Recently, the General Office of the State Council issued the Implementation Opinions on Strengthening the Normalized Supervision of the Use of Medical Security Funds (hereinafter referred to as the Opinions).
The "Opinions" pointed out that the medical insurance fund is the people's "medical money" and "life-saving money". Strengthening the normalization of supervision over the use of medical insurance funds is of great significance to ensure the safe operation of medical insurance funds, improve the efficiency of fund use, standardize medical service behavior, and reduce the burden of medical treatment for the masses. It is necessary to fully implement the spirit of the 20th National Congress of the Communist Party of China, accelerate the construction of a normalized supervision system for the use of medical insurance funds with clear powers and responsibilities, strict and powerful, safe and standardized, and efficient rule of law, and resolutely guard the bottom line of medical insurance fund safety.
The Opinions put forward three policy measures, the main contents of which include:
The first is to clarify the responsibilities of all parties. Strengthen the supervision responsibility of medical insurance administrative departments, and strengthen supervision over the signing and performance of medical insurance agreements of medical insurance handling institutions. Strengthen supervision over the medical service behavior, medical expenses, and use of medical insurance funds for insured persons included in the scope of payment by designated medical institutions. Strengthen the responsibility of medical insurance handling institutions for review and inspection, establish and improve business, financial, safety and risk management systems, and do a good job in service agreement management, expense monitoring, fund allocation, treatment review and payment, etc. Strengthen the main responsibility of self-management of designated medical institutions, establish and improve internal management systems related to the use of medical insurance funds, and rationally and standardize the use of medical insurance funds. Strengthen the responsibility of industry department supervisors, and all departments should implement relevant regulatory responsibilities in accordance with the division of duties. Strengthen the territorial supervision responsibility of local governments, local people's governments at all levels have leadership responsibility for the normalization of the supervision of the use of medical insurance funds within their administrative regions, and should coordinate the resources of various departments in the region to form a joint regulatory force to provide a strong guarantee for the normalization of supervision of the use of medical insurance funds.
The second is to normalize supervision. It is clear that it is necessary to make good use of supervision means such as flight inspections, special rectification, and daily supervision to systematically promote fund supervision. Innovate supervision methods, strengthen intelligent monitoring and big data supervision applications, and build a technical defense line for the whole process of pre-reminder, in-event review, and post-event supervision. Improve social supervision, improve the reporting and complaint mechanism of the medical insurance fund, implement the reporting reward system, continue to carry out the exposure of typical cases, strengthen warning and deterrence, and mobilize the enthusiasm of the whole society to participate in fund supervision.
The third is to improve the system and mechanism. It is clear that it is necessary to further improve the regulatory system and mechanism, strengthen the comprehensive application of agreements, administration, and justice, and solve various regulatory problems. Establish and improve a regulatory mechanism that places equal emphasis on incentives and constraints, and stimulate the endogenous motivation of medical institutions to standardize the use of medical insurance funds. Promote information exchange and sharing, and strengthen the effective connection between administrative law enforcement and criminal justice before, during, and after the event. Promptly transfer leads on suspected violations of discipline, violations of official duties, and crimes committed in public office to the discipline inspection and supervision organs. Establish and complete credit management systems, clarifying punishment measures for untrustworthy institutions and personnel. Establish a cross-regional supervision mechanism for medical treatment in different places, and implement the supervision responsibilities of the place of medical treatment and the place of insurance participation. Establish and complete mechanisms for handling major matters, and strengthen local supervision and guidance.
The "Opinions" requires that all regions and departments should be guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully understand the importance of strengthening the normalization of supervision of the use of medical insurance funds, strengthen organizational leadership, refine goals and tasks, and strengthen the implementation of responsibilities. At the same time, improve supervision capabilities, strengthen accountability, do a good job in publicity and education, and create a good public opinion atmosphere. (CCTV News Client)