Eight "welfare" of the medical assistance system in Shandong Province benefit the people: realize the full coverage of residents and employees in difficulties, and the full capital of the special poverty

New Yellow River Reporter: Chai Yingying

On September 5th, the Shandong Provincial Government held a press conference on the health care system of improving major diseases and rescue systems in Shandong Province to interpret the "Implementation Opinions on the Implementation of Medical Insurance and Rescue System of Electricity and Extraordinary Diseases" (hereinafter referred to as the "Implementation Opinions") interpretation Essence

Zhang Ningbo, Secretary of the Party Group and Director of the Shandong Medical Security Bureau, introduced at the press conference that the "Implementation Opinions" from the scope of medical assistance objects and insurance funding standards, strengthening basic medical insurance and major illness insurance guarantee functions, consolidating medical assistance support function, and the support function of the bottom of the medical assistance, and the support function, and the support function of medical assistance. Establish and improve the long -term mechanism of preventing and resolving the poverty -return poverty due to illness, regulating management services for the management, and actively guiding social forces to participate in the support of rescue guarantees.

The first is to clarify the scope of medical assistance objects and achieve full coverage of residents and employees in difficulties. The medical assistance system determined by the "Implementation Opinions" is fairly covered with difficult residents and employees with heavy medical expenses, including special difficulties, subsistence allowance objects, returning poverty -poverty -poverty population, members of the minimum -living family members, preventing targets for returning poverty monitoring, and failure The scope of the above rescue objects but patients with serious difficulties in the family's basic life due to high medical expenses caused by high medical expenses, and poverty -cause diseases are poverty -stricken. Other special difficulties stipulated by governments at or above the county level will give corresponding assistance according to the category of rescue objects.

The second is to implement the subsidy of the classification of insurance participation to reduce the personal payment burden of the rescue target. The "Implementation Opinions" clearly stipulates that the personal payment of the basic medical insurance for the residents' basic medical insurance shall be fully funded by medical assistance funds. Funding and consolidating the difficulties of difficulties should guarantee all the results.

The third is to improve and improve the system of general outpatient and outpatient clinics. The "Implementation Opinions" proposes that on the basis of consolidating the treatment of hospitalization reimbursement, before the end of this year, the cities will comprehensively establish a general outpatient system for residents and employee medical insurance to further improve the inclusiveness of medical security. Uniformly standardize the basic diseases and identification standards of slow special diseases in the province. The basic diseases of the first batch of slow special diseases of the first outpatient clinic are not less than 50, which further improves the level of maintenance of slow special diseases.

The fourth is to focus on key rescue targets and reduce the burden of medical expenses of major illnesses. The "Implementation Opinions" stipulates that for the three key rescue targets of special difficulties, subsistence allowance objects, and poor people who return to the poor and poor, the annual starting line of residents and employees' illness insurance will be reduced by 50%, and the proportion of reimbursement in section will increase The highest payment limit of the year, cancel the use of major disease insurance special effects drugs.

Fifth, the scientific design rescue system, further enhance the function of medical assistance. For people with special poverty, subsistence allowances, and poor people who return to the poor, medical assistance does not set up a line of payment, the proportion of personal burdens within the scope of the policy is not less than 70%, and the annual rescue limit is increased from not less than 10,000 yuan to no less than less than less than less than less than less than less than 10,000 yuan to not less 30,000 yuan, further enhance the bottom of the support. For members of the subsistence allowances and the targets of preventing poverty -relief monitoring and assistance, the proportion of rescue ratios of more than 3,000 yuan within the scope of the policy is not less than 50%. After the above -mentioned rescue objects are guaranteed by the triple system, if the personal burden fee is still heavier within the scope of the policy, re -rescue is given at a ratio of not less than 70%. The annual limit can reach up to 20,000 yuan. For patients with poverty due to illness, the individual burden fees within the scope of the policy are more than 25%of the per capita disposable income of residents within the scope of the policy, and the rescue is given at a ratio of not less than 60%.

Sixth, the innovative dynamic monitoring mechanism is used to prevent poverty due to illness. The "Implementation Opinions" stipulates that after reimbursement of basic medical insurance and major illness insurance, the annual individual burden and expenses within the scope of the policy will exceed the skeleton edge family members of the minimum -fidelity in the province's per capita disposable income of the province, and the target of helping the poverty monitoring and assistance. As well as the annual personal burden of personal burdens, the annual cumulative insured persons who have exceeded the per capita disposable income of the residents of the province in the province are included in the scope of early warning and monitoring, and early warning screening is implemented to ensure the help of people in need. The medical insurance department analyzes the comparison monthly analysis, and promptly push the early warning information to the civil affairs and rural revitalization departments to confirm in accordance with relevant regulations, so as to timely discover, accurate identification, and accurate assistance.

Seventh, to promote integrated service services, and improve the convenience of medical settlement for the people difficulties. Relying on the national unified medical security information platform, the integration of basic medical insurance and medical assistance services, on the basis of achieving a network of medical expenses in the city in the city, actively promote the "one -stop" service in the provincial and inter -provincial medical expenses settlement, " The handling of one window to improve the service capabilities of grass -roots medical insurance, and facilitate the reimbursement of the people for medical treatment.

Eighth is to strengthen comprehensive policies and build a multi -level guarantee system. The "Implementation Opinions" requires that relying on charitable and social donations to raise funds to form an effective connection between government assistance and charity assistance. Support trade union organizations to actively carry out medical mutual assistance to employees, and give help to suffer from major illnesses in difficult workers. Promote the innovation and development of commercial medical insurance, properly tilted the people in difficulties in terms of product pricing and compensation policies, and jointly reduce the burden of individuals in difficult people.

Edit: Weekend

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