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    Home > Medical News > Latest Medical News > 97.5% of the country's co-ordination area implemented the total amount of health insurance payment control!

    97.5% of the country's co-ordination area implemented the total amount of health insurance payment control!

    • Last Update: 2020-07-31
    • Source: Internet
    • Author: User
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    Guide: 2019 National Medical Security Development Statistics Bulletin.just now, the State Administration of Health Insurance issued a statistical bulletin on the development of the national medical security industry in 2019, covering seven aspects, such as medical insurance, medical assistance and medical insurance poverty alleviation, medical insurance drug catalogue, drug procurement, and medical insurance payment reform.on the list of medical insurance drugs, the communique announced: The 2019 edition of the National Medical Insurance Drug Catalog, a total of 2709 Western and Traditional Chinese medicines, of which 1370 Western medicine, 1339 Chinese medicine. In addition, 892 Chinese medicine tablets have been included in the national standard. In the 2019 health insurance access negotiations, 70 new health insurance access negotiations were added, a decline of 60.7 percent on average, while 27 previous negotiated drugs were successfully renewed, a decrease of 26.4 percent on average.on drug procurement:as of the end of 2019, the total amount of orders collected in 31 provinces (regions and cities) through the provincial centralized drug procurement platform was 991.3 billion yuan. Among them, western medicine (chemicals and biological products) orders amounted to 811.5 billion yuan, and orders for traditional Chinese medicine amounted to 179.8 billion yuan. The amount of orders for medical insurance drugs in online medicine amounted to 832.7 billion yuan, accounting for 84%.by the end of 2019, the "4 plus 7" drug centralized-belt procurement pilot areasthe average completion of the agreed procurement of 25 drugs, the procurement of selected drugs accounted for 78% of the same generic drug procurement volume. After the pilot national expansion, all 25 generic varieties were successfully purchased, the price of the expansion was reduced by an average of 59%, and on the basis of the "4 plus 7" pilot was reduced by 25%.on the reform of medical insurance payment:to promote the reform of payment methods, 97.5% of the country's co-ordination areas have implemented total control of medical insurance payments, 86.3 percent of the co-ordination areas carried out pay-per-disease. Thirty cities have been included in the national CHS-DRG pay-per-view pilot. More than 60 per cent of the co-ordination areas are paying for long-term, chronic ally in-patient medical services on a bed-to-bed basis, and exploring a combination of pay-per-head and chronic disease management for primary health care.the following are: , medical insuranceto participate in the national basic medical insurance in 2019 135.407 million people, the participation rate is stable at more than 95%. In 2019, the total revenue of the National Basic Health Insurance Fund (including maternity insurance) was RMB244.21 billion, an increase of 10.2% over the previous year, accounting for about 2.5% of GDP for the year, while the total expenditure of the National Basic Health Insurance Fund (including maternity insurance) was RMB2085.4 billion, an increase of 12.2% over the previous year's GDP. About 2.1%; The national basic medical insurance fund (including maternity insurance) has a cumulative balance of 276.97 billion yuan, of which the basic medical insurance co-ordination fund (including maternity insurance) has accumulated a balance of 1927 billion yuan, and the personal account of basic medical insurance for employees (hereinafter referred to as workers' health insurance) has a cumulative balance of 842.6 billion yuan.(1) Basic medical insurance for employees1, the number of insured persons continues to increase. The number of employees participating in health insurance increased by 12.44 million, or 3.9%, over the previous year. Among them, 24.224 million employees were employed, an increase of 3.9% over the previous year, and 87 million retired workers, an increase of 3.9% over the previous year. The in-service retirement ratio was 2.78, flat year-on-year.enterprises, institutions, flexible employment and other categories of insured persons (including active workers and retirees) were 22.267 million, 62.32 million, 44.26 million, respectively, an increase of 7.47 million, 1.13 million, 3.84 million, respectively, accounting for 67.6 percent, 18.9 percent and 13.4 percent of the total number of insured persons, respectively. The total account combination of workers' health insurance and the number of co-insured personnel for single-building insurance were 302.35 million and 26.9 million respectively, accounting for 91.8% and 8.2% of the total number of employees' medical insurance coverage, respectively.2, the fund income and expenditure scale to expand. In 2019, the income of the employee health insurance fund (including maternity insurance) was RMB1584.5 billion, an increase of 10.7% over the previous year, while the expenditure of the fund (including maternity insurance) was RMB126.63 billion, an increase of 10.4% over the previous year. In 2019, the employee health insurance co-ordination fund (including maternity insurance) generated 100.5 billion yuan, an increase of 10.9% over the previous year; In 2019, the personal account income of employees' health insurance was RMB584 billion, an increase of 10.3% over the previous year;3, enjoy the number of people receiving more. In 2019, 2.12 billion people were treated for health insurance for employees, an increase of 7.3 percent over the previous year and a decrease of 1.7 percentage points. Among them: 1.81 billion emergency visits, an increase of 5.8% over the previous year; 260 million outpatient chronic diseases, an increase of 19.4% over the previous year; and 0.6 billion hospitalizations, an increase of 6.8% over the previous year.2019, the per capita number of medical insurance participants attended 6.4 visits, an increase of 0.2 times over the previous year, and the hospitalization rate was 18.7%, an increase of 0.4 percentage points over the previous year. Among them: the hospitalization rate of active workers was 10.1%, an increase of 0.4 percentage points over the previous year, and the hospitalization rate of retirees was 42.5%, an increase of 0.4 percentage points over the previous year.4, the second hospital costs continue to grow. In 2019, the average hospital cost for workers nationwide was 11,888 yuan, an increase of 6.3% over the previous year.5, hospital reimbursement water stable slightly increased. The hospital expenses fund within the scope of the employee health insurance policy pays 85.8%, the actual hospital expenses fund pays 75.6% and the personal burden 24.4%. The payment of hospital expenses funds within the policy scope of secondary and sub-level medical institutions was 87.2% and 89.3%, respectively, higher than 2.2 and 4.3 percentage points respectively for tertiary medical institutions.the total medical expenses of employees' medical insurance participants in 2019 were RMB140.1 billion, an increase of 15.3% over the previous year, of which the expenses incurred by medical institutions were RMB117.1 billion and the personal accounts were spent on pharmacies by RMB202.9 billion. Among the expenses incurred by medical institutions, the medical expenses of retirees amounted to 705.4 billion yuan, an increase of 12.8% over the previous year, while the medical expenses of active workers amounted to 491.8 billion yuan, an increase of 16.0% over the previous year, and the per capita medical expenses amounted to 3,723 yuan, an increase of 12.4% over the previous year.(2) Basic medical insurance for urban and rural residents 1, the number of insured persons continues to increase. In 2019, 102.483 million people participated in basic medical insurance for urban and rural residents (hereinafter referred to as residents' health insurance), a decrease of 0.3% over the previous year. Among them, adults, primary and secondary school children and university students were 76.942 million, 23.519 million and 20.22 million, respectively, an increase of 16.1%, 10.1% and -2.9% respectively over the previous year, accounting for 75.1%, 22.9% and 2.0% of the total number of insured persons, respectively.2, the fund income and expenditure scale continues to expand. In 2019, the residents' health insurance fund generated 857.5 billion yuan in revenue and spent 819.1 billion yuan, an increase of 9.3% and 15.1% respectively over the previous year. In 2019, the residents' health insurance fund had a current balance of 38.4 billion yuan and a cumulative balance of 514.3 billion yuan.2019, the per capita fund-raising of residents' health insurance will be 781 yuan, an increase of 88 yuan, or 12.7 percent, over the previous year, and the per capita financial subsidy will be 546 yuan, an increase of 49 yuan, or 9.9 percent, over the previous year.3, the number of people entitled to treatment and medical expenses continue to increase. In 2019, residents' health insurance participants received 2.17 billion treatments, an increase of 34.0 percent over the previous year. Residents received 1.95 outpatient treatment, an increase of 0.25 compared with the previous year. In 2019, residents' medical and health care costs amounted to 1440.6 billion yuan, an increase of 35.7% over the previous year, and the per capita medical expenses amounted to 1406 yuan, an increase of 18.8% over the previous year.4, hospitalization rate and secondary hospitalization costs all increased. The hospitalization rate of residents' medical insurance participants was 16.6%, an increase of 1.4 percentage points over the previous year; Among them, the average hospitalization costs of medical institutions at the third, second, second and below levels were RMB12,350, RMB6076 and RMB 3,281 respectively, representing an increase of 8.6%, 3.4% and 4.3% respectively over the previous year.5. The proportion of actual payments of funds increased. The hospital expense fund within the scope of the residents' health insurance policy paid 68.8%, an increase of 3.2 percentage points over the previous year; According to the level of medical institutions, the policy within the scope of the hospital expenses fund payment scored: level III 63.6%, secondary 72.1%, level 1 and below 77.5%. Among them, the fund paid 73.5% within the policy scope of the secondary and below medical institutions, which is 9.9 percentage points higher than the proportion paid by the tertiary medical institutions.(iii) Maternity insurance2019, 21.417 million people nationwide participated in maternity insurance, an increase of 4.8% over the previous year. The number of maternity insurance benefits increased by 478,000, or 4.4%, over the previous year. Per capita expenditure on maternity treatment was RMB20,311, an increase of 2.7% over the previous year., medical assistance and medical insurance poverty alleviation2019, the National Medical Assistance Fund spent 50.22 billion yuan, supported 87.51 million people participating in basic medical insurance, implemented outpatient and inpatient assistance 70.5 million times, the national average in-patient assistance, outpatient assistance was 1123 yuan, 93 yuan, respectively. In 2019, the central government will invest 24.5 billion yuan in medical aid grants, and 4 billion yuan will be earmarked to support the improvement of medical security for the poor in deepand areas.by the end of 2019, the participation rate of the poor in rural areas with a file-based lika reached more than 99.9%. The comprehensive health insurance poverty-relief policy has benefited nearly 200 million people living in poverty and helped 4.18 million people living in poverty because of illness to lift themselves out of poverty.3. The medical insurance drug cataloguethe 2019 edition of the National Medical Insurance Drug Catalog, a total of 2709 Western and Traditional Chinese medicines, of which 1370 are Western medicines and 1339 are Traditional Chinese medicines. In addition, 892 Chinese medicine tablets have been included in the national standard. In the 2019 health insurance access negotiations, 70 new health insurance access negotiations were added, a decline of 60.7 percent on average, while 27 previous negotiated drugs were successfully renewed, a decrease of 26.4 percent on average.. 4. Drug procurement as of the end of 2019, the total amount of orders collected through the provincial-level centralized drug procurement platform in 31 provinces (regions and cities) was 991.3 billion yuan. Among them, western medicine (chemicals and biological products) orders amounted to 811.5 billion yuan, and orders for traditional Chinese medicine amounted to 179.8 billion yuan. The amount of orders for medical insurance drugs in online medicine amounted to 832.7 billion yuan, accounting for 84%. by the end of 2019, the average purchase volume of the 25 selected drugs in the pilot areas of the "4 plus 7" drug centralized band procurement was 183 percent of the agreed purchase volume, and the procurement volume of selected drugs accounted for 78% of the purchase volume of generic drugs. After the pilot national expansion, all 25 generic varieties were successfully purchased, the price of the expansion was reduced by an average of 59%, and on the basis of the "4 plus 7" pilot was reduced by 25%. V. Health Insurance Payment Reform to promote the reform of payment methods, 97.5% of the country's co-ordination areas implemented the total amount of medical insurance payment control, 86.3% of the co-ordination area carried out pay-per-disease. Thirty cities have been included in the national CHS-DRG pay-per-view pilot. More than 60 per cent of the co-ordination areas are paying for long-term, chronic ally in-patient medical services on a bed-to-bed basis, and exploring a combination of pay-per-head and chronic disease management for primary health care. 6, off-site medical treatment 2019, 43.72 million medical treatment for employees and health insurance personnel, and 133.9 billion yuan in off-site medical expenses. Among them, the hospitalization cost was 119.7 billion yuan, accounting for 16.7% of the hospitalization expenses of the employees' medical insurance participants, and the average hospitalization cost was 18328 yuan. 2019, 54.18 million medical visits were made by residents' health insurance participants, and 302.2 billion yuan was spent on medical treatment. Among them, the cost of hospitalization was 290 billion yuan, accounting for 24.1% of the hospitalization expenses of residents' medical insurance participants; by the end of 2019, the number of direct settlement-point medical institutions across provinces and provinces was 27,608; The coverage of primary medical institutions continued to expand, with 24720 designated medical institutions at the second and following levels. Throughout the year, 2.72 million direct settlements were made for medical treatment across provinces, with medical expenses amounting to 64.82 billion yuan and the fund paying 38.32 billion yuan. The average daily direct settlement of 7452 people. The average hospital cost 24,000 yuan, the average fund paid 14,000 yuan. to promote the pilot work of inter-provincial settlement of outpatient expenses. By the end of 2019, all 41 cities in the Yangtze River Delta region have achieved full coverage of the direct settlement of outpatient expenses across provinces and regions, and 5,173 designated medical institutions are connected to the Internet, of which all medical institutions with outpatient clinics in Shanghai have been networked. The Yangtze River Delta region has settled a total of 646,000 people, involving a total medical expenses of 14.2622 million yuan. Beijing-Tianjin-Hebei and five provinces in the southwest (Yunnan, Guizhou, Sichuan, Chongqing, Tibet) to launch cross-provincial and off-site medical outpatient expenses direct settlement services. 7. The supervision of the medical security fund continue to carry out special governance to combat fraudulent and fraudulent medical security fund, and a total of 815,000 designated medical institutions have been inspected by medical insurance departments at all levels throughout the year to investigate and punish violations of laws and regulations.
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