Always medical insurance!Anhui Provincial Medical Insurance Bureau issued a document to solicit opinions

August 29th

Opinions of the provincial overall planning of Anhui Province Basic Medical Insurance

Public comments

Opinions of the provincial overall planning of Anhui Province Basic Medical Insurance

(Draft for comments)

In order to accelerate the provincial level of basic medical insurance, in accordance with the requirements of the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System" and "Notice of the General Office of the State Council on Printing and Distributing the" Fourteenth Five -Year Plan "National Medical Security Plan," The provincial -level overall work of basic medical insurance (hereinafter referred to as "basic medical insurance") is currently put forward the following implementation opinions.

1. Overall requirements

(1) Guidance thought

Guided by Xi Jinping's thoughts of socialism with Chinese characteristics in the new era, comprehensively implement the spirit of the 19th National Congress of the Communist Party of China and the 19th Plenary Session of the Plenary Session, and in accordance with the decision -making and deployment of the Party Central Committee and the State Council on medical security work, based on the new stage of development, implementing the concept of new development, building a new development concept, building a construction concept New development pattern, adhere to the people -centered development ideas, deepen the reform of the medical and health system, promote the establishment of basic medical insurance provincial -level overall planning for the establishment of the province's unification of the province as the core, the provincial regulation of the medical insurance fund as the guarantee, and the establishment of information standardization. Mechanism, strive to build fair medical insurance, continuously improve the level of modernization of medical insurance governance, and enhance the sense of gain, happiness, and security of the majority of participating people.

(2) Basic principles

1. Persist in policy unity and fairness. The province's basic medical insurance (hereinafter referred to as employee medical insurance) treatment security policy and urban and rural residents' basic medical insurance (hereinafter referred to as resident medical insurance) treatment policies, and fully implement the medical security treatment list system. Adhere to the consistency of fundraising policies and treatment guarantee coordination, income and expenditure responsibilities and overall equal rights.

2. Adhere to the fund adjustment and balance the risk. Establish a provincial -level adjustment fund system for basic medical insurance, reasonably balance the pressure and risks of medical insurance funds in various localities, improve fund use efficiency and anti -risk capabilities, and ensure the sustainability of the fund. Clarify the duties of provincial, municipal, and county -level governments, and strengthen the main responsibilities of basic medical insurance management at all levels.

3. Persist in paying efficiently and uniform standards. Unified basic medical insurance payment scope, deepen the reform of medical insurance payment methods, further play the role of medical insurance payment leverage, and improve the efficiency of fund use. Unified medical insurance information system platforms, optimize public services for medical insurance, and provide strong support for the realization of scientific management of management decision -making, equalization of medical insurance services, and standardized fund supervision.

2. Key task

(1) Unified scope of insurance participation

Employers and employees in the province shall participate in employee medical insurance. Individual industrial and commercial households without employees, non -full -time employees who have not participated in employees' medical insurance in employees, and other flexible employees can participate in employee medical insurance. All urban and rural residents who should participate in employee medical insurance or those who enjoy other guarantees in accordance with other guarantees will participate in residents' medical insurance. In principle, the insurance shall not be repeated.

(2) Uniform fundraising management

The employee's medical insurance premiums are paid on a monthly basis. The employer pays the employee medical insurance premiums at a proportion of about 7%(including maternity insurance) of about 7%of the total employee salary of all employees in the previous year. Personally pays the employee medical insurance premiums at a percentage of 2%of the monthly average monthly salary of his previous year. The average monthly salary of the employee himself last year was lower than the average monthly salary of employment staff in the province's annual urban units in the annual urban unit, and the monthly salary of 60%was paid at 60%; those higher than 300%were paid at 300%. When the insured reaches the legal retirement age, the cumulative payment period has gradually transitioned to male employees for 30 years and female employees for 25 years. After retirement, employee medical insurance premiums are no longer paid. If the specific accumulated payment period fails to reach the prescribed period, it can continue to be paid to the prescribed life, or pays at one time to the prescribed period at one time. The cumulative payment period includes the actual payment period and the period of payment. The legal retirement age shall be implemented in accordance with the relevant provisions of basic endowment insurance, and the payment period shall be implemented in accordance with relevant national regulations. The employee medical insurance funding policy is formulated separately by the provincial medical insurance department in conjunction with the finance, taxation and other departments.

Residents' medical insurance shall be implemented in concentrated insurance payment on a year -on -year insurance. In principle, the resident medical insurance payment will be completed before December 31st each year. Newborns implement the "landing" insurance policy. The individual payment part of rescue objects such as predators and subsistence allowances to participate in residents' medical insurance shall enjoy classified funding in accordance with regulations. Residents' medical insurance payment standards shall be reasonably determined by the provincial medical insurance department in accordance with the regulations of the financial, taxation and other departments in accordance with national regulations and the provincial medical insurance fund.

(3) Unified guarantee treatment

In principle, the employee's medical insurance insured personnel shall enjoy the employee medical insurance treatment from the following month for their participation registration and pay in accordance with the prescribed fees. If the flexible employees apply for insurance registration for the first time, they will enjoy employee medical insurance benefits after 3 months of payment. Residents' medical insurance treatment is enjoyed year by year, and the guarantee period is from January 1 to December 31. The basic medical insurance relationship transfer continuation and treatment connection shall be implemented in accordance with relevant regulations.

In principle, the standards for hospitalization for medical insurance and residents' medical insurance for medical insurance are not higher than the average salary of employment personnel in urban units in the previous year, and 10%of the per capita disposable income of residents in the previous year. The proportion of hospitalization expenses within the scope of the policy stabilizes about 80%and 70%, respectively, and a 5-15 percentage payment ratio is maintained between different levels of medical institutions. In principle, the maximum payment limit of employees' large medical expenses (including employee major illness insurance) and residents' medical insurance superimposed residents' major illness insurance in principle reached the average annual salary of employees in the previous year and the per capita disposable income of residents. Social development, people's health needs, and fund support capabilities are reasonable. The exploration pilots of the treatment guarantee policy are uniformly carried out, and patients are guided to seek medical treatment in the province and go to the grassroots level. Promote the province's unified employee medical insurance outpatient and bidding system and the overall planning system for residents' medical insurance clinics. In principle, the proportion of medical insurance payment for general outpatient expenses within the scope of the policy is not less than 50%. Improve the province's unified outpatient clinic slow disease diseases and treatment.

Implementation plan for the implementation of employee medical insurance and urban and rural residents' medical insurance protection treatment shall be formulated separately by the provincial medical insurance department in conjunction with the financial department.

(4) Unified Fund Budget Management

The Budget of the Basic Medical Insurance Fund adheres to the principles of settlement and expenditure, balanced revenue and expenditure, and a slight balance. According to factors such as the payment base (or payment standard), the payment rate, and the number of participants, the comprehensive, accurate and complete preparation of the income budget of the basic medical insurance fund. Comprehensive consideration of previous annual expenditure scale, local medical expenses, medical expenses control goals, the age structure of insured personnel, the number of benefits, and the adjustment of the treatment policy. In principle, the deficit budget was not prepared in principle, and the cumulative balance deficit budget was not prepared over the years. Except for basic medical insurance treatment expenditures, for major illness insurance expenditure, transfer expenditure, resolving superior expenditures, and subsidized subordinates, other expenditure budget should not be prepated in principle.

Strengthen the supervision of budget implementation, comprehensively implement budget performance management, strengthen performance monitoring, evaluation and results of results, build a balance mechanism for income and expenditure, establish and improve the fund operation risk assessment and early warning mechanism, and promote the long -term sustainability of the fund.

(5) Uniform fund adjustment management

Establish a provincial -level adjustment system for medical insurance. The basic medical insurance fund implements the provincial city -based city transfer, and the city's cities in the county (cities, districts) of the districts are management. Basic medical insurance provincial -level adjustment funds are used to balance the risk of basic medical insurance funds in the province, and the adjustment of the basic medical insurance funds in various places will be resolved. Provincial -level adjustment funds are accused according to employee medical insurance and residents' medical insurance. The withdrawal ratio is determined by 5%of the income of 5%of the revenue of the basic medical insurance overall funds in the previous year. Except for the adjustment of the cities in various districts, other remaining funds (including over the years, new balances) remain in each city. The use of balance funds must be reported to the provincial medical security agency for record and included in the city's annual fund budget management.

Part of the adjustment gold is directly allocated in accordance with the factors method, and the risk of equilibrium funds is used as a budget for all localities; the other part is used as a reasonable over -agent balance in various places. The fund shall jointly borne according to a certain proportion; if the balance fund is insufficient or there is no balance, the fund gap shared by the balance fund shall be resolved by each district and cities.

The specific measures shall be formulated separately by the provincial financial department and medical insurance departments.

(6) Unified medical insurance payment system

Strictly implement the national basic medical insurance directory, unify the management of medical insurance, drugs, and consumables in the province, and unify the proportion of individuals in the medical insurance catalog. Uniformly establish and improve the working mechanism of national negotiation drugs, and establish a mechanism for the exit mechanism for the payment of medical insurance payment for ethnic drugs, Chinese medicines, and medical institutions.

Improve the total prepaid management, and implement the multi -compound medical insurance payment method based on disease payment. Based on the full coverage of DRG and DIP payment reform, the province's unified hospitalization payment mechanism is studied. Uniformly promote the payment mechanism of paying the outpatient clinic in accordance with the total number of people, uniformly establish and improve the medical insurance payment method that is in line with the characteristics of traditional Chinese medicine, uniformly pay for the daily payment method of chronic diseases, and implement the tight county medical insurance fund management of the total amount of medical insurance for medical insurance for the county.

(7) Unified information system management

In accordance with the standards and specifications of the National Medical Insurance Bureau on the construction of the information system, the province will uniformly build and apply the national (Anhui Province) medical security information platform system to achieve interconnection and information sharing with the province's pharmaceutical institutions. Promote the online handling of government services, and achieve the "One Netcom Office" in the aspects of medical insurance participation, qualification approval, treatment payment, fund settlement, transfer continuation, audit and monitoring, etc.

Relying on the provincial public data platform, the medical security department and the information sharing and application of relevant departments such as public security, civil affairs, rural rejuvenation, taxation and other regions, and the construction of intelligent and integrated digital medical insurance are strengthened. , Improve the ability of medical security. Strengthen big data mining and analysis, and gradually deepen the application of big data in macro decision -making analysis, medical insurance fund supervision, medical insurance business processing, etc., and improve big data support capabilities.

3. Implementation steps

(1) The first stage: Before the end of 2022, formulate and introduce the "Opinions of the Provincial Executive Preparation of Basic Medical Insurance in Anhui Province". Supporting documents such as unified residents' medical insurance protection treatment plan and unified employee medical insurance treatment policy framework and other supporting documents will be implemented from January 1, 2023.

(2) Phase II: Before the end of 2023, formulate and introduce the provincial -level adjustment system of medical insurance, establish a provincial -level adjustment gold account, and collect provincial -level adjustment gold in residents. Formulate and introduce employee medical insurance protection treatment plans, and it will be implemented from January 1, 2024. (3) Third stage: By the end of June 2024, the provincial -level adjustment of employee medical insurance is collected.

Fourth, guarantee measures

(1) Strengthen organizational leadership. Governments of municipalities, counties (cities, districts) must attach great importance to the provincial overall planning of basic medical insurance, fully understand the significance of the provincial -level overall planning of basic medical insurance, and rely on maintaining the implementation of the provincial -level coordinated reform and implementation relying on the maintenance of the safety leadership group of the medical insurance fund.

(2) Strengthen departmental cooperation. The medical security department forms specific policies such as the implementation plan of basic medical insurance and the implementation of major illness insurance insurance for financial insurance and other departments, and has dynamically adjusted according to the level of economic development and the operation of the medical insurance fund. Other departments implement related work according to their responsibilities.

(3) Strengthen publicity and guidance. All localities and departments adhere to the correct orientation of public opinion, take the initiative to do a good job of relevant policy interpretation and service promotion, respond to social concerns in a timely manner, and correctly guide social expectations. Establish and improve major risk prevention and resolution mechanisms, actively and steadily handle various hidden risks in the reform process, and create a good atmosphere of public opinion.

(4) Strengthen policy synergy. On the basis of promoting the provincial -level overall planning of basic medical insurance, study and promote the overall work of major illness insurance and medical assistance, promote the complementary connection of various medical security, and do a good job of provincial overall planning and multiple medical insurance systems. Relevant policies are formulated separately with the relevant departments with relevant departments.

This opinion is implemented from the month of 2022. If the documents that have been issued and issued are inconsistent with this opinion, this opinion shall prevail.

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