Seven departments issued a document: Relieve operational pressure and prepay medical insurance funds to medical institutions!

"It is necessary to ensure that all insurance should be provided, but also to prevent pan-welfare trends.

The "Opinions" clarified that for counties who have been lifted out of poverty, within the specified five-year transition period, through optimizing and improving policy mechanisms, gradually realizing a smooth transition from centralized resources to support poverty alleviation to the normalization of the unified basic medical insurance, critical illness insurance, and medical assistance system .

Some analysts believe that strengthening the high-quality and coordinated development of medical care and medical insurance, as well as classified insurance subsidies are the biggest highlights of this "Opinion".

The specific implementation points are as follows:

01

Conditional, prepaid medical insurance funds

Regions with conditions can prepay part of the medical insurance funds to medical institutions according to the agreement to ease the pressure on their capital operation.

Rural low-income populations are referred in the province according to regulations and seek medical treatment in designated medical institutions, and the hospitalization threshold is calculated continuously, and the policy of equal treatment in the insured area is implemented.

Establish and improve the medical insurance intelligent supervision subsystem, improve the reporting and reward mechanism, conscientiously consolidate the supervision responsibility of the city and county, and intensify the crackdown on induced hospitalization, false medical treatment, and bed-hanging hospitalization.

02Coordinating the unification of policies and inclusive benefits in the region

Promote the unification of policies and inclusive benefits for residents' basic medical insurance in the area.

Carry out the main responsibility for insurance participation and mobilization, and focus on the mobilization of people out of poverty.

03

The hospitalization payment ratio is stable at 70%

Basic medical insurance: Consolidate the level of hospitalization benefits, and the proportion of hospitalization expenses within the policy scope of the county is generally stable at about 70%.

Critical illness insurance: The threshold for serious illness insurance for rural residents has been reduced and unified to 50% of the local residents' per capita disposable income in the previous year, and the payment ratio within the policy range has stabilized at around 60%.

Medical assistance: In principle, within the annual assistance limit, the proportion of individual self-paid hospitalization medical expenses within the limits of the extremely poor, the subsistence allowances, and the poverty-stricken population policy can be determined by the proportion of not less than 70% in each region.