Haidian carefully writes the "warm heart answer"

District Medical Insurance Bureau/Picture

In recent years, the District Medical Insurance Bureau has been based on the "Fourteenth Five -Year Plan" planning development blueprint in Haidian District. It focuses on the new positioning, new goals, and new starting points around the core area of ​​the capital function. Multi -level medical security needs provide diversified medical insurance convenience services. At the same time, coordinating regional medical and health enterprises and medical institutions to integrate supply demand, achieve accurate docking, and assist municipal medical insurance departments to play a policy leverage. The District Medical Insurance Bureau is centered on people's health, closely focuses on the work goals and key tasks of the district, strengthens responsibility, fulfills the duties of the department, promotes reform, protects people's livelihood, stabilizes the overall situation, and helps development. The important role of people's livelihood and maintaining social harmony and stability.

Establish a medical security system system

Since 2019, Haidian District has implemented more than 26,000 medical assistance for various types of difficult groups, with an amount of more than 45.75 million yuan. Haidian District fully builds a multi -level medical security system with Haidian characteristics to meet the diverse and personalized health protection needs of the masses. The District Medical Insurance Bureau implements the basic medical insurance system covering the entire population, participating in the law, employees and urban and rural residents, and realized integrated management. Implement the financial subsidies of the urban and rural residents' medical insurance insured in the region, and implement full subsidies for the insurance premiums such as the three types of difficulties such as minimum security and disability to ensure that the difficult groups should be guaranteed. While improving urban employees, urban and rural residents' major illness insurance systems and increased medical assistance, it has completed the implementation of the "two insurances" of Beijing maternity insurance and basic medical insurance for employees.

The District Medical Insurance Bureau actively classified and carried out medical assistance, optimized the district -level medical assistance guarantee system, and promoted the scope and standards of treatment guarantee to be compatible with the level of regional economic development. Establish a long -term mechanism for preventing and resolving the poverty -elites due to the illness, strengthen departmental cooperation and information sharing, steadily improve the outpatient clinic, hospitalization payment limit, minimum living security personnel, and subsidies for living difficulties to help the cap and rescue proportion, and enhance the support function. Realize the help of groups to help.

The relevant person in charge of the District Medical Insurance Bureau introduced: "In response to the expansion of the pilot to the pilot to land in Haidian, we have formulated a number of medical security innovation measures. Develop and use the idle resources of medical institutions in the zone, pilot the long -term protection of sustainable development+medical insurance as the old service mechanism; technology empowerment is optimized into old medical security services, effectively solve the 'digital gap of the "digital gaps' of the elderly' and the medicine taking the medicine. One hundred meters' and other issues. "The District Medical Insurance Bureau carried out the pilot work of the long protection system, and did a good job of effective connection between medical insurance, long protection and commercial insurance to form basic medical insurance basic with Haidian District -major illness insurance cure illness illness illness illness illness illuminating illness illness illuminating illness illness illuminating illness illness health care diseases were cured diseases. ——The commercial insurance supplementary protection -long -level medical security system for medical assistance to support the disabled people. Expand the pilot of "long nursing insurance" to form a scientific, efficient, long -term nursing insurance operation mechanism with "national demonstration, Beijing leadership, and Haidian model", and pushes away the city.

Promote the "Three Medical" linkage reform

Recently, the notice issued by the Beijing Medical Security Bureau pointed out that on the basis of the original 39 basic medical insurance category A fixed -point medical institution, 10 category A fixed -point medical institutions were added. Among them, Beijing Elderly Hospital is a hospital that has been approved by Haidian District this time to be approved by Beijing Basic Medical Insurance Class A fixed -point medical institution. There are 252 medical institutions that can directly seek medical treatment without choosing a fixed point, including 6 category A fixed -point medical institutions, 13 designated medical institutions of traditional Chinese medicine, 20 special specialized medical institutions, and 213 fixed -point community health service institutions Essence

The District Medical Insurance Bureau improves the basic work of medical insurance review and settlement, continues to promote the reform of medical insurance, and uses the leveraged role of medical insurance in the reform of the three medical insurance, medical insurance, and medical treatment. From "management thinking" to "service thinking", we will continue to launch the "one hospital and one policy" solution for daily review and find problems, and form a fixed -point medical institution "customized version" cost review report every quarter to urge designated medical institutions to strengthen internal management , Implement the rectification of the problem, and do a good job of risk prevention.

At the same time, we will improve the dynamic adjustment mechanism of the country's basic medical insurance drugs, medical services projects, and medical consumables, urge designated institutions to do well in time, improve the normalized mechanism of centralized procurement of drugs, help medical institutions to complete drug maintenance, coordinate medical institutions exist Insurance and other issues to ensure the need for drugs for participants. Carry out the procurement of national pharmaceutical concentrated band quantities and high -value medical consumables, and have started 6 batches of drug collection and mining work to complete the band procurement of artificial crystals and coronary brackets, and promote the normalization of drug consumables.

In addition, improve the total budget management measures for medical insurance funds, improve the quality evaluation system, and standardize the service behavior of designated institutions. Build a diversified composite medical insurance payment system such as the diagnosis of group paid, project payment, single disease payment, and psychiatric daily payment of psychiatry. On the basis of 17 fixed -point medical institutions DRG paid pilots, expand the scope of reform and achieve all disease group coverage. Improve the total budget management measures, improve the quality evaluation system, carry out 60 on -site inspections, standardize the service behavior of fixed -point institutions, promote the use of quality improvement and efficiency of the fund, and give play to the role of medical leverage.

Medical Insurance Economic Counseling "Full Online Council"

"This year, we teamed up with the Municipal Medical Insurance Bureau to promote scientific and technological empowerment of medical insurance to ensure the implementation of more smart scenarios, weaving the intellectual grid of the grassroots level, and opening up the 'medical institution -community (village) -Home' channel to effectively expand smart medical insurance Sinking. "The relevant person in charge of the District Medical Insurance Bureau said. On the basis of the "Smart Medical Insurance Innovation Scene Application Project under the leadership of the party building in the new period", the District Medical Insurance Bureau selected "Credit Medical", "Internet+Smart Medicine Cabinet", "Cloud Pharmacy", "Medical Insurance Data" and "Smart Medical Insurance" and "Smart Medical Insurance Insurance Insurance Insurance" The "five application scenarios in the service hall" piloted the problems of low service efficiency, difficulty in hospital medical medicine, and low medical insurance payment rates in fixed -point pharmacies. At the same time, the construction of Haidian Smart Medical Insurance Projects is constantly strengthened, the activation application of medical insurance electronic vouchers is promoted, and the entire process of medical insurance electronic vouchers is based on medical insurance electronic vouchers appointments for reservations, inspection and inspection reports, vaccination appointment for vaccination. Pilot the online payment function of medical insurance settlement, and promote the "one -stop" handling of basic medical insurance, maternity insurance, medical assistance and other expenses. Relying on the "Cloud Delivery" and medical insurance manual reimbursement intelligent audit system, the medical insurance process is promoted to "full online business". Improve the coverage and integration of medical insurance self -service terminals, and build a new image of medical insurance digital services with full coverage, all -round, all -weather, and whole process. "Hello, I would like to ask how to enjoy Beijing's retired medical treatment? My situation is now like this ..." Mr. Shi, a resident, has been confused about retired medical treatment. Essence Mr. Shi will reach the prescribed retirement age in May this year, but the pension and medical insurance he paid in Beijing have not yet reached the retirement period. The transfer is continuous and deemed to be determined that after completing the working age, you can enjoy Beijing's retirement benefits normally. In view of the upcoming time of Mr. Shi, the District Medical Insurance Bureau took the initiative to contact the Social Security Center of Jingyi County, Hebei to keep an eye on the time node. After the transfer of the transfer service was completed, the follow -up procedures immediately went through the follow -up procedures to ensure that Mr. Shi enjoyed the treatment on time. The District Medical Insurance Bureau continues to promote the orderly implementation of direct settlement services for medical treatment in different places, set up a special class, and carry out system transformation and acceptance work. It effectively improves the quality of direct settlement services for hospital hospitalization and hospitalization. The scope of the institution.

"Going to the medical insurance transfer procedure, I thought I had to go to the window to complete the working day. I did not expect to do it online, and I did not expect that even if it could not be operated online, I could go to the scene on Saturday." The phone was too convenient. " Ms. Liu said happily. When handling transfer business, it is often encountered that the transfer procedures cannot be completed due to uneven materials or other problems. To this end, the District Medical Insurance Bureau extended the time of the operation and incorporated the transfer business into the Saturday delay service project to facilitate the masses to submit materials. The District Medical Insurance Bureau implements the "good bad review" system, implements the "not resting office" service on Saturday, expands the silent calls, robot leaflets, self -service delivery orders, online appointments and other services, and realizes the "full online office" of the process. Essence

Build a fund security barrier

The District Medical Insurance Bureau comprehensively implemented relevant laws and regulations such as the "Regulations on the Supervision and Administration of Medical Security Fund", and adhered to improving the management and fund supervision capabilities on the rails of the rule of law. While optimizing the entry assessment process of designated medical insurance institutions and improving the dynamic management mechanism of fixed -point access to withdraw from the dynamic management mechanism, strictly do a good job of assessment of fixed -point pharmaceutical renewal agreement, continue to promote the construction of "one village, one stop (room)", weaving at the grassroots level fixed -point medical institutions Service networks to improve the masses' medical treatment. Promote the management of medical institutions, optimize the evaluation process of designated medical insurance institutions, and accumulate 27 new targeted medical institutions.

At the same time, we will improve the long -term supervision mechanism, rely on big data analysis and screening technology, jointly carry out special operations to combat fraudulent insurance protection, implement fixed -point medical institutions with full coverage of on -site inspections, establish third -party participation mechanisms, and have completed a total of 75 fixed -point medical care Special audit of institutional medical insurance fund. At the same time, improve the reporting and rewards and clue transfer systems, unblock complaints and reports, and promote collaborative supervision and comprehensive supervision.

In the next step, Haidian District will continue to focus on people's livelihood medical insurance, build a multi -layered security system, promote the reform of the dynamic growth of medical insurance funding for urban and rural residents, the transfer of social security operations, and the adjustment of personal account management methods, and implement the national and Beijing medical insurance treatment list system It stipulates that the annual key tasks and people's livelihood projects are completed. (Reporter Xie Chunyang)

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