Medical insurance fund supervision is on the track of legalization and institutionalization

Breakthrough in medical and health system reform during the "13th Five-Year Plan" period

　　□ Our reporter Hou Jianbin

　　During the "13th Five-Year Plan" period, the construction of a healthy China has embarked on a new journey and opened a new stage.

General Secretary Xi Jinping emphasized that people’s health should be given a strategic priority for development, focusing on popularizing healthy life, optimizing health services, improving health protection, building a healthy environment, and developing health industries to accelerate the construction of a healthy China.

　　Under this guidance, the construction of a healthy China has entered the fast lane: from the important decision of the Fifth Plenary Session of the 18th Central Committee of the Communist Party of China to "promote the construction of a healthy China" to the convening of the first national health and health conference in the new century; China’s action plan-the "Healthy China 2030" Planning Outline, and then to the "Implementation of a Healthy China Strategy" proposed by the 19th National Congress of the Communist Party of China... the guiding ideology, top-level design and implementation path for accelerating the construction of a healthy China with the people as the center, Deepen, systemize, and concretely step by step.

　　In the past five years, the Party Central Committee has incorporated the work of medical reform into the work of comprehensively deepening reform, making overall planning and overall advancement, and deepening the reform of the medical and health system has made breakthrough progress and achieved world-renowned achievements.

　　Professor Chen Yude of the School of Public Health of Peking University told the reporter of the Rule of Law Daily that the new crown pneumonia epidemic is a major public health emergency with the fastest spread, the widest range of infections and the most difficult prevention and control since the founding of New China. Yan is a big test.

This fight against the new crown pneumonia epidemic shows that

　　my country's public health service system, medical service system, medical security system, drug supply security system, and major epidemic prevention and control and emergency management systems are generally effective.

Zhimi Basic Medical Insurance Network

Medical insurance fund supervision is on track

　　Without the health of the whole people, there will be no comprehensive well-off.

　　In the past five years, my country's medical and health system reform has continued to deepen, and the people's health status and the fairness and accessibility of basic medical and health services have continued to improve.

　　Back in January 2016, the State Council issued the "Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents", and medical insurance covering the entire population began to follow reality.

　　In the past five years, the world’s largest basic medical insurance network has been further woven, with a coverage rate of 98%, benefiting nearly 1.4 billion people.

　　Wang Yue, a professor at the School of Medical Humanities of Peking University, believes that although the current level of universal medical insurance is not even between urban and rural areas, China, with the largest population in the world, has achieved the goal of everyone’s medical insurance in the shortest time and gave a "Chinese solution to the medical reform problem." ".

　　In the past five years, the medical reform has yielded fruitful results, and the level of medical security has been greatly improved. The per capita financial subsidy standard for basic medical insurance for urban and rural residents has been increased from 240 yuan in 2012 to 550 yuan in 2020.

　　It is worth mentioning that after the outbreak of the new crown pneumonia, the basic medical insurance network has been accurately deployed to ensure that patients will not be affected by cost issues and that hospitals will not be affected by payment policies.

　　According to data from the National Medical Insurance Administration, as of July 19 this year, 135,500 medical insurance settlements occurred in confirmed and suspected patients with new coronary pneumonia nationwide, involving 1.847 billion yuan in medical expenses and 1.232 billion yuan in medical insurance payments.

　　The supervision of the medical insurance fund is also advancing simultaneously. In order to prevent the medical insurance fund from becoming a new "tang monk meat", the National Medical Insurance Bureau has successively made moves and actions frequently.

　　At the same time, the supervision of medical insurance funds has begun to follow the rule of law and institutionalization.

In 2018, the "Notice on Strengthening the Current Management of Medical Insurance Agreements to Ensure Fund Safety" was issued, and in 2019, the "Notice on Implementing the "Two Pilots and One Demonstration" Work for Medical Insurance Fund Supervision".

　　Since the beginning of this year, many documents have focused on the safety of medical insurance funds.

In March, 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."

In July, the General Office of the State Council issued the "Guiding Opinions on Promoting the Reform of the Medical Security Fund Supervision System".

　　It can be seen that the inefficient use of medical insurance funds and the frequent occurrence of fraudulent insurance problems are being corrected with iron fists.

The medical insurance fund is the "life-saving money" of the people, and the promise of never letting the medical insurance fund become the new "tang monk meat" is being fulfilled.

There is a new "solution" to difficult medical treatment

Orderly advancement of the hierarchical diagnosis and treatment system

　　Promote the lowering of the focus of medical and health work and the sinking of medical and health resources, promote the equalization of basic public services in urban and rural areas, provide the people with safe, effective, convenient and inexpensive public health and basic medical services, and truly solve the problem of difficult and expensive medical care for the grassroots.

　　In the past five years, there has been a new "solution" to solve the hard bone of "difficult medical treatment".

　　Ma Xiaowei, director of the National Health Commission, believes that solving the "difficult to see a doctor" problem that the people are generally concerned about is the focus of my country's medical and health work. The most realistic way is to adopt a hierarchical diagnosis and treatment system.

　　In fact, as early as 5 years ago, my country issued special regulations for the hierarchical diagnosis and treatment system, that is, the "Guiding Opinions on Promoting the Construction of a Hierarchical Diagnosis and Treatment System."

　　Since then, relevant supporting measures for graded diagnosis and treatment have been launched.

　　It is worth mentioning that the "Guiding Opinions on Promoting the Construction and Development of Medical Consortiums" issued by the General Office of the State Council in 2017 is considered by the industry to deepen the reform of medical insurance and medicine linkage, rationally allocate resources, and enable the grassroots to enjoy high-quality and convenient medical services. Important move.

　　In the past five years, the construction of my country's hierarchical diagnosis and treatment system has progressed in an orderly manner.

　　In Zhejiang, 70 counties (cities, districts) have fully launched the construction of medical consortia, 161 medical consortia have been established, and county and township medical and health institutions have been integrated.

　　Anhui takes the construction of a compact county-level medical community as the starting point, and links the six key links of the people to see a doctor, not only allows residents to enjoy county-level medical expert services in towns and towns, but also implements a medical insurance compensation policy of graded diagnosis and treatment, effectively alleviating the difficulty of residents in seeing a doctor. Medical treatment is expensive.

　　In Beijing Fangzhuang Community Health Service Center, the number of outpatient visits in 2019 has reached 481,000. 70% of the contracted residents of Fangzhuang community have their first visits in the community, and the control rate of chronic diseases is also increasing year by year.

　　"The implementation of the hierarchical diagnosis and treatment system has effectively solved the problem of scientific allocation of medical resources. The big hospitals are truly used to solve difficult and miscellaneous diseases, and the primary hospitals can solve the needs of common and chronic diseases to avoid excessive concentration and waste of medical consultations. High-quality medical resources." said Deng Yong, associate professor of medical and health law in the Department of Law of Beijing University of Chinese Medicine.

"Internet +" takes root

Time for medical treatment is greatly shortened

　　In the past five years, with the help of "Internet + medical health", people's medical behavior has undergone profound changes: with only one mobile phone, the entire process from registration payment, information inquiry to online payment can be completed.

　　In Guangdong, 87% of public hospitals above the second level basically implement one-click diagnosis and treatment services such as appointment registration, appointment inspection, inspection and inspection result query, etc. Patients can achieve remote treatment at 1,146 township health centers, 2,377 village health stations, and 57 county hospitals. One-stop medical consultation.

　　The promise of letting information run out more and letting the masses run less” has been fulfilled in the medical field.

　　In 2018, the State Council issued the "Opinions on Promoting the Development of "Internet + Healthcare" (hereinafter referred to as the "Opinions").

Deng Yong said that the issuance of the "Opinions" means that "Internet + medical health" has opened a new stage.

　　Driven by policies, "Internet + medical health" has ushered in a period of opportunity.

　　The National Health Commission revealed that in 2019, more than 5,500 hospitals above the second level provided online services, and more than 9,100 hospitals carried out telemedicine; the appointment rate of third-level hospitals exceeded 50%, and more than 1,200 hospitals carried out day surgery.

　　During the new crown pneumonia epidemic, all localities rely on "Internet + medical health" to provide people with a series of services such as epidemic prevention science popularization, online consultation, psychological counseling, remote consultation, chronic disease follow-up, and drug delivery, reducing the risk of infection in offline crowds.

　　It is worth noting that while more than 40,000 medical staff are rushing to help Hubei, more doctors have used the advantages of information technology to open up a "second battlefield" on the Internet, and strongly support Hubei's main battlefield.

　　Mao Qun'an, Director of the Planning Department of the National Health and Health Commission, said frankly that "Internet + medical health" is convenient to break through time and space. During the epidemic, it has obvious advantages in finding possible infected persons, reducing transmission routes, and reducing the risk of infection.

　　Fortunately, in the past few years, the construction of national health information has made positive progress and results, the top-level design has been gradually improved, the infrastructure has been strengthened, and the benefits of convenience and benefits have become increasingly obvious.

　　Enabling all Chinese people to enjoy a higher level of medical and health services is an important part of the two centenary goals.

In 2020, the first hundred-year goal of struggle will be achieved. The nearly 1.4 billion Chinese people will surely take a healthier attitude towards a well-off road and march towards a new journey towards the great rejuvenation of the Chinese nation.