Circular of the Ministry of human resources and social security on the implementation of the opinions of the State Council on the integration of basic medical insurance system for urban and rural residents

Source: human resources and social security department (bureau) of all provinces, autonomous regions, municipalities directly under the central government and Xinjiang production and Construction Corps (hsbf [2016] No 6): in order to implement the opinions of the State Council on the integration of basic medical insurance system for urban and rural residents (GF [2016] No 3, hereinafter referred to as the opinions) ）Spirit, do a good job in the integration of basic medical insurance system for urban and rural residents, and the relevant matters are hereby notified as follows: first, fully understand the importance of promoting the integration of medical insurance system for urban and rural residents (first) integrate the basic medical insurance system for urban and rural residents, which is of great significance for promoting the coordinated development of urban and rural economy and society and building a well-off society in an all-round way All localities should integrate their thinking and understanding into the central decision-making and the spirit of the opinions, fully understand the significance of integrating the medical insurance system for urban and rural residents, focus on improving the national medical insurance system, establishing a more equitable and sustainable social security system and promoting the overall reform of the medical and health system, and plan as a whole, carefully organize and solidly advance (2) to integrate the basic medical insurance system of urban and rural residents is conducive to solving the prominent problems caused by the division of urban and rural medical insurance system, such as unbalanced treatment, uncoordinated policies, low management efficiency, weak fund sharing ability, etc.; to achieve coordinated and shared development, improve people's well-being, and make urban and rural residents enjoy the rights and interests of basic medical insurance more equitably; to enhance the medical insurance for medical treatment The incentive and restriction function of medical and health services, the promotion of fund security efficiency, and the better play of the basic role of medical insurance in medical reform are conducive to the overall use and play of social security system and policies, and the comprehensive implementation of policies in the aspect of medical insurance poverty alleviation, so as to provide system security for the elimination of poverty caused by illness and the return to poverty caused by illness Second, clear objectives and tasks, do a good job of overall planning (third) in accordance with the requirements of the establishment of a unified urban and rural basic medical insurance system, clear from the policy, promote the task of system integration To integrate the medical insurance system, we should strive to achieve the goals of more equitable security, more standardized management and services, more effective use of medical resources, and sustainable and healthy development of the national medical insurance system At the same time, we should base ourselves on the current situation and take a long-term view, and do a good job in the connection and coordination with the basic medical insurance for employees and other medical insurance systems and policies, so as to lay a foundation for unifying the medical insurance system for the whole people in the future (4) all localities shall, in accordance with the general requirements and basic principles specified in the opinions and on the basis of carefully summarizing and drawing on the successful experiences and practices of the first integrated regions, formulate the overall plan and implementation plan in a timely and scientific manner It is necessary to integrate the medical insurance system of urban and rural residents as an important part of establishing a more equitable and sustainable social security system for urban and rural areas, which should be included in the local "13th five year plan" for the development of human resources and social security On the basis of investigation, comparative analysis, research and demonstration, summarizing and drawing on the exploration experience of the leading regions, we should formulate the overall scheme of integration system and promotion work, and make clear the division of tasks, timetable and road map The provinces (districts and cities) that have not yet been integrated should ensure that the overall planning and work plan are completed by the end of June 2016, coordinate the regions to ensure that the specific implementation plan is issued by the end of 2016, and simultaneously make preparations for the implementation of insurance registration, budget arrangement, cost collection and payment, and strive to start the implementation in 2017 In the areas where the overall plan of medical insurance for urban and rural residents has been implemented, policies and management measures should be further improved in accordance with the spirit of the opinions 3 Accurately grasp the key points of the policy, and formulate the integration plan according to local conditions (5) formulate the basic policies and management measures of basic medical insurance for urban and rural residents in strict accordance with the requirements of "six unifications" Based on the principle of basic guarantee and promoting fairness, we should reasonably determine the financing level, guarantee standard, payment scope and medical treatment platform, which can not only enable urban and rural residents to enjoy the results of reform, but also realize the fund balance and sustainable development of the system In order to integrate the current basic medical insurance system for urban and rural residents, we should not only realize the system unification, but also perfect and explore the system policy and management mechanism in view of the existing problems At the same time, we should properly deal with the special problems encountered in the reform and do a good job in policy convergence (6) improve the management mechanism, effectively play the basic role of medical insurance, and promote the linkage of medical treatment, medical insurance and medicine We need to improve the way of payment, promote the composite payment by disease and by head based on the full implementation and improvement of the total payment control of medical insurance, establish and improve the negotiation mechanism and risk sharing mechanism, and promote suppliers to actively control the cost of medical services We should improve the management of medical treatment, guide the insured to make rational use of medical services, and promote the establishment of hierarchical medical system and two-way referral system We should strengthen monitoring of medical services, comprehensively promote real-time auditing and intelligent monitoring, promote standardized diagnosis and treatment of medical institutions, control unreasonable medical expenses, and crack down on fraud (7) to explore and rationalize the management system, give priority to the integration of handling resources, and strive to improve the efficiency of management services We should pay attention to summing up and learning from the experience and practice of integrating the local areas first, promote the integration of systems, management and handling as a whole, formulate standardized transfer procedures, and transfer the functions, staffing, personnel, funds, information and assets of relevant institutions Properly handle the problems during the period of system and system integration, shorten the integration time, formulate emergency response plans for the problems that may occur in the integration process, and ensure that the management and management team are not scattered, the team is not disordered, and the work is continuous, and urban and rural residents' Insurance contributions and medical reimbursement are not affected (8) it is necessary to strictly manage the fund, strengthen the audit and supervision of the use of the fund, implement the work responsibilities, strictly enforce the work discipline, and ensure the safety and integrity of the fund We should strengthen the audit and supervision of system integration and fund security in accordance with relevant regulations We will improve internal and external control systems, implement organizational structure, business operation, fund finance and information system control, and strengthen fund management Regularly publicize to the society the income and expenditure of basic medical insurance fund for urban and rural residents and the enjoyment of treatment, and take the initiative to accept social supervision The social insurance staff shall strictly abide by the relevant laws and regulations of the state, abide by the discipline provisions for social insurance staff, be honest and self-discipline, and do their own work well (9) strive to build a unified, standardized and convenient nationwide medical insurance management and handling service system According to the new requirements of the national medical insurance management, we should make full use of the existing handling service resources of social insurance, optimize the management service process, innovate the medical insurance management mode, promote the connection of various medical insurance systems, facilitate the cross regional transfer and connection of the people's insurance registration, payment, medical settlement, enjoying various social insurance benefits and insurance relations, and improve the management service efficiency (x) promote the integration of information systems, strengthen business collaboration and provide convenient services According to the requirements of unified standards, resource sharing and service extension, combined with the construction of provincial centralized system, realize the unified management of personnel basic information based on the basic information database of cardholders, upgrade and transform the social insurance information system, realize the data sharing with urban and rural residents' endowment insurance, and realize the integration with urban and rural residents' endowment insurance system and existing medical insurance settlement function in conditional areas, Support unified business handling and data management Promote the wide application of social security card in urban and rural residents' insurance payment, real-time settlement and other work Establish a unified catalog database of all insured personnel, drugs, diagnosis and treatment projects, and service facilities Through the special business network, the information system is connected with all agencies and designated medical institutions, and the information network construction of labor security platforms at all levels is promoted as a whole Promote "Internet + medical insurance" services for the benefit of the people IV strengthen organizational leadership to ensure smooth and orderly progress (XI) the local human resources and social security departments shall, in accordance with the requirements of the opinions and the deployment of the central government, and with the support of the local Party committee and the government, include the integration work in the key tasks of comprehensively deepening the reform, earnestly perform their duties, strengthen the coordination of departments, be brave to take the responsibility and take the initiative to ensure that the integration work is carried out smoothly and orderly, and complete the establishment of a unified city as scheduled The task of basic medical insurance system for rural residents Each province should strengthen the classified guidance for the overall planning area, promote the areas without system integration to put forward the specific implementation plan for the integration of urban and rural residents' medical insurance work, encourage the regions with conditions to make a breakthrough as a whole, and realize the one-step system integration; guide the areas that have achieved system integration to further improve policies and improve management and service efficiency (12) we should scientifically formulate the work promotion plan, do a good job in social stability risk assessment of integration, formulate assessment and evaluation methods, summarize and evaluate the effectiveness of system integration from the aspects of optimizing system policies, improving management service level and improving service efficiency, and timely correct and adjust the problems in promoting integration Establish a communication and coordination mechanism for the integration of ministry and provincial systems, properly deal with the problems in the integration work in a timely manner, and report to the human resources and social security department in a timely manner in case of important situations and major problems in the process of promoting the integration At the same time, establish a system of work scheduling and regular notification, strengthen supervision and inspection, and promote the smooth implementation of integration (XIII) we should adhere to the correct guidance of public opinion, carry out extensive policy publicity, play the role of typical demonstration and guidance, properly respond to the concerns of the masses, reasonably guide public opinion, actively resolve possible conflicts, and strive to create a good atmosphere for the integration of urban and rural residents' medical insurance system Ministry of human resources and social security January 13, 2016