Off-site network settlement, intelligent monitoring and early warning, and price comparison of medicines on the whole network...
Medical insurance informatization benefits millions of households (listen)
Our reporter Li Rui Fangmin Cao Wenxuan "People's Daily" (07th edition on April 20, 2022)
core reading
General Secretary Xi Jinping emphasized: "Let the people have more sense of achievement, happiness and security in the development of informatization."
Medical insurance informatization is the foundation and support for promoting the standardization, standardization and facilitation of medical insurance services.
In recent years, various localities have used information technology to promote the reform of medical insurance, and have made useful explorations in the settlement of medical treatment in different places, the supervision of medical insurance funds, and the centralized procurement of medicines. The sense of gain and happiness of the masses has been continuously improved.
"This time the medical expenses totaled 73,357 yuan. You only need to pay 9,817 yuan by swiping your medical insurance card, and the rest will be settled online." The hospital staff handed over a receipt.
"Don't we need to pay for the medical expenses in advance?" After the confirmation, Li Hai, the family member of the patient, was relieved.
After Li Hai's mother retired, she moved to Qingdao, Shandong from other places.
A few days ago, the old man accidentally fell and was admitted to the Central Hospital of Qingdao West Coast New District. When he was discharged from the hospital, he learned that there was no need to pay in advance, and he praised the reform measures.
In recent years, the construction of medical insurance informatization has been accelerated. All localities rely on intelligent systems and big data platforms to improve management levels and enhance service awareness. The scope of settlement for medical treatment in different places has become wider and wider. With increasing efforts, patients can truly enjoy the benefits of medical insurance reform.
Scan the code for filing, and realize the "all-in-one card" for medical insurance settlement in different places
"In the past few years, reimbursement for medical treatment in other places was not so convenient." Li Hai said that the previous reimbursement process was cumbersome and time-consuming, which was daunting.
In recent years, Shandong Province has built a unified medical security information platform in the province, optimized the settlement mechanism for medical treatment in different places, and achieved full coverage of "one card (code) access".
"Nowadays, the insured can swipe across the province and pay in different places with just a medical insurance card, or activate the medical insurance electronic certificate on the mobile phone. Even if he does not have a medical insurance card, he can scan the code through the medical insurance electronic certificate to pay individuals in different places. Account funds can truly realize the province-wide medical insurance payment for medical treatment and purchase of medicines.” Wang Hongbo, director of the Planning, Finance and Regulations Division of the Shandong Provincial Medical Insurance Bureau, said that since the implementation of “one card (code) access”, Shandong Province has provided a total of Serving 8.6042 million person-times, the province paid an average of 36,000 person-times and 5.472 million yuan per day in different places, and the accumulated funds of medical insurance personal accounts were settled 1.318 billion yuan.
"In the past, the filing procedures were complicated, and long-term residents in different places had to prepare various materials such as household registration certificates and residence permits, and they had to run back and forth. Now they don't need to." Xu Qiang, deputy director of Shandong Medical Insurance Center, said that from January 1, 2022 Since then, Shandong Province has reformed and simplified the policy for medical treatment in other places, integrated and simplified the classification of medical personnel in different places, and improved the efficiency of work.
Meng Qingbo, director of the Medical Insurance Bureau of Qingdao West Coast New Area, demonstrated to reporters, "Look, with the remote registration sign, you can complete the medical insurance registration in a few minutes by scanning the code. It truly realizes 'more information travels, and people run less errands'."
At present, all 4,227 medical institutions in Shandong Province that are eligible for hospitalization have access to the national settlement platform for off-site medical treatment.
All cities in the province have opened the intra-provincial and inter-provincial network settlement for general outpatient clinics, and the number of connected medical institutions has reached 4,497.
Outpatient chronic and special diseases have achieved intra-provincial network settlement, covering all outpatient chronic and special diseases. At present, there are 2,161 medical institutions that have networked settlements.
System monitoring, smart doctors keep people's "medical money"
Walking into the Medical Insurance Fund Investigation and Affairs Center of Jiaojiang District, Taizhou City, Zhejiang Province, the real-time monitoring pictures of 156 private medical institutions in the region are clearly displayed on one side of the monitoring screen.
Ruan Jiyun, head of the Fund Supervision Section of the Jiaojiang District Medical Insurance Bureau, randomly clicked on the picture of a pharmacy, and the video and audio information of the pharmacy was transmitted to the intelligent monitoring system in real time.
This is Jiaojiang District's video and audio monitoring Tianyan Inspection Network. It is also the first intelligent monitoring system built in the province. It covers and monitors all medical insurance designated medical institutions in Jiaojiang District, and realizes the transformation of fund supervision from manual selection and review to big data intelligent monitoring.
The computer operating systems of designated medical institutions in Jiaojiang are also networked with the Medical Insurance Bureau. Once the medical insurance card payment is inflated or the medical insurance usage of individual insured persons is abnormal, the system will automatically warn, forming a closed-loop chain of medical insurance auditing and monitoring.
With the help of digital reform, Jiaojiang District has implemented all-weather, all-round, and full-process monitoring of medical insurance funds to manage the people's "medical money".
In terms of law enforcement, Jiaojiang District has organized multi-departmental forces to establish and improve the medical insurance fund supervision and investigation mechanism before, during and after the event.
"Through the handheld law enforcement system, law enforcement officers are randomly selected to match the inspection objects. After the law enforcement officers arrive at the scene for inspection, they will enter the results into the system for future reference." Ruan Jiyun said.
In 2021, relying on the handheld law enforcement system, Jiaojiang District will inspect a total of 638 designated medical institutions, publicly expose 22 illegal medical institutions, issue warnings to 63 medical institutions, and cancel service agreements for 7 medical institutions. The illegal funds were 1.6319 million yuan.
In terms of medical insurance information review, Jiaojiang District has built an intelligent analysis and review network, which has greatly improved the review efficiency.
"In the past, we used to extract hospital data for manual review. Now, the medical expense settlement of all designated medical institutions has been implemented online. Once a medical institution violates regulations, the system can alert in real time, and realize the whole process of patient inspection, treatment, and medication. Follow up," said Zhang Xiaofen, deputy director of the Jiaojiang District Medical Security Affairs Center.
Price comparison on the whole network, drug procurement has a "reference line" for bargaining
"Felodipine tablets, a commonly used antihypertensive drug, has dropped from 19.2 yuan to 9.6 yuan per box, and children's lung cough granules have dropped from 58.8 yuan to 34.2 yuan per box..." In the Second Affiliated Hospital of Hainan Medical College, Chief Physician of the Department of Pharmacy Wang Wei swiped the mouse and said, "After the pharmaceutical procurement price supervision system was launched, the prices of thousands of drugs have been reduced, saving patients a lot of money."
In 2021, the Hainan Provincial Medical Insurance Bureau began to implement the mechanism of medicine procurement and price monitoring in the province, and introduced third-party information services to guide the price of medicines to return to a reasonable space.
"We rely on the medical insurance information platform to establish a pharmaceutical procurement price supervision system, and use the big data of pharmaceutical prices to horizontally capture the national online prices of drugs and medical consumables, and compare the provincial procurement prices vertically, so that hospitals in Hainan have a bargaining reference line when purchasing. "Hu Yaqiang, Medical and Pharmaceutical Service Management Office of Hainan Provincial Medical Insurance Bureau, said that based on this reference line, they began to monitor the prices of pharmaceutical companies and hospitals participating in pharmaceutical bidding and procurement in the province by introducing an early warning mechanism, establishing point assessment and credit evaluation mechanism.
On Wang Wei's computer, the price of medicines on the bidding website has three areas: red, yellow and green.
She told reporters: "According to the regulations, the hospital can only purchase medicines in the green zone. If it exceeds the standard, the red light or yellow light warns, we will adjust the measures in time, and then negotiate the price."
"For enterprises and medical institutions that have long-term early warnings, low points assessment scores, and refuse to rectify, the competent industry authorities will take the lead in cooperating with multiple departments to adopt interviews, written inquiries, suspension of product listings, inclusion of untrustworthy information records, and prohibition of transactions. and other measures." Hu Yaqiang said.
As of the end of February, the Hainan Pharmaceutical Price Monitoring System had accumulated 252,600 pieces of information on the national price database, and 5,049 pieces of information about companies taking the initiative to reduce prices after early warning. The average drop on the platform was 31.825%, and the highest drop was over 98.93%. billion.
The changes brought about by the procurement and price monitoring mechanism of medicines are not only the price cuts of medicines.
Walking into the health center of Jiamao Town, Baoting County, two panels come into view. There are 340 kinds of medicines and their prices listed on them, while there were only 199 kinds just a year ago.
"We are located in a mountainous area, with a small population and a small amount of drug purchases. Companies are either unwilling to deliver or have a long delivery cycle." Dean Wu Xinguo said that the situation has gradually improved since last year.
"The point assessment and credit evaluation mechanism has set indicators such as grassroots drug supply and delivery timeliness, and it is clarified that if the amount distributed by drug distribution companies to grassroots medical institutions accounts for more than 30% of the total distribution amount, 1 point will be added for every 1% increase, and a maximum of 10 points will be added. "Hu Yaqiang said that combined with the centralized drug procurement policy of primary medical institutions in Hainan, the problem of drug use at the grassroots level has been alleviated.