Donggang District, Rizhao City: Implementing medical security treatment so that the masses are "dependent"

Luwang, September 19th, medical insurance reimbursed most of the medical expenses, and no need to worry about seeing a doctor; direct settlement of medical treatment in different places in the province, no longer need to run from the west, pay the cost; optimize the business processing process, open help office, medical insurance, medical insurance The service is more comfortable ... the "transcript" of medical protection guarantees the people to see a doctor for medical treatment.

Comprehensively implement the medical security treatment, the people will not carry the illness

"In March of this year, I was hospitalized for a sudden cerebral hemorrhage. The treatment cost 110,000, the medical insurance reimbursement was more than 80,000, and the individual only had 24,000. If there was no medical insurance, the burden at home would be too heavy!" After experiencing, Mr. Bi, an insured resident, still remembers.

Medical insurance staff concentrated publicity medical insurance policies

As of the end of July 2022, the number of basic medical insurance participants in Donggang District, Rizhao City was 640,000, of which: 123,700 employees participating in insurance, and 516,300 people with medical insurance for urban and rural residents. The employee's medical insurance levy revenue was 316 million yuan, and the basic medical treatment expenditure of employees was 214 million yuan; the individual residents paid 168 million yuan, and the basic medical treatment expenditure of residents was 161 million yuan.

The implementation of medical security treatment is not a slogan, but a down -to -earth people's livelihood policy. Donggang District has formed a basic medical insurance system based on basic medical insurance.

The level of mass medical protection treatment has continued to improve. In 2022, the government's basic medical insurance government subsidies reached 610 yuan per person per year; the compliance costs of compliance expenses in hospitalized in the secondary hospital in the city were paid to 5,000 yuan to 70%, 5,000 to 150,000 reimburseed 75%, 150,000 to the highest payment of the highest payment The limit reimbursement is 80%; the minimum reimbursement ratio of major illness insurance has increased from 50%to 60%, and the highest section reaches 75%; the reimbursement ratio of more than 5 years of consecutive years has floated by 2 percentage points; 15 types of slow disease diseases of residents' outpatient clinics reached 75 species to 75 species reached 75 species. The number is at the forefront of the province. Part of the reimbursement ratio of municipal employees' serious illness insurance from above 100,000 yuan has increased from 75%to 80%.

The level of maternity medical security has been greatly improved. Insured personnel's fertility treatment standards have increased, of which the payment standard of female employees' maternity quota rises up 1500 yuan, and the prenatal inspection fee has reached 1,000 yuan; the fertility medical expenses of flexible employment employees and female residents increased by 2500 yuan and 3,000 yuan, respectively. , Reach 3500 yuan. After the adjustment, the insured will have a basically zero burden on the individual in the city's second and below designated medical institutions.

The burden of medical insurance for difficult groups is reduced. The region adopted a financial direct replenishment method to subsidize the assistance target to participate in the residents' medical insurance. It has subsidized a total of 16,586 subsidies for medical assistance objects in 2022, with subsidy funds of 5.473 million yuan. Comprehensively realize the "one -stop settlement" of basic medical insurance, major illness insurance and medical assistance, to solve the problem of "cashier" and reimbursement of "leg running" and reimbursement. Since the beginning of this year, the help target has enjoyed 12,425 person -times a one -stop settlement, and reimbursed 61.530 million yuan in medical insurance benefits.

Continuously optimize medical security services, people are not working hard to see a doctor

Ms. Li, who was applying for discharge at Rizhao Central Hospital, said: "I used to apply for admission and discharge, and I had to run upstairs and downstairs. I do n’t need to go out of the ward for medical insurance settlement. It ’s really good to save time and effort!”

The family members of the insured patients are discharged and settled at the nurse station of Rizhao Central Hospital

Medical insurance settlement reimbursement procedures are cumbersome and running back and forth ... This is the pain point for many patients to reimburse for medical reimbursement. In order to solve the problems reflected by the masses, Donggang District continues to promote the optimization of the business processing process, making it more convenient for the masses to see a doctor.

Carry out the "one -click admission and bed settlement" smart medical insurance settlement service, and shorten the time for admission and reimbursement business. The city took the lead in carrying out a new model of medical insurance reimbursement beds at the Rizhao Central Hospital, reduced the original admission and discharge process from more than 10 to 4, and moved the admission procedures and moved the medical insurance settlement to the nurse station before the discharge. The secondary window to handle the business link, effectively alleviate the peak of admission and discharge, greatly shorten the settlement time of the settlement, which greatly facilitates the masses, and truly realizes "more data running, less patients running legs."

Optimize the process of clinic slow disease treatment process to achieve "slow disease" and "fast -proofing". Cultivate medical treatment, recipes, re -examination review, medical insurance settlement, and medicine taking medicines in a medical treatment, re -examination, medical insurance settlement, medical insurance settlement, medical insurance settlement, medical insurance settlement, medical insurance settlement, medical insurance settlement, medical insurance settlement, and medicine. Telled to 15 to 30 minutes in an hour. The outpatient slow special disease service zone has been established in the six fixed -point medical institutions in Donggang District. Among them, the outpatient slow special disease service center of Rizhao City Central Hospital was included in the provincial pilot. At the same time, the outpatient medical institution was moved forward to 11 medical institutions and town street convenience service centers, including the check -up of the outpatient disease and the town street convenience service centers. In addition, insured personnel can also apply for the "Application for the Medical Qualification of Slow Special Diseases" through online channels such as "Rizhao Smart Medical Insurance" WeChat Mini Program.

Broaden the business processing methods and accept medical insurance business in multiple channels. The "Cross -Provincial General Office of the Provincial Office of the Provincial Office" window is opened in the medical insurance service hall. It can help the masses to handle off -site business through the "full -scale online office", "collection and consignment office", "multi -place joint operation". 95 medical insurance service stations (points), decentralized business acceptance permissions, strengthen medical insurance "help offices" and "agency" business guidance, open up grass -roots service contexts, so that the masses can handle medical insurance business at their doorsteps; "WeChat Mini Program," Love Shandong ▪ Rizhao Tong "APP and other online channels to handle medical insurance business, so that the masses can do things without going out. "Medical Insurance Service Point" staff helped the participating people handling business on their mobile phones

Implement the concentrated and quantity procurement, the burden of seeing a doctor for medical treatment is reduced

Injecting insulin in the abdomen every day before going to bed has become one of the living habits of Mr. Li. However, from May 26 this year, the glycry glycry insulin (300 units) commonly used by Mr. Li will be reduced from an average of 180 yuan/branch to 70 yuan/branch. , Can save 3200 yuan.

In addition to the reduction of insulin collection, Donggang District has successively implemented the national selection results of 7 batches, more than 300 kinds of medicines, and two batchs and 87 drugs in Shandong Province. The maximum decrease was 98.6%; the region saved the cost of more than 2,500 million yuan in drugs in the region. Implement the results of the national organization of coronary stent and artificial joint collection. The average price of coronary brackets has fallen from about 13,000 yuan to about 700 yuan, the average price of artificial hip joint drops from 35,000 yuan to about 7,000 yuan. 32,000 yuan dropped to about 5,000 yuan. At the same time, it continuously strengthens the inspection and supervision of the implementation of the selected products using the selected products, and guides patients to use high -quality high -priced products to ensure that each batch of drugs and medical consumables are in place Essence

In addition, Donggang District adheres to traditional services and intelligent service innovation in parallel, and realizes the province's personal account "one -pass" solve the problem of medical purchase of medical and purchase cards for medical purchase of the public, cancel the filing procedures for "temporary medical personnel" in the province, and so on. Let the people's participating people feel more happy in the medical insurance field. (Correspondent Hou Wanying)

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