[Authoritative release] Ten measures for the release of medical insurance and public benefits in Zibo City: medical insurance settlement enters the "era of face brushing"

□ Zibo Daily/Zibo Evening News/Expo News

Reporter Chang Xu

On September 6, the Journal of the Zibo Municipal Government organized the seventh press conference of the theme series of the theme series of "Welcome to the Great Great Quality to improve", and invited the person in charge of the Municipal Medical Security Bureau to release the Zibo medical security for the public. Measures.

Ten measures for convenience and benefit enterprises released this time involve serving people's livelihood, enterprises, development and other fields. It is worth noting that, as the province's pilot, Zibo Medical Insurance Clearing is the first to realize the application of face recognition. At present, 8 health hospitals in the municipal maternal and children's health hospital, the Chinese and Western Medicine Hospital, Zijian Hospital and Gaoqing County Work, the city's medical insurance settlement has entered the "Card Age" into the "Code Times" and "Age of Face", and the people participating in the insurance will enjoy more convenient medical insurance services.

Small and medium -sized enterprises slowly pay "exemption to enjoy" promoting development. Comprehensively implement the "exemption and enjoy" passage model, and the insured unit that meets the conditions of slow payment can enjoy the slow payment policy without applying for a slow payment application. The term of the employee medical insurance unit from July to September 2022 (including maternity insurance premiums, excluding personal payment parts) from July to September 2022. Units that have paid medical insurance premiums in July can slowly pay employees from August to October The medical insurance unit pays the fee and is exempted from late fees during the periodic period. If small and medium -sized enterprises have paid the payment of employee medical insurance units, if the employee's personal payment part is paid normally, the insured's medical insurance rights and interests are enjoyed in accordance with regulations. At present, 52,800 small and medium -sized enterprises who have enjoyed the slow payment policy have been determined. It is expected that the cost of the employee's medical insurance unit for three months is 625 million yuan.

The outpatient clinic is more comprehensive. Expand the scope of reimbursement of slow special diseases of outpatient clinics, 8 types of new employee basic medical insurance clinics have 8 kinds of slow special diseases, and the total number of diseased types is 53. The proportion is 80%; the basic medical insurance clinic of Xinzang urban and rural residents has 27 diseases of slow special diseases, which are included in the total number of diseases, and the reimbursement standard is 500 yuan, and the reimbursement ratio is 55%. The burden on the treatment of slow special diseases helps the basic medical insurance guarantee system fair and efficient. Determine the 30 -point hospital as an outpatient slow special disease appraisal institution. Among them, the five targeted medical institutions realized the instant application for outpatient disease. In August 2022, the full process of the Slow Special Disease Sutra Business Process was launched. Participants could use the "Zibo Medical Insurance" WeChat Mini Program to implement the Slow Special Disease Online Appraisal and Signing, Reform) Contracts, etc. Medical expenses are settled in networking. As of the end of August, the number of slow special diseases in Zibo City was 312,000, with a cumulative reimbursement amount of 537 million yuan.

The implementation of traditional Chinese medicine diagnosis and treatment is more money. Select the municipal traditional Chinese medicine hospital, municipal Chinese and western medicine combination hospital, and Yiyuan County Traditional Chinese Medicine Hospital to carry out the pilot of medical insurance settlement for diagnosis and treatment of traditional Chinese medicine. Class Chinese medicine diagnose diseases. Participants occurred in the pilot disease expenses of pilot diseases during the TCM diagnosis and treatment centers. The start -up standards and reimbursement ratio implement the basic medical insurance hospital reimbursement policy of the same level of medical institutions. The bed fees and nursing fees are implemented at 30%of the current charging standards. Since the pilot for more than 4 months, the three pilot hospitals have settled 435 times, and the average costs have decreased by 35%year -on -year, which has effectively exerted the advantages of traditional Chinese medicine and reduced the burden of medical treatment.

The "dual channel" of Guotan drugs is guaranteed. Adjust the scope of "dual -channel" management drugs and the scope of "three fixed" management drugs, improve the negotiating drug outpatient guarantee policy, and improve the level of negotiating drug protection. From June 15th, the proportion of individuals' self -proving self -payment has been reduced from 25 % to 20 %, and some of the proportion of individuals such as Chinese medicines, "two diseases" drugs, and new crown pneumonia drugs in negotiated drugs have fallen to 10 %. Expand the coverage of the "dual channel" pharmacy, and 15 "dual -channel" pharmacies in Zibo City cover all administrative districts and counties. Among them, there are 1 comprehensive pharmacy, equipped with 138 negotiated drugs, 99 special diseases and two diseases, and implemented instant network settlement. As of the end of August, the total number of reimbursers in Zibo's "dual channel" pharmacy was 1,5515, with reimbursement amounts of 125.86 million yuan.

Reimbursement for medical treatment at different places is more convenient. Adjust the medical treatment policies for different places, integrate and simplify the two types of "long -term residents" and "temporary long -term residents" for "long -term residents" and "temporary abroad" and "temporarily goes out". The transfer of the transfer of the transfer hospital, temporarily go out to seek medical treatment procedures across the province; reduce the personal burden of the insured persons, and the employees and residents "temporarily go out to medical personnel" first pay a unified proportion to 10%; The number restrictions, the medical treatment is directly recorded to the medical place, the insured person can take the autonomous medical treatment in all fixed -point medical institutions in the record place and settle directly. Since the implementation of the reform measures for medical treatment in different places, the number of people in the city's insured has increased by 15%compared with the same period last year.

Network settlement achieves a wide range of coverage. Zibo 436 fixed -point medical institutions realized the internet settlement of the province's cross -city and inter -provincial general outpatient clinics, of which the inpatient medical institution was fully covered; extending the "one card through" in the province, and promoting the fixed retail pharmacy of the employee's personal account to the province Realize the full coverage of 1674 fixed -point retail pharmacies; network settlement in the province of slow special diseases in the outpatient clinic is fully covered in the second and above medical institutions; 12 medical institutions in Zibo City realize hypertension, diabetes, malignant tumor outpatient chemotherapy, uremia dialysis, dialysis, and dialysis, and uremia dialysis, and urea dialysis, and dialysis, urea dialysis, and dialysis, and uremia dialysis, and dialysis, and uremia dialysis. Organized anti -rejection treatment of 5 outpatient diseases after the treatment of 5 outpatient diseases across the provincial networking two -way opening, and completed the "various administrative districts (counties) deployed by the provincial bureau at least one clinic slow special disease internet settlement medical institution" in advance. Expansion work. As of August, as a place of medical treatment, the number of insureds in a different place in Zibo City ’s hospitalization networking in Zibo City increased by 29%compared with the same period last year. Purchasing drugs online is more intimate. Give full play to the advantages of the "Internet+Medical Insurance" platform, establish an online pharmaceutical platform such as "Zibo Internet+Big Health", "Hongrentang Jianxia Home", "Optimum Cingsheng", and open the channels for online medical insurance payment channels, break through traditional offline offline The single model of medical insurance purchases, through medical insurance electronic vouchers, expand the coverage of "online store delivery", create "online drug purchase+medical insurance payment+delivery to home" service chain, and the participating people can also use online medical insurance personal accounts directly directly Buy a collection of medicines, enjoy the convenient service of instant delivery to home, and realize "brushing medical insurance at home and delivery to home." At present, online platforms such as "Zibo Internet Big Health Platform", "Hongrentang Jianxia Home", and "Optimum Cingsheng" have paid more than 50,000 strokes.

Medical insurance intelligent settlement is more efficient. Expand the application scenarios of medical insurance electronic vouchers, actively explore face recognition and settlement, transform and upgrade the medical insurance system, ensure that the terminal is one yard, to ensure that the terminal is true, legal, and unique. The insured person's medical treatment session passed the "face brushing" core to ensure that I use medical insurance funds to prevent the risk of stealing the name of the stolen. The face recognition terminal does not rely on smartphones. Bao people can complete the medical insurance business.

The fixed -point institution is easier to record. Adjust the approval authority of the set institution, shall apply to the pharmaceutical institutions in the area of ​​the district and county medical insurance bureaus to apply for the fixed application work, the municipal level is responsible for the filing work, accelerate the application for the application for review and filing, and promptly meet the grass -roots medical care conditions that meet the access conditions of fixed -point medical institutions Health institutions, rehabilitation hospitals, nursing homes and pension institutions are set up in medical security institutions. Strengthen departmental data sharing and cooperation, open up data barriers, establish shared query and data transmission interfaces, and include all legal person ID cards, business licenses, and medical institution practicing licenses, etc. of designated access materials into the scope of sharing identification. As of the end of August, there were 203 newly designated pharmaceutical institutions in Zibo City, with a total of 97 reporting materials, shortening the time limit of 30%.

Upgrading "Zibo Qi Huibao" is more benefited from the people. Since the launch of the province's first inclusive commercial supplementary insurance "Zibo Qihui Insurance" in September 2020, the two consecutive years has been the first in the province, ranking first in the province. As of the end of July this year, the amount of "Zibo Qihui" compensation was 18,089,200 yuan in 2020, with a cumulative compensation of 1,4057, totaling 10,376 people, with the largest single payment of 309,700 yuan. A total of 378,800 yuan in single -person compensation, an increase of 22.3%over last year. The 2022 version of "Zibo Qihui Insurance" will further expand the guarantee on the basis of the 2021 edition, improve the coverage, optimize the claims service, and formulate a guarantee plan to ensure that Zibo Qihui Insurance needs to be healthy while the insurer's multi -level medical security needs, and ensure the health of the product's healthy Run smoothly.

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