In the first half of the year, the work of "Top Ten people's livelihoods" in Zhengzhou City's medical insurance was introduced

□ Henan Daily Client reporter Li Xiaomin Correspondent Zhang Wei

Half a year has passed. What is the progress of the "Top Ten People’s Livelihoods" in the field of medical insurance in Zhengzhou Medical Insurance in 2022? On July 22, the reporter learned from the first half of the operation quality analysis meeting of Zhengzhou Medical Insurance Office that these ten "people's heart projects" have made significant progress and have completed 8 comprehensive completion.

It is understood that the "Top Ten People’ s livelihoods "are: expand the medical direct settlement range of the hospital's outpatient costs, build a" 12393 medical security service hotline "platform, realize the" one -stop settlement "of the approval and payment of maternity insurance benefits, and realize the retired army and rest cadres. Differential medical expenses across provinces, the implementation of employees' medical insurance clinics, the airspace guarantee mechanism, realizing the "global network office" of the chronic disease business, realizing the "One Netcom Office" of designated affairs, promoting the construction of "Zhengzhou Medical Security Service Station", all medical insurance services in the city in the city The lobby is fully applied to the "comprehensive teller system" and realized the "second arrival" of maternity benefits.

Ten "Public Heart Projects" progress list

——Shanging the medical expenses of the hospital for continuous expansion of the medical direct settlement scope of medical treatment. Open 5 pilot outpatient clinics Slow special diseases Different places directly settle in 27 designated medical institutions, and open outpatient costs Different places Different places Directly settle in 186 designated pharmaceutical institutions, and exceed the provincial target in advance.

——Seng Zhengzhou 12393 Medical Security Service Hotline. Adhere to a number to serve "Ten Million Zhengzhou people", adhere to the "7 × 24" full -time online, adhere to policy answers, information inquiry, business guidance, help agencies, complaints and reports to accept the "five -in -one" The results of people's worries and the hearts of the people "have achieved remarkable results. Since the opening of the 12393 hotline, since the opening of April 11, the average daily call volume is 3,000 times, and the connection rate has remained above 98%.

——The "one -stop settlement" for the implementation of maternity insurance benefits and payment. Maternity insurance benefits that occur locally and other places can be reimbursed directly and settled directly. In the first half of the year, a total of 67,166 person -times and 408 million yuan were completed in "one -stop settlement".

——The real estate of retired and military cadres for medical treatment is directly settled across provinces. Complete 26 person -times to complete the medical treatment of retired cadres, and the fund pays 40,300 yuan; completed the number of times to complete the cadre of the military cadres directly, and the settlement amount was 53,800 yuan.

——The employee medical insurance outpatient protection system is fully implemented. Participants who participate in the employee's medical insurance and during the treatment period will enjoy the general outpatient clinic for employee medical insurance in accordance with regulations. During a natural year, insured personnel seek medical treatment at the outpatient medical institution at the designated medical institution, and coordinate the establishment of the fund payment standard and maximum payment limit. The general outpatient clinic coordinating payment standards are set up at a time, 40 yuan each time. One day, the same outpatient medical institution will be planned for multiple medical institutions in one day. The maximum annual payment limit for the co -ordination fund of the employees and retirees was 1,800 yuan and 2300 yuan, respectively. On July 1, 2022, the maximum payment limit for employees and retirees was halved. The general outpatient clinic overall payment limit is not included in the employee medical insurance overall funds of the year's highest payment limit. The general outpatient medical expenses within the scope of the policies above the starting standard and the maximum payment limit shall be paid by the overall funding fund in proportion, and the outpatient medical payment ratio of the outpatient medical institution at the provincial three -level designated medical institution is 55%. The percentage of the outpatient medical institution at other levels of county -level medical institutions is 60%; the proportion of medical payment for outpatient medical treatment in township health centers and community health service centers is 65%. The payment ratio of retirees is 10 percentage points higher than the employee.

——This clinic slow special disease management from "full network office" to "global network office". The scope of business coverage has been expanded from 9 districts in the city to 16 districts and counties (cities), and 162 special medicines are added. In the first half of the year, a total of 37,757 person -times was approved by the outpatient clinic and 26,179 people were approved. In the current period, a total of 989,600 person -times person -by the city's slow special disease treatment.

——The real -point transaction management "One Netcom Office". System development and launch work are ready, and operation is about to start. In the next step, the city's designated pharmaceutical institutions' affairs from admission to changes, and post -evaluation work will all be informationized.

——Shanging the reform of the "one window" and "comprehensive teller system". The city's level and 15 districts (cities) medical insurance agencies have established a "comprehensive teller system" service model. All medical insurance business can be handled in one window, one -by -one acceptance, and one -time settlement.

——Shanging the construction of "Zhengzhou Medical Security Service Station". All 90 "Zhengzhou Medical Security Service Station" construction projects have been started, including 39 designated medical institution sites and 51 financial institution sites. All will be completed and put into operation by the end of September.

——Shanging the reform of the "fertility treatment dialing seconds" reform. The internal process adjustment of the agency has been completed. The next step will be actively coordinated with functional departments and cooperation agencies to fully open up nodes and unblock the network.

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