Throughout the 3-year history of the National Medical Insurance Administration-scientific decision-making and outstanding practice​

On May 31, 2018, the National Medical Security Administration went into operation
.

In the past three years, this new institution has meticulously performed the functions and responsibilities assigned by the central government with new attitudes and new actions, and has proved the scientific nature of the central government's decision to establish the National Medical Security Administration with its outstanding practical results

On May 31, 2018, the National Medical Security Administration went into operation

The practice of the past 20 years has shown that the pattern of multi-sectoral division of management is a major institutional obstacle that affects the reform and system construction of the medical security system.
It not only directly damages the unity and fairness of the medical insurance system, and weakens the protection capacity of medical insurance.
It has also caused the malpractice of the medical insurance business to be handled differently and the information system is different, leading to the inefficiency of the system operation and the waste of resources, and even the relevant policies of different departments still have effect hedging, such as missing insurance, suspension of insurance, and repeated participation.
Frauds in the insurance and medical insurance fields occur from time to time, which directly restricts the deepening of the reform of the medical insurance system and the modernization of medical insurance governance
.

It is against this background that the central government decided to set up the National Medical Insurance Bureau to supervise the nation’s medical security affairs and related work, and assign the basic medical insurance and maternity insurance for urban employees and urban residents of the Ministry of Human Resources and Social Security and the nursing insurance management responsibilities in the pilot.
, The National Health and Family Planning Commission’s new rural cooperative medical management responsibilities, the National Development and Reform Commission’s drug and medical service price management responsibilities, and the Ministry of Civil Affairs’s medical assistance management responsibilities are integrated, realizing the division of national medical security affairs from multiple departments Management is moving towards the goal of centralized and unified supervision
.

Practice in the past three years has shown that the centralized and unified medical security management system has significantly accelerated the integration and optimization of the medical insurance system due to the elimination of the constraints between departments, greatly reduced administrative costs and business handling costs, and realized the benefits of medical care.
Direct management of prices and medical behaviors is more effective
.

Therefore, the establishment of the National Medical Insurance Bureau is an important measure in the new era to enhance the medical security management capabilities and promote the modernization of the medical security governance system.

Introduced a top-level design to comprehensively deepen the reform of the medical security system

In August 2018, the National Medical Insurance Administration launched a special study on comprehensively deepening the reform of the medical security system in accordance with the deployment of the central government and formed a draft policy document
.

In February 2020, the Central Committee of the Communist Party of China and the State Council formally issued the "Opinions on Deepening the Reform of the Medical Security System" (hereinafter referred to as the "Opinions"), which is a programmatic document for comprehensively deepening the reform of China's medical security system in the new era

Important progress has been made in promoting various related reforms

After the establishment of the National Medical Insurance Bureau, the reform of the medical security system has been comprehensively promoted, which is mainly manifested in the following aspects:

First, the integration of the social medical insurance system for urban and rural residents has been realized
.

Starting from the rules of the system, it is the most fair and efficient institutional arrangement to cover the entire population with a medical security system, because different institutional arrangements must have inequality in rights and interests among different applicable groups, and the system will be degraded due to the division of resources.

Second, clearly cancel the personal medical insurance accounts of residents and promote the reform of personal medical insurance accounts for employees
.

In response to this major institutional defect of medical insurance personal accounts and the many drawbacks it caused, the National Medical Insurance Administration and the Ministry of Finance jointly issued a document in May 2019 to clearly cancel the policy of resident medical insurance personal accounts.

Third, the reform of medical insurance payment methods is deepening
.

In 2019, the National Medical Insurance Administration identified 30 cities as national pilots for DRG payment, and established a nationally unified DRG technical standard specification and intelligent monitoring index system, laying the foundation for the next step of comprehensive DRG payment work

Fourth, the construction of the medical insurance fund supervision system has made significant progress and has begun to enter the track of the rule of law
.

Under the situation that various fraudulent insurance frauds in the medical insurance field are common and difficult to manage, since 2018, the National Medical Insurance Administration has jointly launched a special action against fraudulent insurance with multiple departments and achieved initial results

Fifth, a special drug negotiation system and a centralized procurement and use mechanism have been initially established
.

Insufficient high drug prices and excessive consumption are another chronic disease that has long troubled the medical insurance system and brought a huge burden to patients
.
In recent years, the National Medical Insurance Administration has adopted pilot reforms and gradually promoted them, actively promoted special negotiations on medical insurance access for anti-cancer drugs and special centralized procurement at the provincial level, and accelerated the improvement of the centralized drug procurement mechanism and the market-led drug price formation mechanism.
Promoted the establishment of pharmaceutical and medical insurance payment standards and the improvement of pharmaceutical treatment payment methods.
At the same time, the catalogue of pharmaceuticals was continuously improved, effectively exerting the leverage of the medical insurance system to promote the "three medical" linkages, and benefiting hundreds of millions of people
.
At present, this system is moving towards normalization, and it will definitely have a positive and far-reaching impact on the reform of medical expense payment methods and medical institution compensation methods
.

Comprehensive progress has been made in the construction of medical security informatization and standardization

The universality of the occurrence of diseases, the complexity of the medical insurance relationship and the professionalism of medical behaviors determine that informatization and standardization are the basic projects to maintain the construction and orderly operation of the medical insurance system.
It is not only related to the standard and orderly operation of the medical insurance system.
And efficiency, and directly affect the realization of the insured’s rights and the quality of medical services
.
But for a long time, due to the division of departments in our country, a pattern of inconsistent standards, non-sharing of information, system division, and regional closure has been formed, which has affected the implementation and development of the medical security system
.
After the establishment of the National Medical Insurance Bureau, the informatization and standardization of medical insurance have been listed as the most important major tasks and promoted in an all-round way
.
In terms of informatization construction, the information platform construction project including 14 subsystems in four categories: public service, management, intelligent monitoring, and macro decision-making has entered the implementation stage
.
In terms of the standardization of medical insurance, the National Medical Insurance Bureau entrusted the Chinese Society of Social Security to organize a team of experts in accordance with the overall requirements of "unified planning, unified classification, unified coding, unified release, and unified management" to complete the formulation of 15 medical insurance information business coding standards , The website of the National Medical Insurance Bureau opened the window of "Dynamic Maintenance of the Medical Insurance Information Business Coding Standard Database"
.
At the same time, a total of 600 million medical insurance e-vouchers have been activated
.
At this point, a unified national medical insurance information business coding platform has been basically established, providing technical support for improving China's medical security governance capabilities and promoting the high-quality development of medical insurance
.

Fighting the new crown pneumonia epidemic and helping poverty alleviation reflect the effective actions of the medical insurance system

After the outbreak of the new crown pneumonia epidemic in January 2020, the National Medical Security Administration quickly issued corresponding policy documents, through exempting insured persons from new crown pneumonia diagnosis and treatment costs, increasing diagnosis and treatment and drug items, implementing remote treatment and settlement after treatment, and breaking fixed procedures.
A series of measures such as the inclusion of newly established specialized hospitals and temporary shelter hospitals into designated medical institutions have quickly played a good role in calming people's hearts, relieving medical institutions from worries, and preventing patients or suspected patients from escaping medical examinations for diagnosis and treatment costs.
The fight against the epidemic has made a vital contribution, demonstrating the political responsibility and high efficiency of the National Medical Insurance Administration at critical times
.
Practice in response to this epidemic has proved that medical security, as an important part of our national livelihood security system and the backbone of the social security system, is not only the biggest livelihood project to relieve 1.
4 billion people’s medical care and improve people’s health, but also a response An important institutional guarantee for emergent major public health incidents, building a healthy China, and improving the national governance system
.

The National Medical Insurance Administration's new actions in the fight against the new crown pneumonia epidemic have won full affirmation and high praise from all over the world
.
On the afternoon of April 27, 2020, Xi Jinping, General Secretary of the CPC Central Committee, presided over the 13th meeting of the Central Committee for Comprehensively Deepening Reform and delivered an important speech
.
He emphasized that the fundamental reason why China's epidemic prevention and control and the resumption of work and production can be effectively promoted is that the party's leadership and the advantages of China's socialist system have played an incomparably important role
.
The meeting reviewed and approved the "Guiding Opinions on Promoting the Reform of the Medical Security Fund Supervision System"
.
The meeting emphasized that in the process of fighting the new crown pneumonia epidemic, the National Medical Insurance Bureau, the Ministry of Finance and other departments issued relevant policies in a timely manner to include the diagnosis and treatment of new crown pneumonia in the medical insurance fund payment scope and prepaid part of the funds to ensure that patients will not be affected by cost issues.
The admission of hospitals does not affect treatment due to the payment policy, which reflects the superiority of China's socialist system
.
This evaluation is a true portrayal of the National Medical Insurance Administration's fight against the new crown pneumonia epidemic, reflects the consensus of all sectors of society, including social security scholars, and is also an actual manifestation of the National Medical Insurance Administration's overall planning of epidemic prevention and control and the reform and development of the medical insurance system
.

In the fight against poverty, medical security provides a powerful system guarantee
.
Because disease is the most important cause of poverty, it is very important to relieve the medical burden of disease for the poor
.
In view of this, after the establishment of the National Medical Security Administration in 2018, it quickly formulated and implemented the "Three-year Action Plan for Poverty Alleviation by Medical Security (2018-2020)" in conjunction with the Ministry of Finance and the Poverty Alleviation Office of the State Council
.
According to this plan, focus on the "three regions and three states" and other deeply impoverished areas and special poor people such as poverty caused by illness and return to poverty, give full play to the functions of basic medical insurance, critical illness insurance, and medical assistance, and effectively improve the medical security of the rural poor The level of benefit is to achieve full coverage of the medical insurance system for the rural poor by 2020, which in fact provides very strong support for the poor in poverty-stricken areas to get rid of poverty
.
After achieving important results in poverty alleviation through medical insurance, in September 2019, the National Medical Security Administration once again jointly issued the "Guiding Opinions on Resolutely Completing the Hard Tasks of Poverty Alleviation by Medical Security" in conjunction with the Ministry of Finance, the National Health Commission, and the State Council’s Poverty Alleviation Office, which clearly stated Ensure that all the poor are included in the coverage of basic medical insurance, critical illness insurance, medical assistance and other systems as the hard task and bottom-line indicator of medical security for poverty alleviation
.
Medical insurance departments at all levels have vigorously implemented the implementation, and achieved positive results in promoting medical insurance to fight poverty.
Basically, it has basically realized the "guarantee must be fully protected, basically in place, supplementary must be tilted, aid must be firm, cost must be controllable, and services must be convenient.
" Goal
.
Since 2018, the medical insurance and poverty alleviation policies have supported 230 million people insured for poor people, reduced the burden of personal payment by 40.
3 billion yuan, benefited 530 million people in medical care for the poor, and reduced the burden of medical expenses by more than 360 billion yuan.
The insured rate of the poor has remained stable.
99.
9% or more
.
These powerful measures have greatly improved the level of medical security for the poor in rural areas.
The low-income groups with difficulties in medical care have basically been relieved of their medical concerns, and the phenomenon of poverty due to illness and return to poverty due to illness has been fundamentally curbed
.

In short, in the three years since its establishment, the National Medical Security Administration has clarified the clear goals and development directions for the reform and development of China’s medical security system, and has done many major things that it wanted to do but failed to do.
Its practical effects have fully proved that the central government has established a country The decision-making of the Medical Security Administration is a scientific decision, and the actions of the National Medical Security Administration are fully effective
.
Although there are still many difficulties and challenges that need to be further overcome, a brand-new situation in medical security reform and system construction has been fully opened
.
After entering the "14th Five-Year Plan", as long as we always adhere to the development concept of focusing on people's health, adhere to the development orientation of continuously promoting system fairness and improving operational efficiency, and adhere to the essence of co-construction, sharing, and mutual assistance, we have achieved obvious results.
Based on the correct path, grasping key issues and key links, and adopting smart strategies to comprehensively deepen reforms, a high-quality medical security system with Chinese characteristics will surely be completed as scheduled before 2030
.
The maturity and finalization of this major livelihood security system will not only benefit all the people, but will also provide a useful model for the reform and development of other social security systems
.