The head of Yueyang Medical Insurance Bureau learned in detail about the difficulties and bottlenecks in the city’s Government Affairs Center medical insurance window. Photo by Li Liyue
Ouyang Lin Kang Yunhua Li Li Yue
Continue to promote the national insurance plan, and the level of insurance benefits continues to improve; introduce a number of measures to benefit the people to improve the medical insurance benefits of the people; carry out special rectification of "Medical Insurance Clean Wind" to manage the "life-saving money" of the people... Every heartwarming and practical thing paves the road to health for people's livelihood.
In recent years, the medical security department of Yueyang City has adhered to the people's health center, continuously optimized convenient services in the medical insurance field, improved the four-level management and service system of cities, counties, townships and villages, improved the standardized management level of handling services, and actively promoted full coverage of policies, reform and innovation to improve efficiency, fund supervision is not missed, and it is more convenient to do things in other places. The people's sense of gain, happiness, security and identity are constantly enhanced.
covers the whole people
Gongfu Ankang Road "one will not fall"
html In early September, the relevant departments of various counties (cities) and districts gathered in 2023 urban and rural residents' basic medical insurance payment work, paving the road and building bridges for the full coverage of insurance participation in the city in the next year.Yueyang has included the full coverage of basic medical insurance in the comprehensive performance assessment of the county (city) district party committee and government, and established a medical insurance collection system for urban and rural residents with the city and county people's governments as the main body. Supporting documents such as unified fund collection and expenditure, budget management, and risk reserve management have been formulated and issued to comprehensively sort out and collect fragmented medical insurance benefits policies; in October last year, Yueyang officially launched the national medical insurance information platform, fully realizing the "four unifications" of basic policies, fund management, business processes, and information systems; in November last year, it took the lead in establishing a risk warning system for basic medical insurance funds operation.
Yueyang Medical Insurance independently developed a database of basic medical insurance participants, established a multi-channel dynamic update mechanism to accurately survey uninsured people, continuously strengthen information support, expand the accurate and effective coverage of medical insurance policy publicity, and significantly increase the enthusiasm and initiative of the people to participate in insurance. In 2022, 273,687 insured persons were funded, with a funding amount of 58.8241 million yuan, achieving a 100% insurance rate for 311,867 rural revitalization departments of Yueyang City.
Chen Ping, Party Secretary and Director of Yueyang Medical Insurance Bureau, introduced: "By improving the level of coordination, expanding the coverage of insurance participation, and expanding the scale of funds, the fund's risk resistance has been significantly enhanced. The basic medical insurance coverage rate of Yueyang's permanent population has remained stable at more than 95% for three consecutive years, of which the coverage rate of permanent population in 2022 reached 101.22%, achieving full coverage of insurance participation."
One-stop quick service
Convenience "service circle" is built at all levels and
Yueyang's relevant departments further integrate and share across industries, cross-regional and cross-departmental connections, and accelerate the creation of a "15-minute convenient service circle" for medical insurance service matters. Many counties (cities) and districts have established "agent agency assistance" service points for medical insurance services, opened "agent agency" services on self-service platforms, and jointly built a "one-window acceptance, internal transfer" high-efficiency and multi-level joint service mechanism to realize online and offline integrated service, down-to-earth service nearby, and process reengineering and rapid process.
At present, the medical insurance service in 131 townships (streets) and 1,844 villages (communities) in the city has "windows, dedicated personnel, networks, and services", achieving full coverage of medical insurance service at the four levels of cities, counties, townships and villages.
In recent years, Yueyang medical insurance cross-regional management has expanded from within the city to outside the province, and direct settlement in other places has expanded from inpatient to outpatient clinics, and the audit and payment cycle has been from years to daily settlement; the counties (cities) and districts in Yueyang have continuously broken regional restrictions, promoted regional coordination, exchanged local concessions for overall progress, and exchanged short-term pain for long-term win-win results.
Multiple protection
"Protection Network" for the benefit of the people is closely weaved
Yueyang vigorously implemented the policy of first diagnosis and treatment and then payment. For the poor, the extremely poor, and urban and rural minimum living allowance, the deductible for serious illness insurance is reduced by 50%, the payment ratio for serious illness insurance is increased, and the "one-stop" instant settlement for hospitalized medical assistance for people in need is fully implemented.As of the second quarter of this year, Yueyang City severe illness insurance protected 4,376 people in need and paid 55.7584 million yuan; as of the end of August, the city implemented hospitalization assistance to the needy and expenditure of 52,310 people in need and expenditure of 62.7823 million yuan; and implemented outpatient assistance to the needy and expenditure of 23,300 people in need and expenditure of 6.2783 million yuan. We have effectively solved the pressure of "advance funds" and "running errands" for the poor, and the relevant work has been recommended by the provincial government.
In order to further improve the efficiency of fund use and allow the guarantee policy to fully cover minor illnesses, chronic diseases and serious illnesses, Yueyang Medical Insurance has accelerated the establishment of an outpatient mutual assistance mechanism and included outpatient expenses in the payment scope of the medical insurance unified fund; the number of outpatient clinics that can be applied for in an orderly manner from the original 10 to 43, comprehensively promote the use of medication for patients with "two diseases" and "dual channel" medication; launch the "Baling eHehuibao" with a coverage of 4 million yuan to prevent the risk of medical burden on serious and serious diseases of the people.
Strengthen supervision
People's "life-saving money" is a must-see
Yueyang has always regarded maintaining the safety of medical insurance funds as an important political task. The secretary of the municipal party committee and mayor have issued instructions many times; the leadership team of the Municipal Medical Insurance Bureau led the county to supervise; various departments have carried out special rectification of "Medical Insurance Clean Wind" year after year to effectively maintain the safety of the fund.
This year, the strength of the Yueyang City "look back" coordination group has not diminished, and its supervision tentacles have continued to sink, achieving full coverage of inspection and supervision. It has organized 14 member units including health, public security, civil affairs, etc. to hold four joint meetings. As of the end of August, the city has completed the audit and inspection of 959 medical institutions through a "look back", imposed administrative penalties of 107, recovered medical insurance funds and fined approximately 28.6017 million yuan, achieving significant rectification results.
According to the new project management specifications and review procedures of the provincial bureau, Yueyang organized the review and standardization and cleaning of new special medical service projects for public medical institutions at the second level and above in the city, formulate audit behavior norms, strengthen pre-approval, in-process supervision, and ensure that audit behavior is legal and standardized.
In May this year, relying on the national medical insurance information platform, Yueyang took the lead in the province to realize the implementation of intelligent monitoring in the hemodiagnosis and treatment scenarios of Guangji and Shenyou; simultaneously promote the "1+2+2" intelligent review model and credit system evaluation service work, and strengthen the application of big data analysis in supervision; 30 designated medical institutions were selected to deploy and install synchronous video surveillance, and promptly investigate and deal with 24 clues assigned by the provincial level, and review and implement all 306 clues in 11 counties, cities and district bureaus, recover the medical insurance fund and impose a fine of about 15.62 million yuan.
DIPPaid
Randomize the problem of " big prescription "
For the stubborn problems of over-medical behaviors such as "big prescriptions" and "big inspections" and other stubborn problems, this year, Yueyang has officially launched the DIP payment reform. This payment method uses big data to combine diseases according to the "diagnosis + treatment method" as a payment unit. The medical insurance department determines the payment standard for each disease based on the total amount of medical insurance funds that should be paid each year and pays to the hospital according to this standard.
"As a new form of packaged payment, the precise quantification of payment standards can allow insured patients to obtain more reasonable and effective medical services under the premise of scientific and standardized control of treatment costs." The head of the Medical Management Service Department of Yueyang Municipal Medical Insurance Bureau said, "This is conducive to the focus of competition among hospitals to return to medical services and technical level itself, and give full play to their respective advantages and characteristics."
At present, Yueyang has implemented reforms in more than 60% of second-level and above medical institutions in the city, and it is expected that the full coverage of DIP payment for designated medical institutions in the city will be achieved within three years. At the same time, Yueyang has also expanded the payment scope for single disease to 160 diseases, effectively improving the efficiency of medical insurance funds and reducing the treatment costs of insured patients.
volume-based centralized procurement
jointly grasped the "dual channel" drug use guarantee
In order to accelerate the implementation of national centralized procurement drugs, Yueyang launched the public bidding and procurement of low-value medical consumables and testing reagents, realized the comprehensive online procurement of public hospitals, and promoted the standardization of procurement processes and the refinement of procurement management. Currently, the first to seventh batch of centralized drug procurement in the country have been completed. Among them, the average drop in medicines was more than half, and the price of consumables was reduced by nearly 80%, further reducing the price of medical insurance drug consumption and significantly reducing the burden on the people.
Currently, there are 15 designated medical institutions in the city with "dual channel" and 19 designated pharmacies with "dual channel" and more than 160 responsible pharmacies with "dual channel" are clearly defined, so as to achieve the unified reimbursement benefits of insured patients' inpatients, outpatient clinics and pharmacies, so as to effectively ensure the use of drugs with "high clinical value, urgent needs of patients, and treatment of major (rare) diseases", significantly reducing the cost and costs of the public.
Weidedongtian
Medical insurance "traveling the exam" is far away.
By focusing on pain points, clearing up bottlenecks, and relieving difficulties, Yueyang City Medical Insurance Administration has ranked first in the city-level municipal units for consecutive years; the window of the government affairs center has been rated as an excellent red flag window for three consecutive years; Yueyang Medical Insurance Administration reform uses the "five transformations and five offices" to improve the "five quality" practice, and has been recommended by the national industry authoritative journal " China Medical Insurance ".
In terms of strengthening the team and leading the team, Yueyang Medical Insurance uses party spirit to cultivate the people-oriented sentiment, combining "understanding great virtues, abide by public morality, and strict private morality" with " Three Stricts and Three Realities ", and runs through all aspects and bits of daily work and life such as theoretical study, organizational life, clean government construction, business management, social welfare, etc., and has become the theme that must be mentioned at every meeting of the 15th Theoretical Study Group this year and the 13th Party Group Enlarged Meeting.
"'Take hard and work hard', what is the focus of the people's sentiment and what is the will of the people." Chen Ping said, "The modernization reform of social governance and the high-quality improvement of government efficiency are revolutions that turn the knife inward, and use more exchanges to empathize with and empathize with to exchange for social recognition, and use more quality improvement and efficiency to exchange for people's satisfaction."
Medical care is guaranteed and the people have a basis. One by one, one by one, one by one, and one by one, is to better meet the people's growing demand for high-quality medical services. In the journey of accelerating the construction of a veritable provincial sub-center city, Yueyang medical insurance people are working hard and working together with the people.
