Adhere to the four "further" to promote the high-quality development of health insurance

The Fifth Plenary Session of the 19th Central Committee of the Communist Party of China (CPC) is an important meeting of global and historical significance that China will enter a new stage of development and realize the great rejuvenation of the Chinese nation. The
meeting summarized the great achievements made in economic and social development during the 13th Five-Year Plan period, affirmed the achievements of the reform and development of medical security, and put forward the "victory in building a well-off society in an all-round way", that is, the victory in achieving the goal of the first century is in sight. The
Meeting deliberated and adopted the Proposals of the CPC Central Committee on the Formulation of the 14th Five-Year Plan for National Economic and Social Development and the Vision Of 2O35, made strategic decision-making and deployment to start the new journey of building a socialist modern country in an all-round way, and called on the whole Party and the people of all ethnic groups to unite closely around the Party Central Committee with General Secretary Xi Jinping as its core, work with one heart and one mind, work tenaciously and win a new victory in building a socialist modern country in an all-round way.
meeting proposed that a sound multi-level social security system covering the whole people, coordinating urban and rural areas, fair, unified and sustainable, has provided a fundamental guide for the development of medical security.
Standing at the meeting point of the two century-old goals, reviewing and summarizing the 13th Five-Year Plan and looking forward to the 14th Five-Year Plan are of great significance to us in encouraging our fighting spirit and making good progress in building a socialist modern country during the 14th Five-Year Plan period.
, Chengdu medical insurance industry in the "13th Five-Year Plan" period to achieve the "five changes" "13th Five-Year Plan" period, China has built the world's largest medical security system, has achieved remarkable achievements.
especially in the new round of institutional reform, the medical security department has come into being, which fully reflects the importance and concern of the Party and the state for the work of medical security, and the cause of medical security has opened a new chapter in history.
January 2019, Chengdu Medical Security Bureau was established.
Chengdu health insurance department closely around the "13th Five-Year Plan" planning development goals, adhere to the "jump out of health insurance to grasp health insurance" work philosophy, and constantly expand and extend functional responsibilities, enhance the ability to tap resources, integrate resources, pry resources, accelerate the construction of a comprehensive coverage of the whole people, urban and rural integration, clear rights and responsibilities, security, sustainable multi-level medical security system, in the people's livelihood protection, social governance, industrial development and empowerment to play an active role in improving people's sense of well-being.
01 Insurance coverage from "full coverage of the system" to "universal coverage" transformation Chengdu has always adhered to the people-centered development ideas, innovative work initiatives, strengthen the operation of services, fully mobilize the enthusiasm of the masses to participate in insurance, orderly promotion of universal insurance, further weaving the health care network, promote the protection, so that the masses fully share the development of medical security system dividends.
the end of the 13th Five-Year Plan, the city's basic medical insurance coverage reached 17.4816 million people, accounting for 105.43 percent of the resident population, achieving the goal of universal coverage.
02 The institutional framework from "fragmentation" to "systemic" to deepen the reform of the medical security system, promote the smooth convergence of the medical insurance system, efficient operation, from 2009, Chengdu integrated urban residents' medical insurance, new agricultural joint, children's hospital medical assistance, the establishment of a unified basic medical insurance for urban and rural residents;
, in particular, to establish and improve the long-term care insurance system integrated into urban and rural areas, to include urban and rural residents in the scope of protection, to create a care package, to develop standards for nursing services.
At present, Chengdu has formed two basic medical insurance systems for urban workers and urban and rural residents as the "core layer", medical mutual assistance insurance for major diseases and urban and rural residents for the "supplementary layer", maternity insurance and long-term care insurance as the "extension layer", medical assistance system as the "bottom line layer" of the "2 plus 2 plus 2 plus 1" medical security system, the institutional framework system gradually stereotyped.
03 The protection channel from "single supply" to "multiple fund raising" to explore the establishment of a multi-level medical security system, effectively resolve the pressure of health insurance fund expenditure, the first in the country to issue "on promoting the development of health insurance to improve the multi-level medical security system guidance" to promote market subjects to develop commercial health insurance products, the construction of social health insurance and commercial health insurance integration and development of a new model.
04 The mode of governance from "informatization" to "intelligent" Chengdu continues to deepen governance in the field of medical insurance, further promote the construction of the national medical insurance intelligent monitoring demonstration point, in accordance with the idea of solidified 1 foundation, building 2 rule libraries, building 4 core application platforms, explore new models of intelligent monitoring, develop the country's first "Chengcheng medical insurance big data anti-fraud monitoring platform" with independent intellectual property rights, and build a full-dimensional, full-process, all-weather regulatory system.
05 Health insurance function from "one-way power" to "three-doctor linkage" transformation to give full play to the role of health insurance leverage and guidance, the first in the country to set up an "international medical consumption center urban security strategic alliance", set up a "three-doctor linkage" of government and enterprises seamless docking exchange and cooperation platform, explore the "health insurance and commercial insurance" "health insurance and banking" "health insurance and industry" and other multi-dimensional cooperation model, to achieve the pharmaceutical and health industry ecosystem enterprise information exchange, resource sharing, factors link.
innovation to establish a "Yucheng medical insurance living room", and actively preach the health insurance policy, so that enterprises take the initiative to adapt to the direction of national health insurance reform, grasp the law and trend of industrial development.
II. Adhering to the spirit of the Fifth Plenary Session of the 19th Central Committee and constructing a more open pattern of medical security work in the new stage of development for the future, the reform of medical security should always adhere to xi Jinping's new era of socialist ideology with Chinese characteristics as a guide, and to the 14th Five-Year Plan for National Economic and Social Development and the Vision of 2O35. The proposal of the target focuses on the unbalanced development of the medical security industry, adheres to the overall coordination, balanced development, guarantees innovation, and governance, gives full play to the strategic purchasing power, payment support and leverage of the medical insurance fund, and focuses on deepening reform and innovation, strengthening the foundation, improving quality and efficiency, and promoting the higher quality development of the medical security industry.
01 to further improve the multi-level medical security system, one is to adhere to the "moderate protection."
Insist on doing our best and doing our best, give full play to the function of mutual assistance and risk sharing in basic medical insurance, take into account efficiency and fairness according to the level of economic and social development, find a reasonable balance between safeguarding, and establish and improve a long-term mechanism of scientific quantification.
is to insist on "clear rights and responsibilities".
reasonable division of power and responsibility system, maintain the whole society's reasonable expectation of the medical security system, reflect the individual's cost-sharing responsibility, financing responsibility, to prevent the tendency of welfare of basic medical insurance.
is to insist on "sustainable".
To strengthen the construction of the financing mechanism, the basic medical insurance for urban workers should determine the benchmark rate, reflecting the rigidity of the benchmark rate, and the basic medical insurance for urban and rural residents should establish a dynamic financing mechanism to prevent the inverse choice of insurance coverage, highlight individual responsibilities and enhance the stability of financial assistance.
support the development and expansion of commercial health insurance, cultivate the market base, reduce the pressure on health insurance fund payments.
02 to further improve the medical security governance system, one is clear governance authority.
On the basis of promoting provincial-level co-ordination, clarify the responsibilities and responsibilities of the medical insurance departments at the national, provincial and municipal levels, not only to ensure the fairness of the basic treatment system, but also to give more autonomy to the reform and development of local medical security, and to promote local conditions to explore more innovative pilot experiences.
is to optimize the system of governance authority and responsibility.
the overall level of medical security should be raised, the responsibility of financial bottom should be adjusted accordingly to reflect the unity of the overall level of medical security and the responsibility of the financial bottom of the same level.
third is to strengthen the construction of intelligent governance.
implement full and real-time collection of medical data, open the data channels of health care, civil affairs and market supervision, and provide data support for intelligent governance.
to build and improve the governance system for innovative things in the medical field such as Internet hospitals and Internet clinics, and promote the orderly development of industry innovation and norms.
fourth is to strengthen the construction of the governance team.
strengthen the professional construction of the medical insurance management team, explore the establishment of the hospital medical insurance manager examination and training system, improve policy orientation, to ensure the consistency of implementation.
03 Further improve the reform of the supply side of medicine One is to carry out centralized volume procurement.
to the implementation of multi-round collection, price moisture fully squeezed varieties, further optimize the selection mechanism, procurement purposes to reduce the pressure conduction to prevent malicious low-cost selection development.
the "water-squeezing"-based mechanism for varieties that have not yet been collected.
is to play the guiding role of health insurance payment standards.
to explore the mechanism of collecting and forming payment standards to dominate the market.
to solve the relationship between the medical insurance payment standard and the actual purchase quantity of the hospital, and gradually realize the combination of the medical insurance payment standard and the actual purchase quantity of the hospital.
third is to promote the consistent evaluation of consumables.
, in coordination with the market regulatory authorities, speed up the establishment of a consistent evaluation system for consumables, for the centralized procurement of consumables to provide quality endorsement.
fourth is the unified collection and execution scale.
to explore the private fixed-point medical institutions, fixed-point retail pharmacies into the scope of collection, to prevent pharmaceutical enterprises to avoid collection, to ensure that price standards are unified.
04 To further improve the legal system of medical security is to explore and promote medical security legislation.
The Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical Security System provide a top-level design for the comprehensive promotion of reform in the field of medical security, and promote the reform of the national medical security system into a fast track of overall acceleration.
is to promote the innovation and legalization of the medical security system mechanism.
effective experiences and measures emerging from health care reform into the legal system.
A series of effective working mechanisms, such as the first treatment and settlement policy established in the prevention and control of the new crown pneumonia epidemic, should incorporate the emergency mechanism of medical insurance into the legal framework, clarify the procedures for the initiating of emergency response to medical insurance, the use of unconventional means of disposal by medical insurance agencies, and the settlement method of medical insurance payments.
third is to crack the difficult problem of medical security development by legislation.
Focus on the difficulties in the current medical security reform, such as the transfer of medical insurance years and the legal basis of administrative law enforcement, clarify the standards and paths in the law, empower the people through medical security legislation, clarify the people's right to medical security, and give the medical security department the supervisory power and responsibility of the administrative department.