to system integration and give full play to the basic role of medical insurance in the reform of "three medical linkage. We will promote the institutionalization and normalization of centralized procurement of drugs, and deeply explore the reform of the centralized procurement system for high-value medical consumables. Improve the incentive mechanism and promote medical institutions to implement the policy of collecting drugs and medical consumables. Standardize the trading rules of the provincial pharmaceutical centralized procurement platform, and accelerate the establishment and implementation of the pharmaceutical price and recruitment credit evaluation system. Continue to promote the reform of payment methods, implement a multi-compound medical insurance payment method based on disease (group) payment, and explore the implementation of total payment for close medical associations. Innovate agreement management, establish and improve consultation and negotiation mechanisms between agencies and designated agencies, and explore innovative measures such as cross-regional medical treatment agreement management mechanisms and cross-regional medical insurance management collaboration mechanisms. Improve the price formation mechanism of medical services, establish a scientific price determination and dynamic adjustment mechanism, and continuously optimize the price structure of medical services.
 
Better for the people to provide convenient and efficient health insurance public services. Strengthen the construction of handling capacity and vigorously promote the sinking of services. Improve the insurance service to adapt to the new industry and the new economy, consolidate and improve the quality of insurance, and ensure that the insurance should be fully insured. Promote the standardization and standardization of medical insurance public services, realize one-stop service, one-window processing, and one-order settlement, and further improve the direct settlement system for medical treatment in different places. We will continue to promote the construction of the system's professional style, strictly implement the list of administrative service items handled, fully implement the "good and bad evaluation" system, and strive to realize the service items "immediately, online, nearby and once". Accelerate the construction of a unified national medical insurance information system, and promote the standardization and information construction of medical insurance. Adhere to the parallel innovation of traditional services and intelligent services, accelerate the promotion of intelligence and improve the level of aging, and retain and optimize traditional channels. Improve the level of the rule of law in medical insurance, and implement the concept and method of the rule of law to all aspects of medical insurance management.