The circular calls for improving the medical insurance payment mechanism, improving the interest adjustment mechanism, guiding the masses to seek medical treatment in an orderly manner, giving hospitals the motivation to use drugs rationally and control expenses, treating and referring patients reasonably, and stimulating the endogenous motivation of medical institutions to regulate their behavior and control expenses.
At the same time, improve the financing and treatment adjustment mechanism of medical insurance, gradually establish a stable and sustainable basic medical insurance financing mechanism that is compatible with the level of economic and social development and the affordability of all parties, and improve the basic medical insurance treatment adjustment mechanism that is compatible with the financing level. It is necessary to improve the serious illness insurance system for urban and rural residents.
In accelerating the nationwide networking of basic medical insurance and the direct settlement of medical treatment in different places, the notice requires that the hospitalization expenses of retirees resettled in different provinces will be basically settled next year, and by the end of 20 17, the hospitalization expenses in different places that meet the referral conditions will be basically settled.
In addition, the notice also proposes to improve the medical insurance handling mechanism, speed up the establishment of a personnel compensation system that conforms to the characteristics of the medical industry, and mobilize the enthusiasm and creativity of medical staff.
17 province realizes the unified management of people and society with universal medical insurance.
Since the issuance of the State Council's Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, eight provinces (autonomous regions and municipalities directly under the Central Government) such as Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan and Guangxi have officially issued documents to make plans and arrangements for the integration of the medical insurance system for urban and rural residents in this province, and fulfill the task requirements of the State Council in the first half of the year as scheduled.
The above-mentioned eight provinces have made plans and arrangements for comprehensively promoting the integration system from the overall consideration of "trinity" of straightening out the system, integrating the system and improving efficiency. First, it is clearly stated that the management functions of the new rural cooperative medical system undertaken by the health and family planning departments and the medical insurance management functions of urban residents managed by the human and social departments should be merged and unified by the human and social departments. Second, according to the requirements of "six unifications" in the State Council document, it is required to establish a unified basic medical insurance system for urban and rural residents by integrating the two systems of urban residents' medical insurance and the new rural cooperative medical system. The third is to clarify the task division, timetable and road map of the integration work, and put forward specific requirements to ensure the smooth and orderly progress of the integration work.
Up to now, among the 32 provinces, autonomous regions and municipalities (including Corps), 8 provinces (Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan and Guangxi) have issued integration plans, and 9 provinces (Tianjin, Shanghai, Zhejiang, Guangdong, Chongqing, Ningxia, Qinghai and Corps) have fully realized system integration before the release of the the State Council document. The above/kloc It is clear that the integrated and unified basic medical insurance system for urban and rural residents will be handed over to the human and social departments for management, realizing the unified management of the universal basic medical insurance system and even the whole social insurance system, which fully reflects the local party committees and governments' high understanding of the unified medical insurance management system and their profound understanding of the social security system with China characteristics.
From the perspective of local practice, the system integration has achieved remarkable results: First, the masses have generally benefited and the sense of reform has been enhanced. In practice, all localities have adopted the idea of "low payment but not high, high treatment and wide catalogue", and the fairness of residents' medical insurance system has been significantly enhanced, especially the utilization level and security level of rural residents' medical services have been generally improved. The second is to improve the efficiency of public services and reduce administrative costs. Relying on the social insurance public service system, the integrated management services such as enrollment registration, fund collection, rights and interests record and treatment payment have been realized, avoiding repeated investment and multi-head construction and reducing repeated enrollment and subsidies. Only the integration of Shandong Province eliminated 2.5 million duplicate insured persons, saving more than 800 million yuan in financial duplicate subsidies that year. Third, the mutual aid ability of the medical insurance fund has been enhanced, which is conducive to giving play to the basic role of medical insurance in medical reform. All localities pay attention to the laws of social medical insurance system, promote the external incentives and constraints of medical insurance on medical services, and provide a solid foundation for the linkage reform of the three medical services.
The current basic medical insurance system in China
(1) Basic medical insurance for urban workers. It is a social medical insurance system that guarantees the basic medical needs of employees according to the affordability of finance, enterprises and individuals and implements territorial management. The basic medical insurance premium is shared by both employers and employees, and the basic medical insurance is combined with social pooling and individual accounts.
(2) Basic medical insurance for urban residents. It is a medical insurance system with urban minors and unemployed urban residents who have not participated in medical insurance for urban workers as the main participants; The basic medical insurance for urban residents is mainly based on family contributions, and the government gives appropriate subsidies;
(3) New rural cooperative medical system. It is a mutual medical assistance system for farmers with serious illness, which is organized, guided and supported by the government, with farmers participating voluntarily, and individuals, collectives and the government raising funds in many ways.
The State Council interprets and integrates the basic medical insurance for urban and rural residents.
First, why should we integrate the basic medical insurance system for urban residents and the new rural cooperative medical system?
In 2003 and 2007, China established the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system) and the basic medical insurance for urban residents (hereinafter referred to as the medical insurance for urban residents) for rural population and urban unemployed population respectively. Since the establishment of the system, the coverage has been continuously expanded, the level of security has been steadily improved, and the system has been running smoothly, which has played an important role in improving the national basic medical insurance system, meeting the people's basic medical insurance needs and improving the people's health level.
In recent years, with the rapid development of economy and society, the negative effects of the urban-rural division of the two systems have begun to appear, and there have been problems such as repeated participation in insurance, repeated investment and insufficient treatment. On the basis of summarizing the operation of urban residents' medical insurance and the new rural cooperative medical system and exploring practical experience in various places, the CPC Central Committee and the State Council clearly put forward to integrate the two systems of urban residents' medical insurance and the new rural cooperative medical system and establish a unified basic medical insurance system for urban and rural residents.
2. What is the progress of exploring and integrating the medical insurance system for urban and rural residents in various places? What is the implementation effect?
At present, some provinces, cities and counties have realized the integration of medical insurance system for urban and rural residents. All localities generally straighten out the administrative system according to the path of "centralized management first, then integration", unify policies according to the principle of "low fund-raising, high treatment, and narrow catalogue", and gradually transition by means of "one system with multiple files, financing linked with treatment" to establish a unified basic medical insurance system for urban and rural residents. Integrate handling management resources and implement integrated handling services. Improve the level of information management by improving the medical insurance information management system. Properly handle special problems, do a good job of system connection, and achieve a smooth transition.
Generally speaking, local exploration provides a useful reference for integrating the medical insurance system for urban and rural residents nationwide. The integration of some areas has achieved initial results, which has expanded the fund's ability to resist risks and avoided repeated participation in insurance, subsidies and construction to some extent. However, due to the lack of top-level design and system promotion, the coordinated development of medical insurance system and medical service system needs to be further strengthened, and the financing fairness of medical insurance system needs to be further improved.
3. At present, what is the significance of the central government's decision to comprehensively promote the integration of urban and rural residents' medical insurance system?
Integrating the two systems of urban residents' medical insurance and the new rural cooperative medical system and establishing a unified medical insurance system for urban and rural residents is an important measure to promote the reform of medical and health system, realize the fair enjoyment of basic medical insurance rights and interests for urban and rural residents, promote social fairness and justice, and enhance people's well-being, and is of great significance to the coordinated development of urban and rural economy and society and the comprehensive construction of a well-off society. Establishing the medical insurance system for urban and rural residents is conducive to promoting fairer security, more standardized management services, more effective use of medical resources, and promoting the sustained and healthy development of the universal medical insurance system.
4. What is the general idea of comprehensively promoting the integration of medical insurance system for urban and rural residents? How to grasp the basic principle?
The general idea is to start with policies, make things easy first and then difficult, step by step, "unify the system, integrate policies, balance levels, improve mechanisms and improve services". Highlight the integration of systems and policies and implement the "six unifications"; Highlight the rationalization of management system, integrate handling institutions, and provide integrated urban and rural handling services; Highlight the improvement of service efficiency, realize gradual transition and smooth integration, and establish a unified basic medical insurance system for urban and rural residents.
Basic principles: First, overall planning and coordinated development. Incorporate the medical insurance system for urban and rural residents into the development of universal medical insurance system and deepen the overall situation of medical reform, highlight the linkage of "medical insurance, medical care and medicine" and strengthen the system convergence. The second is to base on the basics and ensure fairness. According to the level of economic and social development, the burden of urban and rural residents and the ability to bear funds, fully consider and gradually narrow the gap between urban and rural areas and regional differences to ensure that urban and rural residents enjoy basic medical insurance benefits fairly. The third is to adjust measures to local conditions and advance in an orderly manner. Strengthen the connection before and after the integration, ensure the smooth continuation and orderly transition of the work, ensure that the basic medical insurance benefits of the people are not affected, and ensure the safe operation of the fund and the system. The fourth is to innovate the mechanism and improve efficiency. Adhere to the separation of management and operation, improve the management and operation mechanism, and further promote the reform of payment methods. Give full play to the role of market mechanism and mobilize social forces to participate in basic medical insurance services.
Verb (abbreviation of verb) How to implement "six unifications" in the process of integrating medical insurance system for urban and rural residents?
Starting from the policy, we should integrate the medical insurance system for urban and rural residents, with the focus on integrating its financing and treatment guarantee policies. On the basis of studying and comparing the differences between the original two systems and summing up the practical experience of various places, the policy integration requirements of "six unifications" are put forward.
First, we should unify the coverage. Medical insurance for urban and rural residents covers other urban and rural residents except the urban employed population. Migrant workers and flexible employees who have difficulties in participating in employee medical insurance are allowed to choose to participate in urban and rural residents' medical insurance.
Second, we must unify the fund-raising policy. Adhere to multi-channel financing, reasonably determine the unified financing standards for urban and rural areas, improve the dynamic adjustment mechanism of financing, and improve the financing sharing structure. In areas where there is a big gap between urban residents' medical insurance and the new rural cooperative medical system, different payment methods can be adopted to gradually transition. Gradually establish a mechanism linking individual payment standards with per capita disposable income of urban and rural residents.
Third, we must unify protection and treatment. Gradually unify the scope of protection and payment standards, maintain the proportion of hospitalization expenses within the policy range at around 75%, and gradually improve the level of outpatient protection. Properly handle the convergence of special safeguard policies before and after integration, and gradually narrow the gap between the payment ratio within the policy scope and the actual payment ratio.
Fourth, we must unify the medical insurance catalogue. According to the relevant provisions of the state, all provinces follow the principles of clinical necessity, safety and effectiveness, reasonable price, appropriate technology and affordable funds, and on the basis of the existing urban residents' medical insurance and the new rural cooperative medical system, give due consideration to the changes in the needs of the insured, and formulate a unified catalogue of medical insurance drugs and medical services.
Fifth, we must unify fixed-point management. Unify the management measures of designated institutions, strengthen the management of designated service agreements, improve the evaluation mechanism, and implement dynamic access and exit. Adopt a policy of equal treatment for social medical care.
Sixth, we should unify fund management. Implement a unified fund financial system, accounting system and fund budget and final accounts management system, strengthen internal control management and external supervision system, promote total payment control, improve fund operation risk early warning mechanism, reasonably control fund balance, prevent fund risks and improve efficiency.
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