The policy interpretation of the Notice on doing a good job in basic medical security for urban and rural residents in 2020.

Introduction: How to adjust the financing standard of basic medical insurance for urban and rural residents in 2020?
, in order to implement the 2020 Government Work Report task requirements, improve the unified basic medical insurance system for urban and rural residents and the insurance system for major diseases, the State Medical Security Administration, together with the Ministry of Finance and the State Administration of Taxation, issued the Notice on doing a good job in the basic medical security of urban and rural residents in 2020 (Medical Insurance Issue (2020) No. 24, hereinafter referred to as "Notice"). The relevant content is read as follows:
, 2020, urban and rural residents of basic medical insurance financing standards how to adjust?
in order to ensure that the masses share the fruits of reform and development, adapt to economic and social development, "Notice" around the 2020 "Government Work Report" for the protection and improvement of people's livelihood requirements, reasonable increase of urban and rural residents basic medical insurance financial subsidies and personal contribution standards, clear lying in 2020 urban and rural residents basic medical insurance per capita financial assistance standard s30 yuan, to reach no less than 550 yuan per person per year; At the same time, based on the basic medical insurance financing, the operation of major disease insurance, the overall improvement of the financing standards of major disease insurance. The steady improvement of the level of financing and the gradual optimization of the financing structure can promote the stable and sustainable financing of residents' health insurance and provide a solid foundation for the consolidation of the level of treatment security.What are the policy arrangements for
protection?
2019, the basic medical insurance and disease insurance for urban and rural residents have fully realized urban and rural co-ordination, urban and rural residents enjoy more fair access to medical insurance rights and interests; In 2020, we will improve the treatment guarantee mechanism from three aspects to enhance the people's sense of gain, well-being and security: First, to give full play to the overall realization of urban and rural health insurance system dividends, the overall level of hospital expenses within the policy range to reach 70%, the full implementation of hypertension, diabetes outpatient drug guarantee mechanism. Second, to consolidate the level of insurance coverage for major diseases, to fully implement the starting line to reduce and unify to half of the per capita disposable income of residents, the proportion of paymentwithin the policy range to 60%, to encourage conditional areas to explore the lifting of the cap line. Third, play the role of medical assistance support protection. Classified to support special hardship personnel, low-insurance objects, rural file-file lika poor people to participate in residents' health insurance, to ensure that the difficult masses should be guaranteed.
Wednesday, 2020, medical security to implement the fight against poverty and what hard tasks?
2020 is the decisive year to win the battle to fight poverty, in order to implement the hard task of poverty alleviation of health insurance, medical insurance poverty alleviation three-year action implementation plan task, from four aspects to put forward specific measures to ensure that the fight against poverty is won on schedule: First, to ensure the completion of the task of medical insurance poverty relief. Focus on building the poor people, implement the policy of timely insurance for the new poor, and ensure that the development of the poor should be guaranteed to the fullest. Grasp the listing war, simplify the registration of off-site medical registration, promote the "Internet plus" medical service prices and medical insurance payment policy landing. Second, to consolidate the effectiveness of health insurance poverty relief. We will fully implement and reduce the poverty policy of medical insurance, and continue to play the function of comprehensive protection and reduction of the triple system of medical insurance. Work together to monitor unstable households, marginal households and returning to poverty due to the epidemic, and implement the policy of medical insurance reimbursement and financial assistance for the treatment of new crown pneumonia. The third is to study the continuous work of medical insurance poverty alleviation. Strict implementation of the "four not to pick" requirements, during the transition period, to maintain a relatively stable policy. Steady correction of unrealistic over-protection problems to ensure a smooth transition of treatment. Combined with the sound medical insurance and relief system for serious and serious diseases, the long-term mechanism of poverty alleviation of medical insurance is studied. Fourth, continue to increase the tilt of payments to the poor. During the period of poverty eradication, the starting line for the poor in rural areas was reduced by half compared with the ordinary insured residents, the proportion of payment stood by 5 percentage points, and the top line of the rural file-file lika poor was completely abolished.
, what are the job requirements for the management of health insurance payment?
medical insurance payment is the key mechanism to ensure the masses to obtain high-quality medical services and improve the efficiency of fund use, the Notice putforward forward three requirements: First, to strengthen the management of fixed-point pharmaceutical institutions, improve the performance appraisal mechanism, the results of the assessment and the payment of medical insurance funds, and better promote the fixed-point medical institutions in the matter of after-the-fact management. Second, we will promote the reform of the payment method of medical insurance, generally implement the multi-complex payment method based on disease payment, carry out the pilot work of the disease diagnosis-related sub-group (DRG) paying country in 30 cities, and improve the management of the total amount of medical insurance. Third, strengthen the management of the medical insurance catalogue, gradually unify the scope of payment of medical insurance drugs, establish a mechanism for monitoring the implementation of negotiated drugs, and remove the state key monitoring varieties from the catalogue by the end of June 2020 and complete the digestion of 40% of the additional varieties at the provincial level.
V. How to strengthen the supervision and management of the fund?
health insurance fund is the people's "life-saving money", to ensure the safety of the fund is the top priority of the medical security sector. The Notice stresses the need to continue to strengthen fund supervision and inspection in 2020: First, the establishment of a full-coverage health insurance fund supervision and inspection system, the organization of two health insurance fund supervision and inspection. Focusing on medical insurance agencies and designated medical institutions, the classification and promotion of special governance. Second, to promote the fund supervision and standard year construction, establish and improve the administrative law enforcement publicity, law enforcement throughout the record, major law enforcement decisions legal audit, in order to promote standardized law enforcement. Third, strengthen the long-term mechanism of fund supervision, "two pilots and one demonstration" as a grasping hand, improve supervision and reporting, reporting incentives, intelligent supervision, comprehensive supervision, accountability and other measures, explore the establishment of medical security credit system, the establishment of drug prices and credit evaluation system. Fourth, strengthen the supervision and inspection of commercial insurance institutions that undertake major disease insurance. In addition, the Notice also put forward the work requirements for promoting the co-ordination of the basic medical insurance fund at the municipal level and strengthening the operation of the fund.
, how can the management services be strengthened?
to improve the public service capacity of medical insurance, strengthen the management services, is to achieve the high-quality development of medical security, "Notice" on the operation of services put forward four requirements. First, to do a good job of insurance contributions. Full implementation of the universal coverage plan, to achieve the guarantee of insurance. Under the unified organization of local governments, compaction work responsibilities, strengthen the convergence and coordination of insurance collection and collection business, strengthen the coordination between medical insurance and tax departments, improve efficiency and service levels, and ensure that the quantitative indicators of annual insurance financing are put in place. The second is to promote the operation of the integrated operation. Promote the city within the basic medical insurance, major disease insurance, medical assistance "one-stop service, one window processing, one-system settlement." We will fully implement the list of matters of government services handled by the national medical insurance administration, and improve the cooperative management mechanism of medical treatment in different places. Third, to enhance the management services capacity. We will speed up the construction of a unified national medical security management system, integrate the urban and rural operating system, establish a unified service hotline, and vigorously promote the downing of services. Fourth, speed up the national unified standardization and information construction, and earnestly grasp the information maintenance and testing application of 15 information business coding standards.the Notice of the
also requires all localities to strengthen the organizational leadership of the medical security work of urban and rural residents, clarify their duties, reasonably guide expectations and ensure the implementation of the tasks.
the medical insurance bureaus, finance bureaus (bureaus) of the provinces, autonomous regions, municipalities directly under the central government and the state administration of taxation, the State Administration of Taxation, and the municipal tax bureaus with separate plans:
to further implement the decision-making
the 19th National Congress of the Party on "improving the unified basic medical insurance system for urban and rural residents and the insurance system for major diseases"
, implement the task requirements of the 2020 Government Work Report, and do a good job in the basic medical security of urban and rural residents. In 2020, the per capita financial subsidy standard for basic medical insurance for urban and rural residents (hereinafter referred to as residents' medical insurance) will be increased by 30 yuan, reaching no less than 550 yuan per person per year. The central finance shall, in accordance with the provisions, implement sub-grade subsidies to the local authorities, and local finance at all levels shall arrange the financial subsidy funds in full and in a timely manner in accordance with the provisions. Implement the relevant provisions of the Notice of the State Council on the Implementation of certain fiscal policies to support the civilization of the agricultural transfer population (State Fa (2016) No. 44), the Interim Measures for the Participation of Taiwan Residents of Hong Kong and Macao in the Mainland (The State Medical Security Administration of the Ministry of Human Resources and Social Security) (Decree No. 41 of the State Medical Security Administration of the Ministry of Human Resources and Social Security), and provide subsidies to the insured persons with residence permits at all levels according to the same standards as the local residents.
(ii) steadily raise the standard of individual contributions. In principle, the individual contribution standard is increased simultaneously by 30 yuan, to 280 yuan per person per year. All co-ordination areas should take into account the fund balance of payments, the need for treatment protection and the affordability of all parties, reasonably determine specific financing standards, and appropriately increase the proportion of individual contributions. The level of financing may be reasonably determined according to the actual and reasonable level of financial assistance and individual contributions in the co-ordinating areas where the level of financial assistance and individual contributions has reached the standards prescribed by the State. Based on the basic medical insurance financing, the operation of major disease insurance, the overall improvement of the financing standards of major disease insurance.
(3) improve the financing mechanism combining individual contributions of residents' medical insurance with government subsidies. All co-ordinating regions should adapt to economic and social development, reasonably raise the standard of financial assistance and personal contribution sorains for residents' medical insurance, steadily raise the level of financing, gradually optimize the financing structure, and promote stable and sustainable financing. Based on the 2020 financial assistance standard and the individual contributions collected across the years, a scientific assessment of the 2020 funding structure, with a view to balance of responsibilities, structural optimization and institutional sustainability, and a study of individual contribution growth plans for the next two to three years.
. Second, improve the treatment guarantee mechanism
(4) implement the policy of protecting the medical insurance treatment of residents. Give full play to the system dividends of residents' medical insurance to achieve the overall urban-rural co-ordination, adhere to fair and inclusive benefits, and strengthen the function of basic medical insurance subject protection. To consolidate the level of hospitalization treatment, the proportion of hospitalization expenses paid within the policy range reached 70%. Strengthen the out-patient mutual assistance guarantee, fully implement the high blood pressure, diabetes outpatient drug guarantee mechanism, standardize and simplify the outpatient chronic disease protection identification process. We will implement a new version of the National Health Insurance Drug Catalog and push forward the negotiation of drugs.
(v) consolidate the level of insurance coverage for major diseases. Fullimplementation of the starting line to reduce and unify to half of the per capita disposable income of residents, the policy within the payment ratio increased to 60%, to encourage conditional areas to explore the lifting of the cap line. We will continue to increase the tilt payment for the poor, reduce the starting line for the rural people in the period of poverty eradication by half compared with the ordinary insured residents, increase the payment ratio by 5 percentage points, and completely abolish the cap line for the poor people in rural building a file card.
(vi) to play the role of medical assistance support protection. Implementation of the relief policy for the people in need, classified and subsidized special hardship personnel, low-security objects, rural building file-based lika poor people to participate in residents' health insurance, according to the standard funding, corresponding to the cost of the people, timely transfer of funds to ensure that the difficult masses should be guaranteed. We will consolidate and improve the level of inpatient and outpatient assistance, increase the efforts of assistance for severe and severe diseases, and explore the gradual transition from disease-based relief to the identification standard for the relief of severe diseases at high cost. Combined with the fund-raising situation and the needs of the recipients, the annual rescue limit will be raised in an integrated manner.
third, to win the battle of medical security to fight poverty
(seven) to ensure the completion of the task of medical insurance poverty relief. Focus on the establishment of file card poor people, will work with relevant departments to do a good job of basic medical insurance for the poor, implement the new poor people timely insurance policy, grasp the insurance contributions, improve the account management, synchronous basic information, do a good job in the province (autonomous region) of the internal and off-site insurance verification, the implementation of the poor people's insurance, contributions, rights and interests record process tracking management, to ensure that the poor people should be guaranteed in the dynamic. We should make good efforts to monitor the war, resolutely conquer the bastions of the deep poverty-stricken areas, implement the policy of local treatment for referral to medical treatment in the provinces (autonomous regions) of the poor, simplify the registration and record of medical treatment in different places, and promote the landing of the policy of "Internet plus" medical service prices and medical insurance payment.
(viii) to consolidate the effectiveness of health insurance's efforts to eradicate poverty. We will fully implement and reduce the poverty policy of medical insurance, and continue to play the function of comprehensive protection and reduction of the triple system of medical insurance. Work together to monitor unstable households, marginal households and returning to poverty due to the epidemic, and implement the policy of medical insurance reimbursement and financial assistance for the treatment of new crown pneumonia. Use the function module of medical insurance poverty alleviation dispatch, supervision war and policy analysis to dynamically monitor the progress of the attack. Cooperate with the anti-poverty census, poverty-relief cap-picking county spot checks, inspection and inspection and other work. We will increase the supervision of funds in poor areas and focus on solving the problems of poor people with abnormally high hospitalization rates, large-scale care for minor illnesses and fraud and insurance. Strengthen and standardize the management of agreements and strengthen the supervision of off-site medical treatment.
(9) to study the continuing work of medical insurance against poverty. Strict implementation of the "four not to pick" requirements, during the transition period, to maintain a relatively stable policy. The examination of the effectiveness of the target anti-poverty attack and the special inspection "look back" and other channels feedback problems, steadily correct the unrealistic over-protection problem, to ensure a smooth transition of treatment. Combined with the sound medical insurance and relief system for serious and serious diseases, the long-term mechanism of poverty alleviation of medical insurance is studied.
. Improve the management of medical insurance payments
(10) strengthen the management of fixed-point medical institutions. Improve the performance appraisal mechanism, form a performance appraisal program and operating mechanism based on agreement management, link the results of the appraisal with the payment of medical insurance funds, and better promote the management of the fixed-point medical institutions of basic medical insurance in the affairs and after the fact.
(11) to promote the reform of the way health care payment is paid. We should play an important role in regulating medical service behavior and improving the efficiency of medical insurance fund. The multi-complex payment method based on disease payment is widely implemented, and the pilot work of disease diagnosis-related sub-grouping (DRG) pay-as-you-go countries is carried out in 30 cities to strengthen process management and adapt to the characteristics of different medical services. We will improve the management of total medical insurance and the comprehensive medical insurance guarantee mechanism for major outbreaks.
(12) strengthen the management of the health insurance catalogue. Gradually unify the scope of payment of medical insurance drugs, establish a negotiated drug implementation monitoring mechanism, formulate a three-year digestion plan for supplementary varieties in the provinces, remove the state key monitoring varieties from the catalogue by the end of June 2020 and complete the digestion of 40% of the additional varieties at the provincial level. Control the proportion of expenses outside the scope of the policy, and gradually narrow the gap between the actual payment ratio and the proportion of payments within the policy range.
5. Strengthen the supervision and management of the fund
(13) to strengthen the supervision and inspection of the fund. Establish a full-coverage medical insurance fund supervision and inspection system, and organize two health insurance fund supervision and inspection throughout the year. Focusing on medical insurance operators and designated medical institutions, we will promote the special governance of medical insurance violations and violations, promote the annual construction of fund supervision and regulation, establish and improve the system of administrative law enforcement publicity, the record of the whole process of law enforcement, and the legal examination of major law enforcement decisions, and promote the regulation of law enforcement. Strengthen the long-term mechanism of fund supervision, take "two pilots and one demonstration" as the grasping hand, improve supervision and reporting, reporting incentives, intelligent supervision, comprehensive supervision, accountability and other measures to explore.