[Commentary] On July 26, the State Council Information Office held the "Opinions on Optimizing Convenient Services in the Medical Insurance Field" (hereinafter referred to as the "Opinions") a regular briefing on the State Council's policies.
Duan Zhengming, head of the Fund Supervision Department of the National Medical Insurance Administration, introduced that since its establishment, the National Medical Insurance Administration has cooperated with the National Health Commission and the Ministry of Public Security to jointly carry out special governance. As of 2020, a total of 34.87 billion medical insurance funds have been recovered.
[Concurrent] Duan Zhengming, Head of the Fund Supervision Department of the National Medical Insurance Administration
As of 2020, we have inspected a total of 1.71 million designated medical institutions, and 700 (over) million cases were found to be problematic.
Among them, 14,000 cases were administratively punished, 14,000 cases were cancelled for fixed-point agreements, 770 cases were transferred to justice, and 34.87 billion yuan of medical insurance funds were recovered.
[Explanation] Aiming at difficult problems such as slow medical insurance procedures for ordinary people and multiple materials, Jiang Chengjia, head of the Medical Security Business Management Center of the National Medical Insurance Administration, introduced that the "Opinions" require that the "National Medical Security Administration and Government Services Matters be fully realized by the end of 2021" The "List" (hereinafter referred to as the "National List") system is implemented in all levels of medical insurance departments.
[Concurrent] Jiang Chengjia, Head of the Medical Security Management Center of the National Medical Insurance Administration
The "National List" clearly requires that the handling of service matters involving the masses does not exceed 4 types of materials, which are listed one by one, and the vague expressions such as "other materials" and "related materials" are cancelled. 9 service items can be certified for one certificate. To handle, the commitment system is implemented for 4 service items.
The largest reduction in materials has been reduced from 10 to 3, and the overall reduction in the number of materials required for processing exceeds 40%.
In the "Opinions", we have further made clear arrangements for the list system, requiring full implementation of the list management of medical insurance handling services. By the end of 2021, we will fully implement the list system in all levels of medical insurance departments and basically realize medical insurance handling services. There is no difference in handling across the country, and it is required to resolutely cancel handling links and materials beyond the requirements of laws, regulations and national policies.
[Explanation] There are still some obstacles to the direct settlement of basic medical insurance outpatient expenses across provinces. Jiang Chengjia said that by the end of 2021, the direct settlement of ordinary outpatient expenses will basically achieve full coverage of the inter-provincial coordinated area.
[Concurrent] Jiang Chengjia, Head of the Medical Security Management Center of the National Medical Insurance Administration
Before the end of 2021, the direct settlement of general outpatient expenses will basically be achieved across the provinces and the overall coverage will be fully covered.
At the same time, each province has at least one coordinating area for 5 outpatient chronic diseases that are in high demand and are widely developed in various regions, including hypertension, diabetes, malignant tumor outpatient radiotherapy and chemotherapy, uremic dialysis, and anti-rejection treatment after organ transplantation. Achieve direct settlement of related treatment costs across provinces.
Dong Zeyu reports from Beijing
Editor in charge: 【Luo Pan】