Yunnan Entering the era of medical insurance expenses online payment era

The "dual channel" management mechanism allows ordinary people to buy negotiating medicines and reimbursement; start medical insurance mobile payment, move the payment window into the mobile phone, and reduce the waiting time for patients' queuing to pay ... Since this year, the medical insurance department of Yunnan Province has continued to deepen medical care The reform of the system has continued to introduce a series of policies for medical benefits, benefit the people, and the people.

Employees can enjoy medical assistance benefits

As of the end of 2021, the province's medical insurance reimbursement ratio of employees reached 86.94%, and the proportion of residents' medical insurance reimbursement reached 73.33%. The proportion of rescue targets such as subsistence allowances and special personnel complied with the regulations was generally not less than 70%. The comprehensive guarantee ratio reached 80 80 %about.

With the in -depth advancement of medical reform, issues such as inconsistency, low overall levels, and insufficient performance of the guarantee function of the medical assistance objects have gradually emerged. To this end, the Provincial Government issued the "Several Measures for the Medical Insurance and Rescue System in Yunnan Province to Improve the Medical and Diseases Medical Insurance and Rescue System", proposed 18 specific measures in 7 aspects, and officially implemented from July 1. The new policy brings 4 changes in aspects:

The targets of medical assistance are expanded from the countryside to the city, and the residents are expanded to employees. According to the four types of personnel (special personnel, subsistence allowance objects, and poor people who return to poverty, the subsistence allowance margin objects, and rural areas that are included in the monitoring scope. Employees in difficulty, patients with serious illness in the family's basic life due to high medical expenses, relative difficult workers, and other special difficulties prescribed by governments at or above the county level are implemented. Before the reform, employees' participants did not belong to the target of medical assistance. After the reform, employees who met the conditions of rescue conditions could also enjoy medical assistance benefits.

Given full funding for the participation of the residents' medical insurance, the funding of the subsistence allowances and the people who return to the poor and the poor will be funded. The cost shall be borne by the medical assistance fund. It is clear that the target of new medical assistance is not limited by the centralized payment period of the residents' medical insurance, that is, as long as a new medical assistance object is added, a logo is set in the medical insurance information system as soon as possible to ensure that the people in the difficulties will participate in the basic medical insurance as soon as possible, and enjoy the medical insurance benefits in time Realize the full coverage of medical rescue targets for medical security.

Rescue standards are "three unifications, one specification, one improvement". "Three unifications" means that the scope of medical assistance reimbursement is unified in the province; payment standards (medical insurance reimbursement "threshold fees") are unified; reimbursement ratio is unified in the province, and the first type of personnel maintains the current 100%proportion of rescue, the second type of personnel At a proportion of 70%, the third type of personnel rescue at a ratio of 60%, and the fourth type of personnel rescue at a ratio of 50%. The "one specification" means that the medical assistance payment limit is not lower than the per capita disposable income of urban and rural residents in the coordinated region. "One improvement", that is, the overall level of medical assistance before 2023 was raised from county -level coordination to states to overall plans, fully reflecting the "large number of laws" of social insurance, and enhancing security capabilities.

The basic medical insurance subject guarantee function is further played, and the major illness insurance is appropriately tilted to the people in need (major illness insurance has reduced the standards of special personnel, subsistence allowance objects, and poverty -stricken people who return to the poor by 50%. The maximum payment limit of major illness insurance is canceled); all eligible medical assistance targets can also be given tilt assistance again.

"Dual channels" allow people to buy negotiating medicines to be reimbursed

Since its establishment, the National Medical Security Bureau has carried out the adjustment of the national medical insurance and drug catalog for four consecutive years. The national medical insurance negotiating drugs have increased from 36 to 275.

Yunnan Province has taken multiple measures and promoted the implementation of negotiating medicines. As of now, the national negotiation of drug medical insurance has accumulated 43.898 million people, with a total cost of 3.335 billion yuan and a medical insurance reimbursement of 2.374 billion yuan. In order to broaden the channels for medical insurance negotiations for medical insurance negotiations and improve the level of negotiating drug supply guarantee, the State Medical Security Bureau, with the National Health Commission, issued the "Guiding Opinions on Establishing and Improve the" Double Channel "management mechanism of the National Medical Insurance negotiation drugs."

The Yunnan Provincial Medical Security Bureau, the Yunnan Provincial Health and Health Committee, and the Yunnan Provincial Drug Administration issued the "Notice on Establishing and Improve the" Dual Channel "Management Mechanism of Medical Insurance negotiations" at the end of last year. The "dual -channel" electronic prescription center was launched, and some designated pharmacies were used as a "dual -channel" pharmacy for national medical insurance negotiating drug supply guarantees. They were simultaneously incorporated into medical insurance reimbursement. In the designated hospital and pharmacies, they can "buy negotiating medicines, and they can be reimbursed after buying." As of now, 569 "dual -channel" pharmacies have been selected in the province, covering 14 states (except Xishuangbanna, Diqing Prefecture) and 120 counties (cities); Yunnan University Affiliated Hospital, Yunnan Cancer Hospital, Yunnan Province, Yunnan Province Five hospitals in the elderly sick hospital, Wuhua District People's Hospital of Kunming City, and Yuxi City People's Hospital have opened electronic prescription circulation services in advance. After seeing a doctor of medical treatment at the above hospital, the patient can use the medical insurance electronic voucher or Electronic social insurance card, independently select "dual -channel" pharmacy to purchase medicines, and realize "one -stop" medical insurance reimbursement.

At present, the list of hospitals and pharmacies that have been opened for "dual channels" can be checked in the WeChat small program of "Yunnan Medical Insurance". In the next step, Yunnan will steadily expand the scope of the "dual channel" hospitals and pharmacies, mature a family into one, and realize online inquiries.

Gao Zhixue, deputy director of the Yunnan Medical Security Bureau, said that all negotiating drugs in the national medical insurance drug catalog in 2021 were included in the "dual -channel" guarantee drug scope while encouraging conditions for states with conditions to meet the special diseases used by outpatient clinics. (Except for anesthesia, psychotropic drugs, and medical drugs) Incorporate the scope of the "dual channel" guarantee. Insurance patients purchase "dual -channel" drugs at the "dual -channel" pharmacy with prescriptions. Like prescribing medicine in the hospital, the hospital can be reimbursed, and it can be reimbursed "one -stop" in the "dual -channel" pharmacy. Patients participating in the province in the province can also be reimbursed "one -stop" drugs to purchase "dual -channel" pharmacies in the "dual -channel" pharmacy. If they cannot be reimbursed due to special circumstances, patients can use the medical hospital or "dual -channel" pharmacy uniformly prescribed uniformly Invoices, prescriptions, and manual reimbursement at the medical insurance agency in the place of insurance. The current outpatient special diseases and chronic disease policies continue to remain unchanged. Medical insurance mobile payment moves the payment window into the mobile phone

Since the beginning of this year, the Yunnan Provincial Medical Security Bureau has strengthened the transformation of the medical insurance information system, successfully completed the construction of the medical insurance mobile payment center, carried out pilots in some hospitals, and completed the docking with the HIS system of the hospital. After the medical insurance mobile payment business is launched, the insured person does not need to use a social security card or queue in the payment window. By the hospital's WeChat public account, Alipay applet, and national medical insurance service platform app, use medical insurance electronic vouchers to complete medical insurance online online to complete medical insurance The reimbursement of the fund and the "one -click" settlement of the personal payment fee. At present, 19 hospitals in Kunming Medical University first, second, and third affiliated hospitals, Kunsteel Hospital, and 19 hospitals in the four states of Kunming, Qujing, Dali, and Chuxiong have been launched on medical insurance mobile payment functions to achieve WeChat, Alipay, banks Full channel payment, including hybrid payment. Since May 9, 3674 people have used medical insurance mobile payment, with a cumulative settlement amount of 570,900 yuan, personal account payment of 344,700 yuan, medical insurance reimbursement of 131,700 yuan, and personal payment of 134,200 yuan. In addition, 17 hospitals are about to launch medical insurance mobile payment functions.

The Yunnan Provincial Medical Security Bureau has cooperated closely with multiple departments. From July, the employee medical insurance units that have allowed small and medium -sized enterprises and individual industrial and commercial households to be insured by units are allowed to pay, social groups, foundation, and social services Social organizations such as institutions, law firms, accounting firms and other social organizations are implemented. During the slow payment period, the delay deposit, the treatment of the insured is not affected, and adopt the "exemption to enjoy the enjoyment" through the model to allow the policy to directly reach the market entity. Eligible market entities can enjoy policy dividends without submitting a slow payment application to reduce Enterprise burden.

Gao Zhixue introduced that since the province has promoted the use of medical insurance electronic vouchers in 2019, as of now, 32.19 million insured people have completed the activation, accounting for 71%of the number of participants. Second, 24.60%of the cumulative settlement of medical insurance, laid the foundation for the promotion of medical insurance mobile payment. Strive for all tertiary hospitals in the province to achieve medical insurance mobile payment before the end of the year, and gradually promote it to the province.

Source: Cloud Personal News Sister Cloud

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