The reporter went to four places to investigate: it is better to open up the blocking points to facilitate the masses to seek medical treatment in different places

The government work report proposes to improve the direct settlement method for cross-provincial medical treatment in different places, and realize the basic uniformity of the scope of medical insurance drugs across the country
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At present, China has built the world's largest basic medical security network covering the entire population
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The direct settlement of hospital expenses for inter-provincial and out-of-town medical treatment has been fully rolled out, the direct settlement of out-patient expenses across provinces has been steadily piloted, and the registration service for out-of-town medical treatment is being promoted
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Statistics show that the cross-provincial direct settlement of hospital and outpatient expenses nationwide has accumulated more than 10 million person-times
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What are the blocking points found in the pilot test of medical insurance settlement for medical treatment in different places? How to get through the blockage? Xinhua News Agency reporters recently went to Shanxi, Jiangxi, Guangdong, and Beijing to investigate and investigate the blocking points of medical insurance in different places, and connect the representatives of the two sessions to offer advice and suggestions
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How to solve the inconvenience of filing filing - both to ensure "just need", but also to prevent medical resources from running out of Taiyuan City, Shanxi Province, Ms.
Zhang, a worker in Taiyuan City, Shanxi Province, thinks that the disease cannot be effectively treated locally, and wants to go to Beijing for medical treatment.
Feeling inconvenient
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The unit she worked for was unable to issue the "red-headed document" required by the Taiyuan Municipal Medical Insurance Bureau for medical insurance to seek medical treatment in other places.
Ms.
Zhang tried to go through the referral procedures at the local hospital, which was also unsuccessful
.
Ms.
Zhang chose to pay by herself to go to Beijing for medical treatment
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Zhang Xinglong, deputy chief of the Medical Institution Service Section of the Taiyuan Medical Insurance Management Service Center, told reporters that according to the current medical insurance policy in Taiyuan, the registration of medical insurance for medical treatment in different places is limited to three special groups: retirees who are resettled in different places, retirees who live in different places for a long time, and those who live in different places.
On-the-job employees
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The "red-headed document" mentioned by Ms.
Zhang is the material that can prove that the on-the-job employees of Taiyuan City need to stay in other places for work
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Zhang Xinglong said that since Ms.
Zhang has started to seek medical treatment in another place and paid in advance by herself, if it is really critical and severe, she will be reimbursed according to 70% of the reportable range
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If she does not belong to this category, she will be reimbursed according to the relevant regulations of "non-emergency without referral" and 50% of the reportable range.

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Li Weixing, chief of the medical service management and treatment security section of the Taiyuan Medical Security Bureau, said that online self-service filing for medical insurance in other places is expected to be gradually liberalized this year
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The reporter learned from the investigation that the direct settlement of medical treatment in different places is handled in accordance with the principle of "the directory of medical treatment places, the policies of the insured places, and the management of medical treatment places"
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Due to the differences in catalogues in different places, there is currently a difference in treatment between direct settlement and reimbursement at the participating places
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Han Qinghua, a member of the National Committee of the Chinese People's Political Consultative Conference and vice president of the First Hospital of Shanxi Medical University, said in an interview with reporters that the blocking point of this case is that policies such as medical insurance settlement for medical treatment in different places and hierarchical diagnosis and treatment are still being implemented, and further improvement and coordination are needed
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Han Qinghua suggested that the top priority is to make it easier for people who live in other places and those who "just need" to seek medical treatment in other places.
There is a run on the city's medical resources
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(Reporters Xu Xiong and Zou Duowei) How to make the filing faster - strengthen information sharing and avoid multiple applications At the beginning of this year, Mr.
Chen, a Shenzhen resident, planned to seek medical treatment in a local outpatient clinic due to abdominal discomfort during a business trip in Shijiazhuang, Hebei
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He learned about the "National Remote Medical Treatment Recording" applet through online inquiry.
On January 6, he submitted an application for remote medical treatment for the record.
The system prompted that it would take 2 to 3 working days to wait, and the application would not be approved until January 11
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The mini-program of “National Remote Medical Treatment Recording” is a registration channel for remote medical treatment launched by the National Medical Insurance Bureau.
At present, manual review is still used in Shenzhen
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The reporter saw on February 15 that 390 filing applications were submitted through the mini program that day, but only 2 staff members of the Shenzhen Municipal Medical Insurance Bureau reviewed them
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The staff told reporters that Shenzhen has opened a variety of off-site medical record application channels.
Through the official website of Shenzhen Medical Insurance Bureau, "online application" can be achieved without manual review, and "instant approval in seconds" can be achieved
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However, the reporter learned from interviews that some insured people did not know this way.

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Wen Bing, director of the treatment management department of the Shenzhen Medical Insurance Fund Management Center, said that the Shenzhen Medical Insurance Bureau is currently promoting the localization of the "National Remote Medical Recording" applet
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After the functional transformation is completed, the insured can apply for it in the system by itself, without manual review, and it can be processed in seconds
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At present, the problems reported by the masses belong to the transitional period, and the Shenzhen Municipal Medical Insurance Bureau will promote the early completion of the system connection
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At the same time, it will increase publicity to let more insured people know that before the renovation is completed, they can apply for self-service in the personal online system on the official website of Shenzhen Medical Insurance Bureau
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The reporter learned from the investigation that in the filing process, the "National Remote Medical Treatment Filing" mini-program and the National Medical Insurance Service Platform APP have been developed and launched to provide a national unified online filing service in two forms: rapid filing and self-service opening
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Quick filing requires manual review, usually about three working days, covering 362 co-ordination areas; self-service opening is automatic review, effective immediately, covering 90 co-ordination areas
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The insured can log in to inquire about the co-ordination areas that have opened direct settlement, and file online as required
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Yu Xueqin, deputy to the National People's Congress and vice chairman of the trade union of Dongguan Bus Co.
, Ltd.
, pointed out that the blocking point of relevant cases is that there are many manual review links and long processes
.
She suggested that we should speed up the unification of medical insurance filing channels in different places, avoid multiple applications and multi-port applications, strengthen information interconnection and sharing between localities and platforms, and simplify the application process, and implement automatic system review
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(Reporters Xu Hongyi, Hu Nayun, Wang Yueyang) How to solve the difficulty of issuing a referral certificate for the first filing - explore refined management, and strive to ensure that "all transfers should be transferred" When filing for the first time, a referral certificate issued by a designated medical institution with referral qualifications must be provided
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If you have been hospitalized in the same designated medical institution for the same disease process for many times, the referral certificate will not be issued for the second time or later
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All localities are adjusted according to local actual conditions
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When Mr.
Bai from Nanchang City, Jiangxi Province applied for medical insurance to seek medical treatment in other places, he was required to provide a referral certificate
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Mr.
Bai inquired from various sources, and it was difficult to obtain a referral certificate
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Zhang Xiaofeng, head of the off-site medical treatment management section of the Jiangxi Provincial Medical Insurance Fund Management Center, introduced that most medical insurance co-ordination areas in the country require a referral certificate, but they can also explore the "commitment system" and "absence-tolerant acceptance system" in light of local actual conditions.
material
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Nanchang, Ganzhou and other places have carried out the first trial of the certificate of no referral and transfer
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Jin Linjin, director of the Jiangxi Provincial Medical Insurance Fund Management Center, introduced that whether referral or hospitalization is necessary is determined by the hospital's clinical experts based on the severity of the insured patient's disease and the medical technology level of the medical institution
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If the insured patient really needs to be referred and transferred to another hospital, the visiting medical institution should issue a certificate for the insured person according to regulations; if the insured person does not meet the referral and transfer standard, and the insured person asks for medical treatment in another place, the medical institution will generally not issue a certificate
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Jin Linkin said that Mr.
Bai did not request the medical institution to issue a referral certificate before.
After the Jiangxi Provincial Medical Insurance Fund Management Center learned about the situation from the medical institution, the medical institution issued a referral and referral certificate in different places according to the needs of Mr.
Bai's condition, so as to facilitate Mr.
Bai handles medical records in other places
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Cai Xichun, deputy to the National People's Congress, believes that the blocking point of relevant cases is that the "referral and referral certificate" originally designed to promote hierarchical diagnosis and treatment, but in practice, due to the safety of fund operation and economic benefits, the policy is difficult to effectively implement.
On the basis of the experience in the pilot areas of the "referral-free transfer certificate", the policy details should be further clarified, so that the people who really need to be referred and transferred "should be transferred as much as possible"
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At the same time, it is also necessary to strengthen the guidance of insured personnel and the management of medical institutions, vigorously promote hierarchical diagnosis and treatment, and form a reasonable and orderly medical order.

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(Reporters Min Zuntao, Yu Gang, Zhou Yuan) How to reduce the settlement process in different places without filing records - let the information "run more" and let the people "run less errands" At the end of January 2022, Ms.
Jiang from Jilin went to Beijing for medical treatment.
In the case of filing in advance, you must hold the identity certificate of the Beijing residence registration card in order to continue to complete the direct settlement of cross-provincial medical treatment
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However, Ms.
Jiang was unable to apply for online face recognition due to the use of hormone drugs to affect her face, and she could not apply offline due to limited mobility, so she wanted to entrust her father to apply for a residence registration card on behalf of her
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The reporter learned from an interview at the Jiaowangzhuang police station that according to relevant requirements, others are limited to the elderly, disabled or minors with limited mobility, and Ms.
Jiang's situation does not meet the conditions for acting/handling
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After learning about Ms.
Jiang's situation, the police from Jiaowangzhuang Police Station applied to the Tongzhou Branch for a "special case", allowing Ms.
Jiang's father to handle the matter on her behalf
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On February 11, Ms.
Jiang successfully received the residence registration card, and the procedures for applying for reimbursement of medical insurance in different places have since been streamlined
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Gao Tiejun, deputy director of the Jiaowangzhuang police station, said that applying for a residence registration card is an important part of realizing direct settlement for medical treatment in other places
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When the insured person handles the direct settlement of inter-provincial medical treatment, they generally need to follow the process of "filing first, selecting a point, and using the card code to seek medical treatment"
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The insured can open the registration through the national medical insurance service platform APP and the national remote medical registration mini-program, and then select a designated medical institution for medical treatment in a cross-provincial and remote medical network, and hold a medical insurance card or an activated medical insurance electronic certificate.
, discharge settlement or settlement at the outpatient billing window, conduct inter-provincial direct settlement
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If the insured fails to file the record, interrupt payment, the social security card is not activated, or the city, county and medical institution where the insured does not open outpatient direct settlement, it may lead to settlement failure
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In the process of seeking medical treatment in other places, for the safety of funds, the relevant departments often need to provide materials such as identity certificates, which is easy for patients to “break the leg” in the processing of materials, and the application is not humane enough.
Provide efficient and convenient public services to test
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Wu Ming, a member of the National Committee of the Chinese People's Political Consultative Conference and a professor at the School of Public Health of Peking University, believes that under the conditions that meet the policy, all relevant departments should adhere to the people-oriented, taking into account the actual difficulties of the sick group, let the information "run more" and let the people "run less errands".
"
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Under the requirements of national policies, all localities should simplify the processing procedures according to local conditions, and effectively solve the problems of "complex materials" and "complex procedures" for medical insurance applications in different places
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(Reporters Lin Miaomiao, Lu Chang, Wang Pu, Wang Xiunan, Peng Yunjia) (Writing by: Hou Xueqing, Xie Xiyao, Liu Yuanyuan)