Full analysis of the 10 key points of medical insurance in 2021

us" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Under the impact of the epidemic, my country's economic development has shifted to a stage of high-quality development, and is committed to building a new development pattern in which domestic and international cycles are the mainstay and the domestic and international dual cycles promote each other.

Medical insurance is no exception.

Subsequently, Hu Jinglin published a paper in the Study Times on March 12, proposing that during the 14th Five-Year Plan period, medical security work should adapt to the requirements of entering a new development stage, implementing new development concepts, and building a new development pattern, and promote the high-quality development of medical security.

Towards the goal of high-quality development, how will medical security work be carried out in 2021? According to the ten major work priorities of the National Medical Security Work Conference, including poverty alleviation, improvement of protection for major and major diseases, and normalized centralized procurement, the health sector has conducted in-depth interpretation and prospects.

Under the impact of the epidemic, my country's economic development has shifted to a stage of high-quality development, and is committed to building a new development pattern in which domestic and international cycles are the mainstay and the domestic and international dual cycles promote each other.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

1.
In line with the rural revitalization strategy, medical insurance is "always on the road" for poverty alleviation

1.
In line with the rural revitalization strategy, medical insurance is "always on the road" for poverty alleviation

1.
In line with the rural revitalization strategy, medical insurance is "always on the road" for poverty alleviation

1.
In line with the rural revitalization strategy, medical insurance is "always on the road" for poverty alleviationus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

2021322，，，5。。

，，。：

，，。

。，，，。，。，。

，。，、。，，。，。

2021322，，，5。。

，，。：

，，。，，。

，，。

，，

。，，，。，。，。

。。

，。，、。，，。，。

Third, we must integrate and improve the medical insurance and relief system for major diseases, and study the long-term mechanism of medical insurance for poverty alleviation.
Third, we must integrate and improve the medical insurance and relief system for major diseases, and study the long-term mechanism of medical insurance for poverty alleviation.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

2.
Improving the medical insurance and assistance system for major diseases

2.
Improving the medical insurance and assistance system for major diseases

2.
Improving the medical insurance and assistance system for major diseases

2.
Improving the medical insurance and assistance system for major diseasesus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Since my country comprehensively deepened the medical reform in 2009, a multi-level medical security system framework based on basic medical insurance, medical assistance as the foundation, supplementary medical insurance, commercial health insurance and other common developments has basically taken shape.

"Although the medical security system has achieved full urban and rural coverage, the level is not high.
Once suffering from a serious disease, not to mention people in financial difficulties, even ordinary people can hardly afford high medical expenses," the deputy minister of the Ministry of Civil Affairs.
Gong Puguang once said that inadequate protection for serious illnesses often leads to poverty due to illness, return to poverty due to illness, and even some extreme phenomena that impact the bottom line of social morality.

In recent years, relevant central documents have frequently mentioned "Improving the medical insurance and relief system for major diseases".
In order to achieve this goal, it is recommended that the medical insurance department need to do three specific tasks:

First, we must standardize the development of medical assistance.
Unify and standardize aid policies, scientifically determine the scope of objects, cost ranges, and aid standards, implement classification and tiered aid; second, promote the integration of medical aid and medical insurance, simplify applications and procedures, improve aid fund budget management, and coordinate charity and society The use of funds such as donations, to do a good job of linking rescue and medical insurance overall level; third, we must support multi-party participation.
Encourage the development of charitable medical assistance, guide charitable organizations to better play a supplementary role in medical assistance, and strengthen the connection and mutual assistance with commercial insurance.

Since my country comprehensively deepened the medical reform in 2009, a multi-level medical security system framework based on basic medical insurance, medical assistance as the foundation, supplementary medical insurance, commercial health insurance and other common developments has basically taken shape.

"Although the medical security system has achieved full urban and rural coverage, the level is not high.
Once suffering from a serious disease, not to mention people in financial difficulties, even ordinary people can hardly afford high medical expenses," the deputy minister of the Ministry of Civil Affairs.
Gong Puguang once said that inadequate protection for serious illnesses often leads to poverty due to illness, return to poverty due to illness, and even some extreme phenomena that impact the bottom line of social morality.

In recent years, relevant central documents have frequently mentioned "Improving the medical insurance and relief system for major diseases".
In order to achieve this goal, it is recommended that the medical insurance department need to do three specific tasks:

First, we must standardize the development of medical assistance.
Unify and standardize aid policies, scientifically determine the scope of objects, cost ranges, and aid standards, implement classification and tiered aid; second, promote the integration of medical aid and medical insurance, simplify applications and procedures, improve aid fund budget management, and coordinate charity and society The use of funds such as donations, to do a good job of linking rescue and medical insurance overall level; third, we must support multi-party participation.
Encourage the development of charitable medical assistance, guide charitable organizations to better play a supplementary role in medical assistance, and strengthen the connection and mutual assistance with commercial insurance.

First, we must standardize the development of medical assistance.
First, we must standardize the development of medical assistance.
Second, we must promote the integrated management of medical assistance and medical insurance, second, we must promote the integrated management of medical assistance and medical insurance, and third, we must support multi-party participation.
Third, we must support multi-party participation.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

3.
Establish and improve the mutual aid guarantee mechanism for employees' basic medical insurance outpatient clinics

3.
Establish and improve the mutual aid guarantee mechanism for employees' basic medical insurance outpatient clinics

3.
Establish and improve the mutual aid guarantee mechanism for employees' basic medical insurance outpatient clinics

3.
Establish and improve the mutual aid guarantee mechanism for employees' basic medical insurance outpatient clinicsus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

As we all know, the current employee medical insurance system adopts the "pooled account" model, in which the pooled account mainly solves the hospitalization expenses, while the outpatient expenses are mainly borne by the personal accounts.
This has played a positive role in encouraging participation in insurance and enhancing patients' awareness of saving in the early stage, but the disadvantages are also obvious: personal accounts cannot be coordinated, and the function of sharing the risk of medical expenses is insufficient.

The clinic itself is diversified and divided into many categories according to the condition.
Some clinics cost less, such as the common cold.
After going to the hospital, the doctor will recommend drinking more hot water or taking a few pills to recover; while some clinics It costs more.
Chronic diseases such as hypertension and diabetes require long-term medication or inspections.
In this process, the voices of reforming personal accounts that lack mutual assistance and mutual aid have gradually increased.

Since the National Medical Insurance Administration issued the "Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism (Draft for Comment)" on August 26, 2020, the improvement of the employee basic medical insurance outpatient mutual aid guarantee mechanism has frequently appeared in the government work report In other central documents, promoting the implementation of this policy has thus become one of the key tasks of medical insurance in 2021.

Specifically, the policy mainly includes three aspects:

One is to enhance the mutual aid guarantee function in outpatient clinics.
Starting with chronic diseases such as hypertension and diabetes, which are burdened by the masses, the general outpatient medical expenses for frequently-occurring and common diseases are gradually included in the scope of the overall planning fund.
Ordinary outpatient clinics cover all employees who participate in medical insurance, and the payment ratio starts from 50%.
As the fund's capacity increases, the level of protection is gradually improved, and the payment of benefits can be appropriately tilted to retirees.

Once the co-payment mechanism for general outpatient clinics is established, especially when the proportion of the overall fund payment is increased, this means that outpatient expenses, like inpatient treatment, can be shared and paid by the overall fund.
This is extremely important and effective for reducing the outpatient burden on employees (especially retired employees and employees in difficulties).

The second is to improve the method for crediting personal accounts.
The amount of unit payment is more included in the overall planning fund, and the personal account is still retained.
In principle, the individual payment shall not exceed 2%.
This is not only to reduce the burden of individual payment, but also to enhance the mutual aid sharing function of the overall fund for outpatient payment.

The third is to standardize the scope of use of personal accounts.
Personal accounts can be used for mutual aid and mutual aid between immediate family members.
In doing so, it can not only improve the mutual aid ability of outpatient payment among family members, but also reflect the family's self-protection function.

It is reported that at present, all localities are earnestly studying the spirit of the document, increasing publicity and interpretation, and preparing for the implementation of the policy.

As we all know, the current employee medical insurance system adopts the "pooled account" model, in which the pooled account mainly solves the hospitalization expenses, while the outpatient expenses are mainly borne by the personal accounts.
This has played a positive role in encouraging participation in insurance and enhancing patients' awareness of saving in the early stage, but the disadvantages are also obvious: personal accounts cannot be coordinated, and the function of sharing the risk of medical expenses is insufficient.

The clinic itself is diversified and divided into many categories according to the condition.
Some clinics cost less, such as the common cold.
After going to the hospital, the doctor will recommend drinking more hot water or taking a few pills to recover; while some clinics It costs more.
Chronic diseases such as hypertension and diabetes require long-term medication or inspections.
In this process, the voices of reforming personal accounts that lack mutual assistance and mutual aid have gradually increased.

Since the National Medical Insurance Administration issued the "Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism (Draft for Comment)" on August 26, 2020, the improvement of the employee basic medical insurance outpatient mutual aid guarantee mechanism has frequently appeared in the government work report In other central documents, promoting the implementation of this policy has thus become one of the key tasks of medical insurance in 2021.

Specifically, the policy mainly includes three aspects:

One is to enhance the mutual aid guarantee function in outpatient clinics.
Starting with chronic diseases such as hypertension and diabetes, which are burdened by the masses, the general outpatient medical expenses for frequently-occurring and common diseases are gradually included in the scope of the overall planning fund.
Ordinary outpatient clinics cover all employees who participate in medical insurance, and the payment ratio starts from 50%.
As the fund's capacity increases, the level of protection is gradually improved, and the payment of benefits can be appropriately tilted to retirees.

One is to enhance the mutual aid guarantee function in outpatient clinics.
One is to enhance the mutual aid guarantee function in outpatient clinics.

Once the co-payment mechanism for general outpatient clinics is established, especially when the proportion of the overall fund payment is increased, this means that outpatient expenses, like inpatient treatment, can be shared and paid by the overall fund.
This is extremely important and effective for reducing the outpatient burden on employees (especially retired employees and employees in difficulties).

The second is to improve the method for crediting personal accounts.
The amount of unit payment is more included in the overall planning fund, and the personal account is still retained.
In principle, the individual payment shall not exceed 2%.
This is not only to reduce the burden of individual payment, but also to enhance the mutual aid sharing function of the overall fund for outpatient payment.

The second is to improve the method for crediting personal accounts.
The second is to improve the method for crediting personal accounts.

The third is to standardize the scope of use of personal accounts.
Personal accounts can be used for mutual aid and mutual aid between immediate family members.
In doing so, it can not only improve the mutual aid ability of outpatient payment among family members, but also reflect the family's self-protection function.

The third is to standardize the scope of use of personal accounts.
The third is to standardize the scope of use of personal accounts.

It is reported that at present, all localities are earnestly studying the spirit of the document, increasing publicity and interpretation, and preparing for the implementation of the policy.

It is reported that at present, all localities are earnestly studying the spirit of the document, increasing publicity and interpretation, and preparing for the implementation of the policy.
It is reported that at present, all localities are earnestly studying the spirit of the document, increasing publicity and interpretation, and preparing for the implementation of the policy.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

4.
Establish and improve a long-term mechanism for fund supervision

4.
Establish and improve a long-term mechanism for fund supervision

4.
Establish and improve a long-term mechanism for fund supervision

4.
Establish and improve a long-term mechanism for fund supervisionus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

The medical insurance fund is the people's "medicine money" and "life-saving money", and it involves the people's vital interests.
However, medical insurance funds have many users, long chains, many risk points, and difficult supervision.
The problem of fraudulent insurance continues to occur frequently, and the supervision situation has always been relatively severe.

Strengthening fund supervision and maintaining fund security has always been an important political task of the National Medical Insurance Administration.
Among them, the National Medical Insurance Bureau mainly conducts its work from two aspects:

First, continue to form a high-pressure situation in fund supervision, carry out in-depth special management and unannounced inspections to combat fraud and insurance, implement clue transfer and reporting incentives, and expose major cases to the public.
Preliminary statistics show that in 2019, medical insurance departments at all levels across the country inspected 815,000 designated medical institutions, investigated and dealt with 264,000 medical institutions that violated laws and regulations, handled 33,100 illegal insured persons, and recovered 11.
556 billion yuan in funds; inspections were conducted in 2020.
More than 600,000 designated medical institutions, plus the self-examination of designated medical institutions, dealt with more than 400,000 medical institutions that violated laws and regulations, and recovered 22.
31 billion yuan in medical insurance funds.

。，。20206，《》；12，《》（），202151。

“，。”，。

，《》。“，，，，、。”。

“”“”，。，、、、，，。

、。，：

，，，。，201981.
5，26.
4，3.
31，115.
56；202060，，40，223.
1。

First, continue to form a high-pressure situation in fund supervision, carry out in-depth special management and unannounced inspections to combat fraud and insurance, implement clue transfer and reporting incentives, and expose major cases to the public.
First, continue to form a high-pressure situation in fund supervision, carry out in-depth special management and unannounced inspections to combat fraud and insurance, implement clue transfer and reporting incentives, and expose major cases to the public.

The second is to build a long-term mechanism for fund supervision.
Surprising actions alone cannot fundamentally cure the persistent illness of medical insurance fraud.
It is also necessary to establish and improve the medical insurance fund supervision system.
In June 2020, the State Council issued the "Guiding Opinions on Promoting the Reform of the Medical Security Fund Regulatory System"; in December, the State Council Executive Meeting reviewed and approved the "Regulations on the Supervision and Administration of the Use of Medical Security Funds" (hereinafter referred to as the Regulations), in 2021 It will be implemented nationwide from May 1st.

The second is to build a long-term mechanism for fund supervision.
The second is to build a long-term mechanism for fund supervision.

"The regulations are the institutionalization of the practical experience of anti-medical insurance fraud in recent years under the severe conditions of the supervision of medical insurance funds.
" Zheng Gongcheng, president of the Chinese Society of Social Security said, this will lay a strong legal foundation for the supervision of medical insurance funds.

It can be seen that one of the priorities of the future medical insurance bureau is to ensure that the "Regulations" are fully implemented.
"Especially by continuing to resolutely crack down on medical insurance fraud, benefiting law-abiding and compliant persons, and allowing those who violate laws and regulations to pay the corresponding price, can they exert the deterrent power of the rule of law and guide medical insurance agencies, designated medical institutions and the public to abide by laws and regulations.
" Zheng Gongcheng said.

It can be seen that one of the priorities of the future medical insurance bureau is to ensure that the "Regulations" are fully implemented.
It can be seen that one of the priorities of the future medical insurance bureau is to ensure that the "Regulations" are fully implemented.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

5.
Institutionalized and normalized implementation of centralized bidding and procurement of pharmaceutical consumables

5.
Institutionalized and normalized implementation of centralized bidding and procurement of pharmaceutical consumables

5.
Institutionalized and normalized implementation of centralized bidding and procurement of pharmaceutical consumables

5.
Institutionalized and normalized implementation of centralized bidding and procurement of pharmaceutical consumablesus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Centralized procurement not only greatly reduces the burden on patients, but also promotes the replacement of generic drugs, eradicating the space for sales with gold, allowing companies that focus on R&D, quality and cost to grow and strengthen, and promote the formation of a clean and healthy life in the pharmaceutical industry.
Hailiangheqing has a good atmosphere.
At the same time, the supporting fund balance retention policy allows medical staff to share the reform dividends for reasonable diagnosis and treatment, greatly standardizes diagnosis and treatment behavior, and brings hope to the reform of the "three-medicine linkage" reform.

Since 2018, the National Medical Insurance Administration has carried out a number of batches of national drug collections, and various regions are actively exploring and advancing, and an institutionalized and normalized mechanism has gradually formed.
In January 2021, the General Office of the State Council issued the "Opinions on Promoting the Normalized and Institutionalized Development of Centralized and Volume Procurement of Drugs", which clearly stipulates the determination of procurement volume, competition grouping, selection rules, volume method, and selection cycle.

In the future, centralized procurement will implement dynamic adjustments.
At the same time, while the centralized procurement rules continue to improve, we will promote the formation of a unified and open drug centralized procurement market across the country, clarify the responsibilities of the central and local governments, carry out centralized drug procurement in different levels, and guide local governments to focus on areas other than centralized procurement by national organizations, which are expensive and widely used.
We will carry out large-scale centralized procurement with a large amount of products, and gradually solve the problem of clinical medicine and the price return of large varieties through national and local double-layer operations.

In terms of procurement types, consumables may be the next focus of centralized procurement.
Chen Jinfu, deputy director of the National Medical Security Administration, said that based on the purchase experience of coronary stents, mature, competitive, and quality-controlled products will be selected in the future, and one product, one strategy will be adopted to optimize the election rules and gradually enter the field of medical consumables.
expand.
In addition, in the future, large varieties of Chinese patent medicines and biological analogues will also be gradually included in the national centralized procurement, and the price of medicines may further decline.

Centralized procurement not only greatly reduces the burden on patients, but also promotes the replacement of generic drugs, eradicating the space for sales with gold, allowing companies that focus on R&D, quality and cost to grow and strengthen, and promote the formation of a clean and healthy life in the pharmaceutical industry.
Hailiangheqing has a good atmosphere.
At the same time, the supporting fund balance retention policy allows medical staff to share the reform dividends for reasonable diagnosis and treatment, greatly standardizes diagnosis and treatment behavior, and brings hope to the reform of the "three-medicine linkage" reform.

Since 2018, the National Medical Insurance Administration has carried out a number of batches of national drug collections, and various regions are actively exploring and advancing, and an institutionalized and normalized mechanism has gradually formed.
In January 2021, the General Office of the State Council issued the "Opinions on Promoting the Normalized and Institutionalized Development of Centralized and Volume Procurement of Drugs", which clearly stipulates the determination of procurement volume, competition grouping, selection rules, volume method, and selection cycle.

In the future, centralized procurement will implement dynamic adjustments.
At the same time, while the centralized procurement rules continue to improve, we will promote the formation of a unified and open drug centralized procurement market across the country, clarify the responsibilities of the central and local governments, carry out centralized drug procurement in different levels, and guide local governments to focus on areas other than centralized procurement by national organizations, which are expensive and widely used.
We will carry out large-scale centralized procurement with a large amount of products, and gradually solve the problem of clinical medicine and the price return of large varieties through national and local double-layer operations.

In the future, centralized procurement will implement dynamic adjustments.
In the future, centralized procurement will implement dynamic adjustments.

In terms of procurement types, consumables may be the next focus of centralized procurement.
Chen Jinfu, deputy director of the National Medical Security Administration, said that based on the purchase experience of coronary stents, mature, competitive, and quality-controlled products will be selected in the future, and one product, one strategy will be adopted to optimize the election rules and gradually enter the field of medical consumables.
expand.
In addition, in the future, large varieties of Chinese patent medicines and biological analogues will also be gradually included in the national centralized procurement, and the price of medicines may further decline.

In terms of procurement types, consumables may be the next focus of centralized procurement.
In terms of types of procurement, consumables may be the next focus area for centralized procurement.
In the future, large varieties of Chinese patent medicines and biological analogues will also be gradually included in the national centralized procurement, and the price of medicines may further decline.
In the future, large varieties of Chinese patent medicines and biological analogues will also be gradually included in the national centralized procurement, and the price of medicines may further decline.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

6.
Deepening the reform of medical service prices

6.
Deepening the reform of medical service prices

6.
Deepening the reform of medical service prices

6.
Deepening the reform of medical service pricesus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Since its establishment, the National Medical Insurance Administration has attached great importance to the reform of medical service prices.
However, due to the sensitivity of medical service prices, the reform is relatively cautious and the pace is relatively slow.
Specifically, the following three measures have been introduced:

One is to increase the proportion of medical service income in the hospital's total income.
To adjust the price of medical services, the main principle of the National Medical Insurance Administration is to "optimize and adjust the price structure and price comparison of medical services", focusing on increasing the price of medical services that reflect the value of technical labor such as diagnosis and treatment, surgery, rehabilitation, nursing, and Chinese medicine, and reducing high-level inspections The price of inspection and treatment of large-scale equipment, support the development of short-board disciplines, and support public medical institutions to increase the proportion of service income without increasing the growth rate of medical expenses.

According to statistics, during the "Thirteenth Five-Year Plan" period, the number of technical value medical service items for which the prices of various provinces have been raised has exceeded half.
Compared with the end of the "Twelfth Five-Year Plan" period, medical services in various provinces have increased by 20%-100%; surgical medical services have increased by 40%-150%; nursing medical services have increased by 50%-200% ; TCM medical services increased by 20%-60%.

In the future, the National Medical Insurance Bureau will follow the principle of “total volume control, structural adjustment, ups and downs, and gradual implementation” to guide localities to establish a dynamic adjustment mechanism for medical service prices in public hospitals, and support public hospitals to increase their medical service revenue in total hospital revenues.
proportion.

Second, new projects with mature support conditions are included in the scope of national medical service price projects and medical insurance reimbursements.
The rapid development of medical technology and the timely acceptance of new medical technology services with clinical value or cost-efficiency advantages are also one of the important contents of medical security work.
At present, all provinces have issued procedures and working rules for the acceptance and review of new medical service price items according to local actual conditions.
Medical institutions can apply to the local medical insurance department for new items and set charging standards in accordance with the procedures.

In the future, the National Medical Insurance Bureau will study the establishment of priority review channels in accordance with the principle of "encouraging innovation and the use of appropriate technologies", and include new items with mature conditions into the national medical service price items in a timely manner.
Encourage qualified places to consider including items in the scope of medical insurance reimbursement.

Third, we must establish a dynamic adjustment mechanism for medical service prices.
Scientifically set and adjust indicators such as startup conditions and trigger mechanisms.
Carry out price adjustment evaluation every year, dynamically adjust the price of medical services that meet the starting conditions, gradually straighten out the relationship between price comparisons, and optimize the price of medical services.

Since its establishment, the National Medical Insurance Administration has attached great importance to the reform of medical service prices.
However, due to the sensitivity of medical service prices, the reform is relatively cautious and the pace is relatively slow.
Specifically, the following three measures have been introduced:

One is to increase the proportion of medical service income in the hospital's total income.
To adjust the price of medical services, the main principle of the National Medical Insurance Administration is to "optimize and adjust the price structure and price comparison of medical services", focusing on increasing the price of medical services that reflect the value of technical labor such as diagnosis and treatment, surgery, rehabilitation, nursing, and Chinese medicine, and reducing high-level inspections The price of inspection and treatment of large-scale equipment, support the development of short-board disciplines, and support public medical institutions to increase the proportion of service income without increasing the growth rate of medical expenses.

One is to increase the proportion of medical service income in the hospital's total income.
One is to increase the proportion of medical service income in the hospital's total income.

According to statistics, during the "Thirteenth Five-Year Plan" period, the number of technical value medical service items for which the prices of various provinces have been raised has exceeded half.
Compared with the end of the "Twelfth Five-Year Plan" period, medical services in various provinces have increased by 20%-100%; surgical medical services have increased by 40%-150%; nursing medical services have increased by 50%-200% ; TCM medical services increased by 20%-60%.

In the future, the National Medical Insurance Bureau will follow the principle of “total volume control, structural adjustment, ups and downs, and gradual implementation” to guide localities to establish a dynamic adjustment mechanism for medical service prices in public hospitals, and support public hospitals to increase their medical service revenue in total hospital revenues.
proportion.

Second, new projects with mature support conditions are included in the scope of national medical service price projects and medical insurance reimbursements.
The rapid development of medical technology and the timely acceptance of new medical technology services with clinical value or cost-efficiency advantages are also one of the important contents of medical security work.
At present, all provinces have issued procedures and working rules for the acceptance and review of new medical service price items according to local actual conditions.
Medical institutions can apply to the local medical insurance department for new items and set charging standards in accordance with the procedures.

Second, new projects with mature support conditions are included in the scope of national medical service price projects and medical insurance reimbursements.
Second, new projects with mature support conditions are included in the scope of national medical service price projects and medical insurance reimbursements.

In the future, the National Medical Insurance Bureau will study the establishment of priority review channels in accordance with the principle of "encouraging innovation and the use of appropriate technologies", and include new items with mature conditions into the national medical service price items in a timely manner.
Encourage qualified places to consider including items in the scope of medical insurance reimbursement.

Third, we must establish a dynamic adjustment mechanism for medical service prices.
Scientifically set and adjust indicators such as startup conditions and trigger mechanisms.
Carry out price adjustment evaluation every year, dynamically adjust the price of medical services that meet the starting conditions, gradually straighten out the relationship between price comparisons, and optimize the price of medical services.

Third, we must establish a dynamic adjustment mechanism for medical service prices.
Third, we must establish a dynamic adjustment mechanism for medical service prices.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

7.
Continue to deepen the reform of medical insurance payment methods

7.
Continue to deepen the reform of medical insurance payment methods

7.
Continue to deepen the reform of medical insurance payment methods

7.
Continue to deepen the reform of medical insurance payment methodsus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

The use of efficient payment methods to restrict medical service behavior and adjust medical configuration, and better protect the rights and interests of insured persons, is the main aspect of the role of the medical insurance mechanism.
Deepening the reform of payment methods has always been one of the key tasks of the National Medical Insurance Administration.
At present, the national pilot projects of DRG and DIP are being promoted in an orderly manner, and the reform of the payment method of the compact county medical community has been promoted.
The proportion of payments has been declining.

According to policy requirements, the two reforms of DRG and DIP in 2021 will be transferred to the actual payment stage, which will also become one of the focuses of local work.
Among them, starting from March, the actual payment can be initiated in the qualified DIP areas after filing; all DRG and DIP pilot cities before the end of the year must realize the actual payment.

At the same time, we must continue to promote the reform of outpatient payment methods and the reform of county medical community payment.
Relying on primary medical institutions, starting from diabetes, hypertension, chronic kidney disease and other treatment plans and chronic diseases with clear assessment indicators, exploring the combination of family doctors' contracted services and head payment; the county-level close medical community is currently in the process of "per capita total budget," The reform of “reserving surplus and sharing reasonable over-expenditure”.

The use of efficient payment methods to restrict medical service behavior and adjust medical configuration, and better protect the rights and interests of insured persons, is the main aspect of the role of the medical insurance mechanism.
Deepening the reform of payment methods has always been one of the key tasks of the National Medical Insurance Administration.
At present, the national pilot projects of DRG and DIP are being promoted in an orderly manner, and the reform of the payment method of the compact county medical community has been promoted.
The proportion of payments has been declining.

According to policy requirements, the two reforms of DRG and DIP in 2021 will be transferred to the actual payment stage, which will also become one of the focuses of local work.
Among them, starting from March, the actual payment can be initiated in the qualified DIP areas after filing; all DRG and DIP pilot cities before the end of the year must realize the actual payment.

At the same time, we must continue to promote the reform of outpatient payment methods and the reform of county medical community payment.
Relying on primary medical institutions, starting from diabetes, hypertension, chronic kidney disease and other treatment plans and chronic diseases with clear assessment indicators, exploring the combination of family doctors' contracted services and head payment; the county-level close medical community is currently in the process of "per capita total budget," The reform of “reserving surplus and sharing reasonable over-expenditure”.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

8.
Continue to manage the medical insurance catalog

8.
Continue to manage the medical insurance catalog

8.
Continue to manage the medical insurance catalog

8.
Continue to manage the medical insurance catalogus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Since 2018, after three consecutive years of adjustments to the medical insurance catalog, especially the promulgation of the "Interim Measures for the Administration of Basic Medical Insurance Medications" at the end of July 2020, a dynamic adjustment mechanism for the medical insurance drug catalog has basically taken shape.

After three rounds of adjustments, 433 new and good drugs were included.
Among them, 17 negotiating drugs entered the catalog in 2018, 97 in 2019, a total of 114 negotiating drugs, and the average drop in drug prices exceeded 50%.
According to estimates, from January to November 2020 alone, the burden on patients will be reduced by 72.
1 billion yuan.

In the future, in addition to the annual drug catalog, the following three aspects need to be done: First, ensure that the new version of the drug catalog is implemented, adjust the information system as soon as possible, improve the payment policy, and let the people use the new drugs as soon as possible; Do a good job in patient medication connection and public opinion monitoring.
The second is to continue to do a good job in the digestion of provincial supplementary medicines, continue to clean up 40% of the provincial supplementary medicines, and ensure that the national drug catalog is basically unified in 2022.
Third, we must continue to improve the management methods for medical consumables.
In 2021, medical consumables management measures will be issued to standardize the catalog of medical consumables and lay the foundation for the formulation of a national medical consumables access catalog.

Since 2018, after three consecutive years of adjustments to the medical insurance catalog, especially the promulgation of the "Interim Measures for the Administration of Basic Medical Insurance Medications" at the end of July 2020, a dynamic adjustment mechanism for the medical insurance drug catalog has basically taken shape.

After three rounds of adjustments, 433 new and good drugs were included.
Among them, 17 negotiating drugs entered the catalog in 2018, 97 in 2019, a total of 114 negotiating drugs, and the average drop in drug prices exceeded 50%.
According to estimates, from January to November 2020 alone, the burden on patients will be reduced by 72.
1 billion yuan.

In the future, in addition to the annual drug catalog, the following three aspects need to be done: First, ensure that the new version of the drug catalog is implemented, adjust the information system as soon as possible, improve the payment policy, and let the people use the new drugs as soon as possible; Do a good job in patient medication connection and public opinion monitoring.
The second is to continue to do a good job in the digestion of provincial supplementary medicines, continue to clean up 40% of the provincial supplementary medicines, and ensure that the national drug catalog is basically unified in 2022.
Third, we must continue to improve the management methods for medical consumables.
In 2021, medical consumables management measures will be issued to standardize the catalog of medical consumables and lay the foundation for the formulation of a national medical consumables access catalog.

One is one is two is two is three must be three must

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

9.
Improve the efficiency of medical insurance public management services, and improve direct settlement of medical treatment in different places

9.
Improve the efficiency of medical insurance public management services, and improve direct settlement of medical treatment in different places

9.
Improve the efficiency of medical insurance public management services, and improve direct settlement of medical treatment in different places

9.
Improve the efficiency of medical insurance public management services, and improve direct settlement of medical treatment in different placesus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Since the three ministries and commissions jointly issued the "Guiding Opinions on Further Completing the Settlement of Medical Expenses for Basic Medical Insurance in Different Places" in 2014, the direct settlement system for medical treatment in different places has been continuously improved.

According to the official website of the National Medical Insurance Administration, at present, hospitalization expenses have been fully reimbursed in different places, and more than 40,000 designated medical institutions have opened direct settlement services for hospitalization expenses in different places across provinces; in addition, since February 1, 2021, there have been 27 general hospitalizations across the country.
Inter-provincial direct settlement of outpatient expenses in pilot provinces has realized interconnection, and the trial operation of inter-provincial direct reimbursement of outpatient expenses has started.

At present, inpatient expenses have been fully settled in different places.
Promoting the comprehensive inter-provincial settlement of outpatient expenses will become one of the key tasks of future development.
The country is expected to basically realize direct settlement of outpatient expenses across provinces by the end of 2021.

Since the three ministries and commissions jointly issued the "Guiding Opinions on Further Completing the Settlement of Medical Expenses for Basic Medical Insurance in Different Places" in 2014, the direct settlement system for medical treatment in different places has been continuously improved.

According to the official website of the National Medical Insurance Administration, at present, hospitalization expenses have been fully reimbursed in different places, and more than 40,000 designated medical institutions have opened direct settlement services for hospitalization expenses in different places across provinces; in addition, since February 1, 2021, there have been 27 general hospitalizations across the country.
Inter-provincial direct settlement of outpatient expenses in pilot provinces has realized interconnection, and the trial operation of inter-provincial direct reimbursement of outpatient expenses has started.

At present, inpatient expenses have been fully settled in different places.
Promoting the comprehensive inter-provincial settlement of outpatient expenses will become one of the key tasks of future development.
The country is expected to basically realize direct settlement of outpatient expenses across provinces by the end of 2021.

At present, inpatient expenses have been fully settled in different places.
Promoting the comprehensive inter-provincial settlement of outpatient expenses will become one of the key tasks of future development.
The country is expected to basically realize direct settlement of outpatient expenses across provinces by the end of 2021.
At present, inpatient expenses have been fully settled in different places.
Promoting the comprehensive inter-provincial settlement of outpatient expenses will become one of the key tasks of future development.
The country is expected to basically realize direct settlement of outpatient expenses across provinces by the end of 2021.

us" style="margin:10px 0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;text-align:center;box-sizing:border-box;">

10.
Promote the refined management of medical insurance and improve the ability and level of medical insurance governance

10.
Promote the refined management of medical insurance and improve the ability and level of medical insurance governance

10.
Promote the refined management of medical insurance and improve the ability and level of medical insurance governance

10.
Promote the refined management of medical insurance and improve the ability and level of medical insurance governanceus" style="margin:0px;padding:0px;font-family:;color:#333333;font-size:16px;white-space:normal;box-sizing:border-box;">

Refined management is an important part of the medical insurance governance system and capacity modernization.
It is an inevitable choice to promote the high-quality development of medical insurance in the new development stage, and it is also an inevitable way to play the role of strategic purchase of medical insurance.

Therefore, refined management means seeking benefits from management, and "embroidery effort" in careful planning, meticulous advancement, subtle landing, and precise management, to promote the continuous deepening of medical insurance reform.

The National Medical Insurance Bureau has also successively published many cases of medical insurance management efficiency enhancement, which has accumulated experience for the refined management of medical insurance ; various localities are exploring the practice of enhancing medical insurance management efficiency.
For example, the Chengdu Municipal Medical Insurance Bureau issued the "Improving Medical Insurance Refinement" in March 2021.
Management level to create a happy and beautiful life action plan (2021-2022)" and so on.

，，，，。

，，。

，，、、、“”，。

，；，20213《 （2021-2022）》。

，

，，，，。