In 2021, under the correct leadership of the Municipal Party Committee and Municipal Government, the Municipal Medical Insurance Bureau will fully implement the central, provincial and municipal medical security work arrangements, and focus on improving the overall level of medical insurance from the perspective of safeguarding people’s rights and interests in life and health. Progress, several reforms, and innovations have made breakthroughs, and several people’s livelihood facts have won a good reputation. The self-developed ” Digital Platform for Medical Insurance Payment Reform ” was successfully selected as an excellent application of the ” Star Observatory “for digital transformation in Zhejiang Province, and won sixth place in the selection of the best application in Taizhou in 2021, reported by China News Network and the website of the Provincial Commission for Discipline Inspection and Supervision. In 2021, in response to relevant practices, our bureau made two exchange speeches at the provincial medical insurance agency work conference, and the health The total payment method of the community medical insurance was introduced at the national close-type medical insurance total payment reform seminar; in 2021, our bureau was also awarded the “2020 Advanced County (City, District) Medical Security Bureau “in Zhejiang Province, and was awarded In 2021, Yuhuan’s only demonstration site for party building in Taizhou City, and the Municipal Medical Insurance Service Center was awarded the 2020 Taizhou Youth Civilization Number.
1. Summary of work in 2021
(1) Improve the system to secure the bottom line, and strive to relieve the people’s worries about medical treatment of diseases
The first is to actively promote the overall planning of basic medical insurance at the municipal level. From January 1, 2022, the whole of Taizhou City will implement the municipal-level overall planning of basic medical insurance. The work requirements, our bureau strictly implements the national medical insurance method and the implementation rules, unifies the urban and rural medical insurance financing standards, and actively promotes the city-level overall planning of basic medical insurance. On November 14, the new system was launched, with full docking in the early stage and careful planning, achieving a smooth transition. The second is to do a good job in ensuring the cost of medical treatment for major epidemics in an orderly and effective manner. Reimbursement does not implement the regulations on the reduction of the proportion of medical expenses transferred to other places to reduce the risk of infection caused by the flow of patients. The payment of the new crown vaccination fee is based on the unified deployment of the superior, and the fund that generates the expenses meets the requirements directly. In 2021, the vaccine and vaccination fee will be paid 76.3278 million yuan. The third is to further play the role of the critical illness insurance system in reducing the burden. Implement the 2021Taizhou critical illness insurance policy, improve the level of critical illness insurance, and increase the proportion of critical illness insurance compliance medical expenses to 70%. The threshold for serious illnesses for medical assistance objects is reduced from 20,000 yuan to 10,000 yuan, and the cumulative amount of personal self-payment within a medical insurance year reaches 10,000 yuan. The reimbursement ratio of some serious illness insurance above 10,000 yuan has been increased from 65% to 85%, reducing the burden of medical expenses for the insured and the poor. Fourth, actively promote commercial supplementary health insurance. Since the launch of ” Taizhou Limin Insurance “, our bureau has taken this work as an important project to reduce the financial burden of medical treatment for the poor and promote common prosperity. As of January 15, 2022, the city’s insurance coverage rate was 42.97 %. Fifth, establish and improve a long-term mechanism to prevent and resolve the return to poverty due to illness and cause poverty. Focusing on the requirements of helping common prosperity, we will accurately implement medical assistance. Strictly implement the medical assistance policy and achieve 100% of the three. It took the lead in drafting and promulgating the “Implementation Measures for Medical Assistance in Yuhuan City” in Taizhou to standardize medical assistance.
(2) Learn from history and act for the people, and make practical moves in key reform areas to see actual results
The first is to solidly promote the reform of the payment method of multiple and compound medical insurance. In 2021, the reform of the medical insurance payment method in our city will enter the reform deepening stage, fully implement the multi-modal medical insurance payment method under the total budget management, package all medical insurance funds to the health community, pay per capita for outpatient services, and pay DRGs for hospitalization expenses. payment method. The trend of excessive growth of funds has been significantly curbed, and the cost of medical treatment for insured citizens has been effectively reduced. The second is to implement and implement the reform of the recruitment and procurement system for medical devices. Monitor the procurement of medicines and consumables in medical institutions through the Zhejiang Provincial Pharmaceutical Equipment Procurement Platform, supervise the relevant medical institutions if there are problems such as slow procurement and abnormal procurement progress, and promptly solve new problems encountered by medical institutions in the procurement of medicines and consumables. the situation, new problems. The third is to implement the work related to the implementation of higher-level medical service prices. According to the unified deployment of the Taizhou Municipal Bureau, the city’s adjustment and improvement of medical service price projects will be sorted out and reported. Urge public medical institutions to implement the “Taizhou Public Hospital Medical Service Price Structural Adjustment Plan”, “Notice on Announcement of the First Batch of ” Internet +” Medical Service Price Items in Zhejiang Province and Other Related Matters”, “On Adjustment of Novel Coronavirus Nucleic Acids” Notice on the Price of Testing Items”, “Notice on Adding and Adjusting and Improving the Price Items of Medical Services”, “Notice on Adding and Improving the Price Items of TCM Medical Services” and other documents. Fourth, continue to deepen the reform of” run at most once “.Efforts will be made to create a “30 -minute service circle ” for medical insurance handling, and the function of the medical insurance handling window will be moved forward. At present, the city has 11All township (street) convenience service centers that can handle simple medical insurance services and provide medical insurance receipt services (this work was reported by Zhejiang Satellite TV’s “News Network” last year). Vigorously promote the ” non-face-to-face ” service of medical insurance handling, various medical insurance matters can be handled through the medical insurance hospital interactive platform, Zhejiang government service network, Zhejiang Office app, and telephone and other online and handheld channels, so that 100% of medical insurance matters can be handled. The rate of online office, online office, and hand office reached 97%. From January 2021, the direct settlement of outpatient and inpatient services across provinces across the country has been realized. Actively promote medical insurance electronic vouchers to achieve a convenient medical insurance experience that does not require a medical insurance card to see a doctor and buy medicines, and can scan the code on a mobile phone. Taizhou City Medical Insurance Electronic Voucher Work Site Promotion Meeting was held in our city. The fifth is to innovate and develop the ” digital platform for medical insurance payment reform “. Relying on information technology to strengthen the digital and refined management of medical insurance for designated medical institutions, by building systems, focusing on data, promoting collaboration, breaking barriers, and realizing data and information sharing on one network. At present, 15 synergies have been achieved, covering 11 departments, benefiting 470,000 insured people. It effectively solves the problems of information asymmetry, inaccurate evaluation of reform effectiveness, and lack of means to control medical expenses. Sixth, strictly implement the standard implementation of medical insurance information business coding. Set up a special class for the implementation of the standard, clarify the division of responsibilities and the time limit for the implementation of various codes, find and solve the contradictions and problems in the work in time, ensure that the implementation of the standard is carried out in an orderly manner, and complete the tasks assigned by the Taizhou Municipal Bureau on time, quality and quantity. The maintenance of information coding for designated medical institutions and their medical insurance physicians, nurses, and pharmacists has been fully completed, and more than 3,200 people have been registered.
(3) Improve the supervision ability of medical insurance funds and be a good defender of the interests of the insured
First, continue to crack down on fraud and insurance fraud. Joint public security, justice, finance, health, city supervision, and other 6 departments to formulate and promulgate the “Yuhuan City in-depth special rectification action plan to crack down on fraud and insurance fraud”, clarify the leadership organization, target tasks, and complete time limit, and increase the number of fraud and fraud. Guaranteed strike force. The city’s designated medical institutions have carried out self-inspection and self-correction work to standardize the use of medical insurance funds. The self-inspection found that there were 3 designated medical institutions involved in violations, involving an amount of 1,900 yuan, all of which have been voluntarily returned and rectified in place. Carry out special treatment of designated medical institutions to ” look back ” for induced hospitalization, false hospitalization, etc. An inspection team formed with the health department and medical experts to carry out ” white + black ” surprise inspections on 8 designated hospitalized medical institutions . 13 inpatient wards were randomly selected, a total of 567 people were checked, and 65 medical records were randomly selected. No violations such as induced hospitalization and false hospitalization were found. In 2021, a total of more than 280 designated medical institutions will be inspected, 18 will be warned, 39 agreements will be suspended, 1 medical insurance doctor will be punished, about 170,000 yuan will be punished for violations, and 2 agreements will be rescinded voluntarily. home, achieving a breakthrough of zero administrative penalties for medical insurance. Through the medical insurance system, more than 2,300 dead and cremated personnel lists were compared, 5 cases of suspicious data of post-mortem credit card swiping were found, and the illegal fee of about 5,000 yuan was recovered in time. The website of the Provincial Commission for Discipline Inspection and the Provincial Supervision Commission reported the special governance practices of our bureau’s fund supervision. The second is to publicize and implement the Regulations on the Supervision and Administration of the Use of Medical Security Funds. Through various forms in April, a centralized publicity month campaign with the theme of ” Propaganda and Implementation of the Regulations and Strengthening Fund Supervision ” was carried out to thoroughly study and publicize the Regulations on the Supervision and Administration of the Use of Medical Security Funds. Set up on-site publicity in pedestrian streets and village cultural halls, answering more than 200 people, and distributing more than 300 publicity materials. Taking the municipal medical insurance center and designated medical institutions as the main propaganda positions, hanging propaganda slogans, posting more than 250 propaganda posters, and distributing more than 8,000 propaganda folds to carry out extensive and in-depth publicity. Effectively use the municipal medical insurance center, the electronic screen of designated medical institutions, the big screen of Yuhuan shopping mall, and the mobile TV of Yuhuan urban and rural buses to play the medical insurance propaganda animation in a loop, and play it more than 8,000 times. For the large-scale training meeting held by more than 300 people in designated medical institutions, lawyer Hong Kewen was invited to interpret the regulations on the supervision of the use of medical insurance funds and make a case-by-case explanation. Improve the awareness of awe and law-abiding medical institutions, and consciously maintain the safety of medical insurance funds.
(4) Adhere to the leadership of party building and enhance the combat effectiveness and cohesion of the party organization
One is to rely on effective carriers to do a good job in the study and education of party history. Relying on the ” Banyuetan ” learning platform and the ” Red Oxygen Bar ” position of the bureau, carry out party history special party courses, reading and sharing, and party history micro-lectures. Organized and carried out ” Learn the Party History, Sacrifice the Martyrs “, walked into the red education bases such as Chumen Oriental Middle School, Dongtou Women’s Militia Company, and other red education bases ” Follow the Red Map to learn the Party History ” activities, carried out revisiting the oath of joining the Party, etc., and filmed ” Sing a hymn to Party Listening ” theme pop-up works. A party history knowledge quiz competition was held, and team members were selected to participate in the city’s ” Red Boat Cup ” party history knowledge competition and won the second prize with the second overall score. By the specific requirements of the provincial party committee’s ” six lectures and six actions “, the upsurge of learning, publicizing, and implementing the spirit of the Sixth Plenary Session of the 19th Central Committee of the Party has been launched, and the study and education of party history have been deepened and expanded. The second is to strictly supervise within the party and further promote the establishment of clean and clean institutions and model institutions. Focus on the risk points of clean government in medical insurance handling, keep an eye on ” things around you “, target key areas, and fight the ” four battles “, to promote the construction of ” integrity medical insurance “. At the same time, online and offline integrity education positions have been set up, and activities such as Red Book Drifting, Banyue Tan, and Handheld Bookcase have been used to carry out exchanges on integrity regulations and business, to keep ideological control; create personal integrity files for cadres and workers, and keep the work style locked; Check the work style and performance, and strictly supervise the customs. The third is to practice the concept of serving the people and improve the integration of party-building business. Set up a medical insurance red running group, a medical insurance lecturer group, and medical insurance managers, focusing on the most urgent concerns of the grassroots, the masses, and enterprises, focusing on the fund safety publicity month, insurance reimbursement policies, medical insurance digital reform, special treatment of poverty and return to poverty due to illness, medical insurance The latest medical insurance policies such as the promotion of electronic vouchers and the promotion of Taizhou’s ” Benefiting the People’s Insurance ” are sent to insured persons, medical insurance physicians, and other groups to build a one-to-one communication bridge, be a good instructor, propagandist, and manager, and actively play the vanguard and exemplary role of party members. In 2021, a total of 39 events will be carried out for the introduction of medical insurance policies into enterprises, communities, and cultural auditoriums, a total of 17,600 medical insurance policy publicity materials will be distributed, 4 press conferences will be held, and 1 televised political interview.
2. Work ideas for 2022
In 2022, the Municipal Medical Security Bureau will closely focus on the development goals of “one pole, three cities” and “four Yuhuan” proposed by the first party congress of the 16th city, adhere to the people-centered, focus on the theme of common prosperity, and focus on equity It aims to accelerate the construction of “six medical insurances” and promote reforms, excellent service, strong foundation, hard work, forging ahead, striving to be a model and leader of the medical insurance reform, so that the results of the medical insurance reform will benefit more and more equitably the insured people in the city. Focus on the following work:
(1) Actively promote the overall planning of basic medical insurance at the municipal level. Closely follow the work requirements of Taizhou City’s “six unifications”, implement the city-level overall planning of basic medical insurance, and make full preparations for the provincial-level overall planning of the medical insurance information system. At the same time, based on the actual situation, we will continue to explore, strive to have innovative breakthroughs in business, and push the reform of the medical insurance field in depth.
(2) Continue to promote the development of commercial supplementary medical insurance. Increase the publicity and promotion of “Taizhou Benefiting the People’s Insurance”, raise funds and mobilize various parties to encourage the masses to participate in the insurance, give full play to the supplementary role of commercial supplementary medical insurance to the national medical insurance system, and guide the masses with real cases and results. Actively insure.
(3) Continue to do a good job in targeted poverty alleviation through medical assistance. Relying on the province’s social assistance platform, do a good job in monitoring the risk of returning to poverty due to illness, and establish and improve the active discovery mechanism, dynamic monitoring mechanism, information sharing mechanism, and precise assistance mechanism to prevent and resolve poverty and return to poverty due to illness, to ensure that the three are 100%.
(4) Promoting the reform of medical insurance payment methods in depth. Deepen the reform of paying for outpatient services based on headcount and contracted services by family doctors, reform the payment method of DRGs for hospitalization, and pay for long-term hospitalization services such as medical rehabilitation, mental illness, and chronic diseases on a bed-day basis. Strengthen the research, comparison, and analysis of designated medical institutions, formulate a reasonable quota verification mechanism, improve settlement management, and formulate a more scientific and reasonable overspending sharing mechanism.
(5) Vigorously promote the refined management of medical insurance in designated medical institutions. By the principle of “based on the medical insurance sector, focusing on medical institutions, and serving the insured personnel”, the concept of fine management is reflected in the whole process of medical insurance work, and the “Yuhuan Medical Insurance Payment Digital Platform” is iteratively upgraded, and takes the lead in planning the Taizhou City Medical Insurance Fine Management Platform Work, and participate in the national project on the refined management of medical insurance in medical institutions.
(6) Implement the medical security treatment list system. Comprehensively sort out the system policies and measures that do not conform to the list, and complete the clean-up of policies outside the list of medical security.
(7) Continue to do a good job in the reform of centralized procurement of medical insurance drug consumables. Do a good job in the guidance, supervision, and evaluation of the procurement of drugs and consumables by designated medical institutions in the city, and steadily implement the policy of dynamic adjustment of medical service prices.
(8) Severely crackdown on fraudulent insurance fraud. Continue to cooperate with public security, health, and other departments to jointly deploy and carry out special rectification actions to crack down on fraud and insurance fraud per the law, and extend the time to the end of December 2022 to crack down on various illegal acts of malicious fraud and defrauding medical security funds, and create a situation of strict control and high pressure. Strengthen the publicity of the rule of law in medical insurance, carry out various publicity modes such as online and offline, continue to guide and strengthen the legal awareness of medical institutions and insured persons, and further form a good environment for “don’t dare to cheat, don’t want to cheat, and can’t cheat”.
(9) Continue to deepen the reform of “run at most once”. Improve the service function of the medical insurance handling hall, and open a love window to facilitate special groups. Consolidate and improve the ” 30 -minute medical insurance service circle”, and guide “online and handheld applications”.
(10) Continue to promote the promotion and application of medical insurance electronic certificates. Urge the two designated institutions to carry out the settlement of medical insurance electronic vouchers, and comprehensively promote the activation and application of medical insurance electronic vouchers to facilitate the masses to seek medical treatment.
(11) Optimize medical insurance handling services. Unify the handling service process, improve the handling service level, establish systems such as “service star selection” and “mobile medical insurance manager”, strengthen staff business training, and gradually realize the integration of window business handling.
