Jiangsu's healthy medical insurance and rescue system for major diseases -should be rescued to build the bottom line of people's livelihood protection

The Provincial Government General Office recently issued the "Implementation Opinions on Implementation of Medical Insurance and Rescue System for Heavy Diseases" to further reduce the burden of medical expenses for the people of difficulties and patients with major illnesses, prevent the poverty due to illness, and build the bottom line of people's livelihood. On July 29, the provincial government held a press conference to interpret the "Implementation Opinions".

The Provincial Medical Insurance Bureau's first -level inspector said that the "Implementation Opinions" is not a single reform of the medical assistance system, nor is it simple policy adjustment and treatment improvement. , Basic protection, persist in rescue, do their best, do their best. From the five aspects of scientifically determining rescue objects, regulating the "triple system" positioning and connection, optimizing the rescue trustee plan, improving the function of preventing and returning to poverty due to illness, and supporting and guiding social forces to participate in rescue guarantees Arrangement, mechanism connection, service management, etc. are made.

Determine the rescue object in time and accurately

The "Implementation Opinions" clarify the difficult workers and urban and rural residents with a heavy burden of medical assistance in medical assistance, and implement classification rescue according to the category of rescue objects. Specific rescue targets include special purse personnel, minimum living security objects, children with difficulties, and eligible people who meet the conditions of national pension subsidies, and the civil affairs departments will be quantitatively quantitatively quantitatively quantitatively quantitated in the 1960s. Municipal and district) Federation of Separate employees, members of the ministors of subsistence allowances, major patients with severe diseases in the family of difficulty in expenditure, and patients with major serious diseases in the temporary rescue objects of local household registration, and other special specially stipulated by the district and municipal people's governments. Difficult person.

According to Xiang Bowei, the "Implementation Opinions" guarantee the rescue identity stable on the basis of difficult personnel, and expand the scope of rescue to dynamic difficulties such as members of the minimum -fidible edge family and family members of expenditure -type difficulties. The needs of requirements and institutional capabilities to ensure that they should be rescued. At the same time, do a good job of sharing and classification management of information sharing and classification of rescue objects, strengthen the connection of identification standards and guarantee policies, and comprehensive rescue for layered classification.

Strengthen the comprehensive guarantee of the "triple system"

In accordance with the relevant national opinions, the requirements for subsidizing residents to participate in medical insurance, the "Implementation Opinions" clearly clearly funded residents and other residents to participate in insurance. Family members of the subsistence allowances, patients with major serious illness in expenditure -type families, etc. 80%of the individual payment standards in the region will be provided with a fixed amount of funding, and the newly -added assistance targets that have not been insured will be funded in a timely manner to avoid the waiting period of treatment. Give full play to the basic medical insurance subject protection function, enhance the burden reduction function of major illness insurance, consolidate the support function of medical assistance, and jointly prevent the risk of returning to poverty due to illness. Xiang Bowei said that this move aims to minimize the burden on the insurance payment of difficulties in difficulties, ensure that the insurance should be guaranteed, and give full play to the "triple system" ladder reduction function.

Consolidate the guarantee of medical assistance

Strengthen the fairness of the medical assistance system, promote the connection between medical assistance and basic medical insurance overall levels, and comprehensively realize the scope of unified rescue, rescue standards, management, fixed -point management and information system construction within the scope of districts and cities. The unity and fairness of the rescue system.

Clarify the scope of rescue expenses. Rescue expenses mainly cover outpatients and hospitalization expenses within the scope of policy scope of the rescue target; the drug, medical consumables, and diagnosis and treatment items paid by the rescue fund shall comply with the regulations on the scope of basic medical insurance payment in the country and province; Personal fees within the scope of the policy below the line are included in the rescue guarantee in accordance with regulations, mainly to clarify the guarantee boundary and prevent the protection of pan -welfare.

Reasonably determine the level of basic assistance. There is no payment standard for the full funding objects and approved employees approved by the Federation of Trade Unions, and rescue at a ratio of not less than 80%. Among them, the desperate personnel, orphans and facts in the children of difficulties and facts will be given 100%assistance; Funding funding targets are not higher than 10%of the per capita disposable income of residents in the previous year, and the rescue ratio is not less than 70%; ordinary outpatient rescue limit is not less than 10,000 yuan, outpatient chronic diseases, special diseases and hospitalizations The shared rescue limit is not lower than that of the per capita disposable income of residents in the last year of the coordinated area, mainly to properly increase the level of rescue and fully reduce the burden of personnel in difficulty.

Coordinate and improve the guarantee measures. For the rescue objects that regulate referrals and seek medical treatment in the province, if the personal burden is still heavy within the policy scope of the "triple system", it is given a tilt assistance; After the basic medical insurance, major illness insurance, and medical assistance were reported, the rescue targets were controlled by the personal payment of personal self -payment in the designated medical institutions in the county's designated medical institutions within 10%of the total hospitalization expenses within the scope of the policy.

Improve the long -term mechanism for preventing the poor due to illness

Strengthen early warning and monitoring of high medical expenses expenditure, and implement comprehensive guarantee policies in accordance with the application. The main measures are to rely on the medical insurance information system to monitor and early warning of the high medical expenses of specific people and all the objects participating objects, improve the departmental coordination mechanism, and rescue the conditions for eligible conditions. The transformation of people "; comprehensively establish a member of the family members of the subsistence allowances, and the large serious disease patients in the family members of the subsistence allowances, and the family members of the majority of the household registration. Time -effectiveness; strengthen comprehensive guarantee measures such as medical assistance, temporary assistance, charitable assistance, etc., and accurately implement layered classification assistance. Actively guide social forces to participate in rescue security

Develop and expand charity assistance, encourage commercial supplementary medical insurance and mutual development of medical insurance, and actively promote the construction of a multi -level medical security system. The main measures are to encourage charitable organizations and other social organizations to set up major illness assistance projects to play supplementary assistance; integrate resources such as medical security, social assistance, charitable assistance, etc., and implement comprehensive guarantees; support the development of commercial supplementary medical insurance to meet basic medical insurance Guarantee demand; support the development of employees' mutual assistance, and promote mutual help of rural public welfare medical care.

"Implementation Opinions" will be implemented from January 1 next year.

(Reporter Huang Hongfang)

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