Universal medical insurance, payment method reform, medical assistance... Looking forward to the "14th Five-Year Plan" of medical insurance

"The Fourteenth Five-Year Plan for National Economic and Social Development of the People's Republic of China and the Outline of Long-Term Goals for 2035" puts forward new requirements for the sound and perfection of my country's medical security system, focusing on the multi-level and diversified medical security needs of the people in the new era , It is recommended to promote the implementation of the Healthy China strategy through unifying systems, improving policies, improving mechanisms, and improving services.

Consolidate the coverage of universal basic medical insurance and improve a fair and appropriate basic medical insurance system

During the "14th Five-Year Plan" period, we should first do a good job in realizing universal medical insurance participation.

It is recommended to redefine and improve the methods of insurance participation for the floating population, and scientifically determine the target of participation in insurance coverage.
It is recommended to break the restrictions of the household registration system and choose the basic medical insurance for the migrant population to participate in the basic medical insurance.
Focus on establishing a clean-up mechanism for re-insurance based on the permanent population, registered population, employed population, urbanization rate and other indicators in the region, and scientifically and rationally determine the annual participation To ensure the expansion of the target, formulate a plan to participate in the insurance, actively connect with the civil affairs and health data, give full play to the advantages of community grid management, and realize the registration of universal participation in insurance.

Establish a list of medical insurance benefits and clarify the payment standards and treatment standards for different types of objects.

Currently, the cross-provincial medical insurance settlement service for hospitalization expenses across the country has been basically realized, and the inter-provincial outpatient medical insurance settlement service is expanding in the pilot phase.

Continue to steadily advance the reform of medical insurance payment methods and give full play to the leverage of the medical insurance system

During the "14th Five-Year Plan" period, the design of the total prepayment system should be further improved, and the total prepayment of the medical insurance fund should be scientifically calculated and determined.

Fully consider the actual situation of medical service institutions, and steadily implement the pilot reform of the payment method of disease diagnosis-related groups (DRGs).

Vigorously promote diversified and compound medical insurance payment methods, and improve medical insurance fund payment methods and settlement management mechanisms.

While adopting different medical insurance payment methods "depending on time, place, person, and disease", it is recommended to further improve the medical insurance fund settlement mechanism, make full use of the medical insurance fund installment payment for the supervision and adjustment of medical institutions, and ensure the timeliness of payment And rationality, reduce the pressure of medical institutions to advance funds, and avoid affecting the normal medical service supply of medical institutions.

Establish a timely and accurate identification mechanism for recipients and improve a unified and standardized medical assistance system

During the "14th Five-Year Plan" period, a dynamic management mechanism for medical aid recipients should be established and improved to truly achieve precise protection.

Reasonably define the scope of medical assistance protection, and give full play to the underpinning function of medical assistance.

Increase the budget input of medical assistance funds to improve the level of medical assistance.

Improve the construction of a multi-level medical security system and improve the quality of commercial health insurance development

During the "14th Five-Year Plan" period, it is recommended to further clarify the development direction of commercial health insurance.

Increase the supervision of professional operation of health insurance.

Improve the construction of the industry standard system, build a data exchange platform, and provide effective technical support for product pricing and risk control.