Keep the people's "life -saving money"

◎ Xingsha Times reporter Wu Wanqin correspondent Liu Guiyuan

The medical insurance fund is the "life -saving money" of ordinary people. Since August 2021, the Changsha County Commission for Discipline Inspection has focused on outstanding issues and weak links in the medical insurance field, continued to carry out special supervision and inspection of "clean medical insurance", urged the functional departments to compact the main responsibilities, improve the institutional system, and conduct fraudulent insurance, suits, and insurance. Illegal acts and various formalist bureaucracy in the process of regulatory law enforcement have severely cracked down on the problem of unreasonable use of medical insurance funds to ensure that various medical policy policies are implemented.

Introduce professional forces and put the "entry and exit valve"

Focus on randomly check 254 medical records, find 9 violations such as over -standard charges, repeated charges, stringing project charges, and over -range medication. The Audit Bureau and the third -party audit institution on a medical insurance fund audit results issued by a hospital.

Each "life -saving money" is used on the blade. During this round of special supervision, while carrying out daily supervision and inspection, the Changsha County Commission for Discipline Inspection and Supervisory Committee will target the source of medical institutions, unite the county's sinking supervision, and dispatch the county audit bureau to set up 3 key hospitals in the county. Audit, focus on cracking problems such as insufficient professional forces and difficulty in verifying expenses, and maintain a high -pressure situation of cracking down on fraudulent protection and setting.

The Changsha County Discipline Inspection Commission and the County Medical Insurance Bureau conducted a special inspection of the "clean medical insurance" of the hospital to check the hospital's medical insurance management system. Photo by Wu Wanqin

"These three key hospitals are more prominent in illegal charges and over -medical care. This opportunity to use this opportunity to combine professional institutions to investigate and recover the funding of funds." The relevant person in charge of the County Medical Insurance Bureau introduced that the audit team would In June, the medical expenses of the medical insurance for medical insurance participation in Changsha County fully started and focused on random inspections. From medication, treatment, and inspection to procurement, the amount of three hospitals suspected of illegal costs was more than 800,000 yuan, all of which were irregularities Illegal expenses such as charges, over -medical care.

In this regard, the county disciplinary committee supervisory committee led the establishment of multiple sectoral clues and joint punishment mechanisms, and the medical insurance, health, public security, audit, market supervision, administrative law enforcement and other departments cooperated to conduct investigations and rectification respectively. At present, the three hospitals have been transferred to the county administrative law enforcement bureau for illegal fees. In the next step, the county disciplinary committee and supervision committee will strictly urge relevant functional departments to recover the illegal fund.

Broaden supervision channels and build a "security network"

"Are there any funds through false materials?" "We must resolutely prevent selling special outpatient drugs." Recently, the County Discipline Inspection Commission and the County Medical Insurance Bureau were unannounced in medical insurance for medical insurance. This is Changsha County. Establish a microcosm of social supervision, self -supervision, and public opinion supervision integration supervision model.

The inspection team checked the special disease outpatient pharmacy, checked the medical expenses settlement list, and inspected the medical insurance funds.

At present, there are 41 medical institutions in the county, 73 special outpatient pharmacies, 272 designated pharmacy clinics with POS machines, and 1.335 million people. The County Discipline Inspection Commission and the County Medical Insurance Bureau broke up the supervision channel. On the one hand, we organize self -examination around 6 aspects such as skewers, fictional drugs, and resale drugs. Investigate the behavior of fixed -point pharmacies and insureds to collect medical insurance funds.

At the same time, the county disciplinary committee supervisory committee in accordance with the responsibilities of the "check, correction, and governance" step -by -step compacting the medical insurance fund supervision department, to comprehensively investigate the risk points and high risk links of the medical insurance field, and urge medical insurance, health and other units to further improve the construction, risk management and control of risk management and control , Fund use and other related systems, investigate the ideological and morality, job responsibilities, business processes, institutional mechanisms, external environment and other risk points of cadres and employees. All units have accumulated more than 30 risks of clean government.

The special inspection team went to the hospital to listen to the development of "clean medical insurance".

Since the launch of the special supervision work, the county disciplinary committee supervisory committee investigated and dealt with the staff of medical insurance and medical institutions to receive 2 clues for the red envelope gifts in violation of regulations, one of them was severely warned within the party, and 9 were given coach and order inspection and processing. Essence The collection of disciplinary funds was nearly 200,000 yuan, and the relevant designated medical institutions took the initiative to withdraw more than 1.5 million yuan in medical insurance funds.

Optimize service level, fund "living water foot"

"Coronary angiography adds brackets, with a total cost of 15,541 yuan, a drop of more than 10,000, paying for 3597 yuan, and a drop of more than 4,000 yuan!" Wang Yan was discharged smoothly after receiving the cardiac stent surgery at Xingsha Hospital. Essence

Wang Yan's experience, many patients in Changsha County have deeply realized. In order to strengthen the construction of "clean medical insurance" and let the medical insurance policy really land, the county disciplinary committee and supervisory committee and the county medical insurance bureau have conducted in -depth investigations of the masses, listen to the voices of the masses, and find the pain points of the people in terms of buying medicine, seeing a doctor, and medical treatment. "One bed is difficult to find" and high medical costs ... To solve the most reports of the masses, we can only promote optimization services and deepen reforms.

Changsha County Maternal and Child Health Hospital announced the cost of drugs, promoted the construction of smart hospitals, and provided more convenient medical services for the masses.

The county disciplinary committee supervisory committee urged the county medical insurance bureau to regulate the recruitment method to "throw" from reducing the cost of medical consumables. Changsha County Maternal and Child Health Hospital will include controllable cost expenditures at 110%of the actual expenditure, and conduct prescription comments on various departments daily, strictly control the cost of medication and consumables. "The medicine is not opened." It really achieves the purpose of compressed and controllable costs. Changsha County Maternal and Child Health Hospital simultaneously promoted the construction of "clean medical insurance" and "clean and honest hospitals", and clean factors can be seen everywhere in the hospital.

The "burden reduction" of medical expenses also began in the countryside. In 2021, Huangxing, Takahashi, Fulin, Orchards, Orchards, Kaihui, Huanghua, and Internship Town, Changsha County, a total of 7 towns (streets) health centers declined in the previous year. This means that the county's diagnosis and treatment services in the county Regulating, the implementation of medical insurance policies is more in place, the medical insurance fund operation is more secure and efficient, the burden of medical treatment has further reduced, and the construction of "clean medical insurance" shows a new weather.

"The medical insurance fund is related to the vital interests of the people." The relevant person in charge of the Changsha County Discipline Inspection Commission said that the construction of "clean medical insurance" should not be tasting. Strengthen the means of supervision, urge the level of optimization of medical services, ensure that the people's medical policy benefits the people should be enjoyed, and effectively protect the "life -saving money" of the people.

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