Cross -provincial medical treatment will be more convenient

Crack the settlement point and difficult point, formulate a unified nationally nationwide norms

Cross -provincial medical treatment will be more convenient

Recently, the State Medical Insurance Bureau and the Ministry of Finance issued the "Notice on Further Doing a Basic Medical Insurance Cross -Provincial Different Place Different Settlement Work" (hereinafter referred to as the "Notice"). This is a new action guide formulated after 6 years later Essence What are the highlights of this notification content and what will it affect the insured person's inter -provincial medical treatment? The relevant person in charge and experts of the National Medical Insurance Bureau interpreted this document.

Relying on online service channels to improve cross -regional business collaborative processing capabilities

In recent years, the direct settlement policy of cross -provincial medical treatment in my country has expanded from hospitalization to ordinary outpatient clinics, and then expanded to slow special diseases of outpatient clinics. However, problems such as inconsistent medical insurance settlement policies, irregular business processes, and inadequate business collaboration have also plagued the in -depth development of this work, affecting the sense of gain of the masses.

Jin Weigang, vice president of the Chinese Society of Social Security and deputy dean of the National Institute of Zhejiang University, said that at present, basic medical insurance is based on municipal prefecture -level coordination. Each coordinating area has certain differences in specific policies and regulations. Medical insurance information systems and medical insurance information systems and regulations The construction and development of the medical information system is not coordinated enough, which has caused some contradictions and problems in the settlement of inter -provincial and different regions.

"Promoting the direct settlement of basic medical insurance cross -provincial medical treatment costs is an important reform measure to improve the medical insurance system and solve the prominent concern of the people." Long Xuewen, the person in charge of the medical insurance management center of the National Medical Insurance Bureau, said that the State Medical Insurance Bureau was in the financial bureau. The Ministry of the Ministry implemented the decision -making and deployment of the Party Central Committee and the State Council, and issued the "Notice" to deepen the direct settlement reform of basic medical insurance across provinces and other places, and strive to solve the difficult problems such as the incomparable medical records of different places.

Long Xuewen said that the "Notice" focuses on four aspects:

The first is to adhere to policy optimization integration. In the early stage of the pilot pilot pilot of direct settlement policies for medical treatment in different provinces, most policies were promoted in a "patches". The "Notice" systematically combed and integrate the previous policies. The time limit is short. The cross -provincial long -term residents cannot enjoy the treatment in both directions and the place of insurance, and the proportion of reimbursement ratios after a temporary inter -provincial medical staff will be low.

The second is to adhere to the unified management of management. For some regions, it does not support the incorporation of rescue expenses, trauma costs, external examinations during hospitalization, and medical expenses after filing for direct settlement, formulate unified nationwide standards, form a national unified business flow, capital, capital, capital, and funds. Stream and information flow specification framework.

The third is to adhere to business collaboration and efficient. In response to the low efficiency of regional issues, the hand -reimbursement of the people's leg running for the people in different places, the difficulty of the large amount of expenses, and the opaque information of the management information, clarify the cooperative responsibilities of the medical insurance departments at all levels, rely on online service channels such as the national medical insurance service platform app, and improve Cross -regional business collaborative processing capabilities.

The fourth is to adhere to the accurate and convenient service. Standardize the service matters, management specifications and time limit requirements of medical insurance agencies at all levels and the designated pharmaceutical institutions of inter -provincial networking, and cover all service institutions for all service institutions. Clarify the service of the pre -medical settlement, neutral, and after -the -after -after -after -after -after -after -after -service service, and cover all business scenarios. Expansion of online management services, promoting medical insurance reimbursement online and offline can be across provinces, covering all government service models.

Crack three major problems of medical treatment, settlement and collaboration across provinces

The "Notice" clearly states that before the end of 2025, the direct settlement rate of hospitalization expenses across provinces increased to more than 70%. The number of ordinary outpatient cross -provincial network -integrated pharmaceutical institutions was realized. Treatment costs are gradually entered into the scope of cross -provincial direct settlement. The regulation of medical treatment is convenient, and basically realizing the online and offline medical insurance reimbursement can be opened across provinces.

In addition, the "Notice" uniformly hospitalized, general outpatient and outpatient slow special disease costs cross -provincial direct settlement policies. It is clarified that the "medical land catalog and the place of insurance place" fund payment policies in principle are clarified in principle; Prepaid and post -liquidation "different places for medical treatment funds management requirements.

Different places for medical treatment, settlement, and collaboration are the three major problems that the masses have reflected in. In order to solve these problems, the "Notice" further regulated the medical record policy policy, the scope of direct settlement services for designated medical institutions, and the cross -regional coordination process of the agency. "Extend the scope of the record personnel to the inter -provincial emergency rescue personnel and non -emergency consultation personnel." "30,000 yuan or more) are not small breakthroughs.

Sun Qirong came to Beijing from his hometown in Jiangxi to help his daughter bring children. Every time she "changed her post" with her own house, she had to re -hold a foreign medical treatment for the record, which made her feel troublesome. The "Notice" will solve such problems and support insured personnel to enjoy the treatment in both directions and the insurance place. At the same time, the "unified filing period is valid, and the validity period can be visited multiple times and enjoy direct settlement services" and expand the "Personal Promise Book" method of filing. These changes will make cross -provincial medical treatment more convenient.

Now the population flow is frequent. Will the filing system be canceled in the future?

Jin Weigang believes that the implementation of the application for filing system for cross -province medical treatment is the basis for establishing a cross -provincial medical treatment system, and it is a necessary measure to guide and standardize the orderly and orderly medical treatment of cross -provinces. If the filing system is easily canceled in the future, it will lead to disorderly medical treatment in different provinces, and high -level medical institutions in each central city will be overwhelmed. Given that my country will not have the objective conditions to implement basic medical insurance in the future for a long time, this filing system will be implemented for a long time. "Objectively speaking, the big data formed by the filing is of great significance. Whether it is medical resource allocation or medical insurance overall planning, these data will provide a reference for decision -making." Long Xuewen said.

The new rules will be implemented next year, and all localities should accelerate the improvement of supporting support

"Unity", "standardization" and "collaborative", the measures in the "Notice" must benefit the people, which means that all regions in the country must act.

In order to open up the last mile of the policy landing, the two departments were issued simultaneously and issued the "Basic Medical Insurance Cross -Provincial Different Places to Medical Council Direct Settlement Regulations" (hereinafter referred to as the "Regulations"), and required formal implementation from January 1, 2023. The "Regulations" stipulates the contents of the ten chapters of scope objects, registration filing, medical management, medical expenses settlement, expense liquidation, review and inspection, etc., strengthen the management of medical insurance agencies at all levels, standardize related business processes, and promote business collaboration.

But even with this regulation, the implementation level of various places still faces many tests. The "Notice" requires that the medical insurance departments in various places should adjust policies and measures that do not match this notice in time to ensure that they will be connected with national policies by the end of December 2022; combined with local conditions, further clarify and refine policy management regulations, streamline materials, simplify materials, simplify simplifying The processing process and optimizing management services; simultaneously adjusting the information system and the "Notice" to ensure the smooth transition of direct settlement work for cross -provinces and different places.

Jin Weigang said that at present, there are still weak links on the review requirements of insured persons across provinces. New measures such as "commitment filing" and "reissue filing" will undoubtedly increase the difficulty of review work. At the same time, whether it is a medical treatment behavior of cross -provincial medical treatment, or the diagnosis and treatment of medical service institutions for cross -provincial medical treatment, supervision is more difficult. In the past, the medical expenses of cross -provincial medical careers were often much higher than the medical expenses of local insured persons with the same disease. Therefore, the level of supervision capacity must be further improved to adapt to the new situation.

Chen Zhonglou, deputy director of the Anhui Provincial Medical Center, said that it will work hard to grasp the specifics, grab the end, accelerate the improvement of the supporting guarantee mechanism of the "Regulations", and make overall preparations for organizational promotion, policy adjustment, technical guarantee, business training and other aspects. (Reporter Sun Xiuyan)

(Sun Xiuyan)

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