Our city introduced the high -quality development work plan of the "14th Five -Year Plan" medical insurance industry

In order to further deepen the reform of the medical security system and promote the high -quality development of the city's medical security undertakings, recently, the "High -quality Development Work Plan of the Fourteenth Five -Year Plan" period in Shantou City was formulated. The plan proposes that by 2025, the medical security system of our city will be more sound, and the reform tasks of key areas of important mechanisms such as treatment guarantee, fundraising operation, medical insurance payment, fund supervision, and medical insurance management services are fully completed. Fair and moderate, the fund operation is more stable and sustainable, the medical insurance management is more fine and efficient, the medical insurance services are more optimized and convenient, and the disease is better guaranteed.

Implement the national insurance plan to improve the quality of participation in insurance participation

The plan proposes that it is necessary to focus on improving the quality of participation, and to promote flexible employment personnel, including various new formats, to participate in basic medical insurance in the appropriate way. Improve the payment method of flexible employment personnel to participate in the insurance, and let the household registration restrictions on the participation of flexible employees. Vigorously promote the employment of Hong Kong, Macao and Taiwan in the new business formation and living place. Implement the national insurance plan, actively guide employees and urban and rural residents to participate in the insurance place and resident place to avoid repeated insurance, and the coverage rate of basic medical insurance insurance participation is stable at more than 95%. Optimize the insurance payment services of urban and rural residents, actively play the role of towns (streets) in the insurance collection, strengthen "online+offline" cooperation such as medical security, tax departments and commercial banks, and enrich the channels for participating in payment. It is necessary to consolidate the treatment of basic medical insurance, steadily improve the treatment of outpatient clinics, and make a good connection of outpatient treatment and hospitalization treatment.

It is necessary to reform the basic medical insurance account of employees and reasonably adjust the method of personal accounts. Improve high blood pressure and diabetes outpatient drug guarantee mechanism for urban and rural residents, and promote early diagnosis and early treatment and medical defense integration. Promote the reform of the payment method of maternity and medical expenses, the hospital delivery is paid according to the disease type, and the prenatal examination is paid according to the head of the person, and the control of the maternity medical expenses is unreasonable. It is necessary to establish a benchmark rate system, uniformly standardize the payment base policy, reasonably determine the rate, and implement dynamic adjustments. Increase the proportion of the overall fund in the basic medical insurance fund of employees.

Explore and broaden medical assistance fundraising channels

The plan proposes that we must improve the multi -level medical security system, explore and broaden the channels for funding for medical assistance, encourage social donations and other channels to raise funds, and strengthen the investment of medical assistance in medical assistance. Improve the timely and accurate identification mechanism of medical assistance objects to implement dynamic monitoring. Establish a multi -level medical assistance system, improve the rescue mechanism for hospitalization and outpatient medical expenses, improve the "secondary rescue" policy, and enhance the guarantee of medical assistance. By clarifying measures such as diagnosis and treatment plans, standardized referrals, and other measures to reduce medical costs, increase annual medical assistance limit, and reasonably control the proportion of costs within the scope of the policy scope of the poor. Comprehensively implement the policy of funding for key rescue objects to participate in the insurance payment policy, establish a mechanism for preventing and resolving the poverty -elites due to illness, and coordinate the implementation of special treatment of major illnesses, actively guide social forces such as charity to participate in the support of assistance, promote the connection between medical assistance and other social assistance system Essence Do a good job of connecting the operating mechanism of emergency rescue assistance in the disease to ensure that patients with emergencies need to be emergency must not affect the treatment in a timely manner due to expenses. Stable establish a long -term nursing insurance system, and explore the establishment of a multi -channel fundraising mechanism of mutual assistance, co -responsibility, and dynamic adjustment.

It is necessary to optimize the service of medical security during major epidemics, and open the "green channel" of medical institutions' funding, settlement and emergency drug procurement. Under emergencies such as emergencies such as emergencies, medical insurance for medical insurance is paid in a timely and full amount to ensure that patients do not affect treatment due to expenses. It is necessary to classify and optimize the comprehensive assistance policy of medical security, comprehensively implement the cost of seeking medical treatment for low -income people in rural areas, guiding reasonable diagnosis and treatment, promoting orderly medical treatment, and improving the level of rural medical security and health management.

Explore the separate payment of medical services and medicines

The plan proposes to deepen the reform of the medical insurance payment method, improve the total budget of the regional digital method and pay the payment method (DIP) medical insurance payment method according to the type of disease. Support the development of grass -roots medical and health institutions, improve the scope of diseases that are suitable for grass -roots medical institutions, guide reasonable medical treatment, and promote the first diagnosis of grassroots. Deepen the reform of the outpatient payment method, improve the general outpatient clinic, pay the first payment, and pay the special chronic diseases of the outpatient clinic at the head or disease. Establish a medical insurance payment method that is in line with the characteristics of traditional Chinese medicine, and guide grass -roots medical institutions to provide appropriate Chinese medicine services. Innovation with the development of high -level hospitals to be adapted to the payment method, and promote the reasonable application of new medical technology. Promote the comprehensive pilot reform of the comprehensive reform of medical insurance payment methods with a performance -oriented medical insurance payment. Promote the payment of medical treatment in different places in the province, guide medical institutions for reasonable diagnosis and treatment, and improve the effectiveness of medical insurance funds. Explore the separate payment of medical services and medicines. It is necessary to comprehensively promote the reform of the centralized procurement system for drugs and medical consumables, establish information monitoring and disclosure mechanisms such as medical prices, diseases and costs, carry out medical prices and bidding procurement credit evaluations, and improve the price letter inquiry and interview system.

The plan proposes that we must deepen the reform of "decentralization of service" in the field of medical security, implement the management of government service services for medical insurance, and realize the "one -stop" service, "one window" processing, and "one -order" settlement.Innovate the medical insurance service model, actively build the service hall and online platforms, mobile terminals, self -service terminals, consulting hotlines, etc. to complement the full -scale service pattern, and explore the implementation of the "video office".Actively promote the "Internet+Medical Insurance", combine service characteristics to improve the management and settlement process, actively explore information sharing, and realize the integrated services of prescription transfer, online payment settlement, and delivery of drugs.(Source Shantou Daily)

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