The three departments jointly issued a plan to do a good job in basic medical security for urban and rural residents in 2021...

On the 8th, the National Medical Insurance Bureau and the Ministry of Finance jointly issued notices on improving the unified basic medical insurance system and critical illness insurance system for urban and rural residents, and earnestly doing a good job in medical security for urban and rural residents

1.

It is necessary to reasonably determine the residents' medical insurance financial subsidies and personal payment standards according to the requirements, and optimize the financing structure

2.

It is necessary to standardize the setting of the waiting period for benefits (hereinafter referred to as the "waiting period").

3.

It is necessary to establish a long-term mechanism to prevent and resolve poverty from returning to poverty due to illness, to monitor the risk of patients with high cost burdens from returning to poverty due to illness, to include qualified personnel in the scope of medical assistance in a timely manner, and to implement medical assistance policies upon application

Fourth, strengthen the management of medical insurance payment

It is necessary to earnestly implement the Interim Measures for the Management of Medical Institutions for Medical Security and the Interim Measures for the Management of Medical Security for Retail Pharmacies, to further simplify and optimize the work of medical insurance for medical institutions, and to incorporate qualified medical institutions into the scope of medical insurance in a timely manner

5.

It is necessary to establish and implement a credit evaluation system for pharmaceutical prices and recruitment and procurement, take restraint measures for bidding and online companies that refuse to submit promises of trustworthiness, publish a batch of typical cases that have achieved effective governance, and promote the implementation of the credit evaluation system

VI.

Consolidate and upgrade the level of overall planning, in accordance with the requirements of "unification of system and policy, unified fund revenue and expenditure, and management and service integration", comprehensively implement basic medical insurance city and prefecture-level coordination, unify coverage, payment policies, treatment levels, fund management, designated management, and payment Management, handling services, and information systems
.
Strengthen the guidance for local promotion of the overall level of coordination, and on the basis of consolidating the municipal and prefectural level coordination, in accordance with the principles of "tiered management, shared responsibility, overall adjustment, and budget assessment", actively and steadily promote the provincial level coordination of basic medical insurance
.
Promote coordination between the medical assistance management level and the basic medical insurance overall planning level
.

In light of the impact of the new crown pneumonia epidemic, strengthen fund revenue and expenditure operation analysis, carry out fund use performance evaluation, improve revenue and expenditure budget management, and improve risk early warning, evaluation, and resolution mechanisms and plans
.
Explore factors such as comprehensive population aging, chronic diseases and other disease spectrum changes, and growth in medical expenditure levels, and carry out fund expenditure forecast analysis
.

7.
Strengthen public management services for medical insurance

Continue to do a good job in the settlement of medical expenses for patients with new crown pneumonia and the national settlement of cross-provincial medical insurance expenses, and settle the new crown vaccine and vaccination expenses in a timely manner
.
Fully implement the "National Medical Security Management Government Service Items List", and promote the standardization and standardization of medical insurance public services
.
Promote the construction of standardized windows and service demonstration sites for medical insurance management offices
.
Strengthen the public service capacity of primary medical security, and promote the integration of public medical security services into county and rural public services.
In areas where the medical insurance management force is insufficient, the government can purchase services to strengthen the medical security management force
.
Regulate the management services of commercial insurance institutions to undertake critical illness insurance
.
Promote the effective connection between medical insurance management services and online government service platforms, adhere to the parallel innovation of traditional service methods and smart service methods, improve the level of aging of online services, optimize offline service models, and protect special populations such as the elderly and the severely disabled Handling business smoothly and conveniently
.

Improve the insurance and payment methods for flexible employees such as new employment forms
.
Strengthen departmental data comparison and dynamic maintenance, prevent "missing insurance" and "breaking insurance", avoid repeated insurance participation, optimize insurance payment services, and compact the insurance collection responsibilities of towns and townships
.
Insist on the combination of online and offline, and promote the "no need to run once" for insured persons to go through insurance registration, report payment, query information, and reminder of arrears
.
Accelerate the implementation of high-frequency medical insurance services across provinces
.

Optimize the cross-provincial direct settlement service of ordinary outpatient expenses, and explore the realization path of inter-provincial direct settlement of outpatient chronic disease and special disease expenses
.
Accelerate the construction of a unified national medical security information platform, optimize and improve the operation and maintenance service management system, safety management system, system specifications, and platform functions
.
Strengthen medical insurance data security management and information sharing, and accelerate the application of medical insurance information business standard codes
.

8.
Do a good job in organization and implementation

It is necessary to attach great importance to the medical security work of urban and rural residents, effectively strengthen organizational security, consolidate work responsibilities, and ensure that various policies and measures are implemented and effective
.
It is necessary to strengthen service awareness, optimize service methods, and better provide the people with fair, accessible, convenient, efficient, and warm and comfortable medical security services
.
It is necessary to further increase policy publicity, popularize the concepts of mutual assistance, shared responsibility, and joint construction and sharing of medical insurance, enhance the public's awareness of participating in insurance and payment, and rationally guide social expectations
.
Medical security, finance, and taxation departments at all levels must strengthen overall coordination, establish and improve departmental information communication and work coordination mechanisms, do a good job in fund operation assessment and risk monitoring, formulate work plans, and promptly report as required when encountering major situations
.