Authoritative release

654381On the morning of October 25th, the Information Office of the Municipal Government organized a series of news conferences on the theme of Jining Huimin Project (the eighth session) to interpret the new policy of improving medical security benefits in our city and answer questions from reporters.

Publisher

Sun Ying, Director of Medical Security Bureau

Member of the Party Group and Deputy Director of Wang Yong Medical Security Bureau

Ji Zhiqiang, chief of the treatment and protection section of the medical insurance bureau.

host

Chief, Press Release and Foreign Exchange Section, Propaganda Department of Huang Guangcan Municipal Committee

Medical security is an important part of people's livelihood security. People's expectation and social concern are related to the happiness and well-being of thousands of families and the harmony and stability of society. This is a major livelihood project and popular support project. The Municipal Party Committee and the Municipal Government always adhere to the development concept of taking people's health as the center, attach great importance to medical security work, and regard improving the medical security level of the insured as one of the practical things for the people in 2022. In August, the municipal government studied and issued the Notice on Further Improving the Level of Medical Security (Zi [2022] No.35), and the Municipal Medical Insurance Bureau, the Municipal Finance Bureau and the Municipal Health and Health Commission jointly issued the Notice on Further Improving the Medical Insurance Treatment of Residents for Private Practical Work (Ji Medical Insurance [2022]17), further reducing the burden on these two documents.

The necessity of improving medical security benefits

Jining began to implement medical insurance for employees in 200 1, and the new rural cooperative medical system and urban residents' medical insurance were merged into basic medical insurance for residents in 2006 54 38+04. All along, the Municipal Party Committee and the Municipal Government have attached great importance to people's livelihood, continuously increased financial input, and established a multi-level medical security system based on basic medical security, supplemented by serious illness insurance, large medical subsidies, civil servants' medical subsidies, and enterprise supplementary medical insurance, constantly improving the level of medical insurance benefits, promoting centralized recruitment of medical materials, strengthening the supervision of medical insurance funds, improving the service level of medical insurance handling, and realizing instant settlement of medical treatment in different places across the country, effectively solving the problem of "people running errands". September 1 20265438 The municipal government issued the Notice on Implementing the Reform Opinions of the Medical Security System and Further Improving the Medical Security Policy System (No.202 1 46). On April 27th, 2022, Jining Municipal Party Committee and Jining Municipal People's Government issued the Notice on Deepening the Reform of Medical Security System. It is required to further deepen the reform of the medical security system, improve the fair and moderate medical security treatment mechanism, improve the basic medical insurance system, steadily improve the treatment level of employees and residents' serious illness insurance, focus on improving the ability to support serious and serious diseases, strengthen the triple guarantee functions of basic medical insurance, serious illness insurance and medical assistance, and promote the high-quality development of medical security. However, with the continuous development of economy and society and the continuous improvement of medical level, the medical needs of insured people are getting higher and higher. Steadily improving medical insurance benefits can effectively reduce the personal burden of the insured and enhance their sense of acquisition.

The main contents of improving the benefit of medical security

In order to further reduce the burden of personal medical treatment, on the basis of extensive research and fund calculation, the medical insurance treatment standard has been improved from the following four aspects.

(1) Increase the maximum payment limit of employee medical insurance. The maximum payment limit of employees' medical insurance was raised from 6,543,800+0.25 million yuan to 6,543,800+0.45 million yuan, among which the maximum payment limit of basic medical insurance was raised from 6,543,800+0.5 million yuan, and the subsidy for large medical expenses for employees was raised from 350,000 yuan to 500,000 yuan.

(two) to improve the proportion of residents' medical insurance hospitalization reimbursement. The proportion of medical expenses incurred by insured residents in primary, secondary and tertiary medical institutions increased by 5% respectively, from 80%, 70% and 55% to 85%, 75% and 60% respectively.

(three) to reduce the residents' medical insurance hospitalization Qifubiaozhun. Insured residents are hospitalized in primary, secondary and tertiary medical institutions, and the minimum payment standard of basic medical insurance fund is reduced from 200 yuan, 500 yuan, 1000 yuan to1000 yuan, 400 yuan and 800 yuan respectively.

(four) to reduce the proportion of residents' medical insurance payment for class B drugs. Residents' basic medical insurance implements the unified national and provincial medical insurance drug list, and the out-of-pocket proportion of Class B drugs in the drug list is reduced by 10%, which is consistent with the out-of-pocket proportion of Class B drugs in employee medical insurance.

Medical insurance fund investment

After the policy adjustment, it is estimated that the medical insurance fund will increase its annual expenditure by more than 600 million yuan, which will effectively reduce the personal burden of the insured for medical treatment. Among them, the insured employees reduced their personal burdens by about 654.38 billion yuan, and the insured residents reduced their personal burdens by more than 500 million yuan.

Next work plan

Accelerate the system construction and build a sustainable medical security mechanism. The first is to improve the medical insurance system. We will fully implement the medical insurance treatment list system, establish and improve the four systems of medical insurance treatment guarantee, medical service, fund supervision and handling services, and achieve breakthroughs in insurance payment, treatment service and fund supervision. The second is to speed up the system construction, further analyze and judge the fund operation in Jining City, and improve the medical security treatment system. The third is to build a stable and sustainable financing operation mechanism, unify the basic rate of medical insurance payment, clarify the base of insurance payment, strengthen the performance management of fund budget, tighten the expenditure plate of medical insurance fund, make good use of every penny of medical insurance fund, and effectively protect the people's medical insurance treatment.

Strengthen supervision and management to ensure the safe operation of the fund. Improve the law enforcement mechanism of medical insurance supervision and management, and improve the efficiency of fund use. Fully implement the supervision and inspection of "double randomness and one openness" and improve the linkage mechanism to combat fraud and insurance fraud. We will promote the construction of the supervision credit system of medical insurance funds, and establish a credit evaluation index system for the supervision of designated medical institutions, pharmaceutical enterprises, medical insurance doctors Yamatonokusushi and insured persons. We will fully implement intelligent monitoring systems such as medical insurance fund revenue and expenditure, purchase and sale of medical consumables, medical service behavior, prescription circulation, and medical insurance fund settlement in designated medical institutions, and realize the whole chain supervision of pre-warning, in-process warning, and post-audit to ensure the healthy and stable operation of the medical security system.

Strengthen convenience and improve the level of medical insurance services. Strengthen the construction of standardized service window for medical insurance handling, and unify the service items and handling processes of medical insurance handling in the city. High-frequency services such as the registration of basic medical insurance for urban and rural residents, the transfer of basic medical insurance relations, and the self-service filing of medical treatment in different places "cross-city". Fully realize the nationwide online settlement of general outpatient clinics; All outpatient chronic diseases were settled online in the province, including malignant tumor, dialysis treatment, organ transplantation, hypertension and diabetes. The personal account of employee medical insurance is fully covered by the designated medical institutions of "one card (code) communication" in the province; Application of electronic medical insurance voucher in the whole process of medical treatment, medical treatment and payment. We will continue to accelerate the construction of Internet medical insurance, promote the integrated development of medical insurance, medical care and medical services online and offline, and effectively improve the convenience and satisfaction of people seeking medical treatment and purchasing medicines.

Strengthen policy propaganda to ensure that policies are effective. Improving the level of medical insurance is a practical and beneficial thing, which highlights the theme of safeguarding people's livelihood. In conjunction with relevant departments, we will further intensify propaganda, concentrate on policy propaganda, give full play to the advantages of newspapers, networks and various media through various channels, carefully plan and innovate forms, and conduct comprehensive and systematic propaganda on medical insurance policies so that people can see and understand them clearly, improve the quality of propaganda, and let more people know, enjoy and benefit early.

What are the convenient measures for Jining insured people to seek medical treatment in different places?

Member of the Party Group and Deputy Director of the Municipal Medical Security Bureau

Since the beginning of this year, in accordance with the requirements of decentralization, strengthening supervision and improving services, the municipal government and the municipal medical insurance department have introduced a series of measures to facilitate medical treatment in different places, mainly in the following aspects:

The first is to completely cancel the referral and transfer procedures. Since June 65438+ 10/day, 2022, the procedures for filing medical treatment in different places have been simplified, the referral has been completely cancelled, the commitment filing system has been implemented, and the self-service filing service of "free of materials, free of audit and instant enjoyment" has been implemented. Insured personnel can be handled anytime and anywhere through the "Jining Medical Insurance" applet, which takes effect immediately. Moreover, temporary medical treatment in the province does not need to be filed, and it is directly settled online.

Second, direct online settlement of hospitalization in different places. Jining city is the insured place, and the insured person can go to the designated hospitals with online settlement function in the country, which can realize direct online settlement; As a medical place, 329 designated hospitals in Jining City have all opened cross-city and inter-provincial online settlement services for hospitalization. Insured persons from all over the country can directly come to Jining for medical treatment with valid certificates such as medical insurance electronic card or social security card.

The third is the inter-provincial settlement of chronic diseases. In terms of inter-provincial network settlement of outpatient chronic diseases, Jining City has realized the two-way opening of the insured place and the medical place, and initiated inter-provincial network settlement of medical expenses for five outpatient chronic diseases such as hypertension, diabetes, malignant tumor, dialysis and organ transplantation. Up to now, the city has opened 22 designated hospitals for inter-provincial chronic disease clinics, covering all counties and cities.

The fourth is the online settlement of medical treatment in different places in general outpatient department. All qualified designated hospitals in the city have opened online settlement of general outpatient services between cities and provinces, with 340 hospitals. Online settlement can be realized when the insured from other places go to Jining outpatient clinic for medical treatment; Insured persons in Jining can also go to the general outpatient department of designated hospitals outside the city for medical treatment, and the treatment standard is consistent with local medical treatment.

We often see medical insurance departments and pharmacies promoting medical insurance electronic certificate. Can you introduce the role of medical insurance electronic certificate?

Ji Zhiqiang

Chief, Treatment and Security Section, Municipal Medical Security Bureau

The electronic certificate of medical insurance is issued by the national medical insurance information platform. It forms electronic identification through real name/face authentication technology, which has important characteristics such as safety, reliability and unique authentication, and can also avoid the loss of medical insurance card.

First, the medical insurance electronic certificate function

The electronic certificate of medical insurance has rich functions and plays a very important role. You can provide medical insurance services such as pharmacy purchase, medical settlement and medical insurance business handling without a physical card.

When purchasing medicine at a designated retail pharmacy, you can show the QR code of medical insurance electronic certificate to the pharmacy and settle it directly. Don't worry about forgetting to bring your physical card.

When you see a doctor in a designated medical institution, you can register, pay medical expenses, register in hospital and settle accounts when you show the two-dimensional code of medical insurance electronic certificate to the hospital, which greatly shortens the waiting time for medical settlement. Show medical insurance electronic certificate for identity verification in the window or self-service machine of medical institutions above the second level, and realize the whole process of medical services such as appointment registration, diagnosis and treatment, outpatient settlement, medical insurance settlement, self-service machine settlement, pharmacy taking medicine, report inquiry, etc.

When handling medical insurance business, the electronic certificate of medical insurance can be used as identity authentication to query personal medical insurance account information, medical insurance payment records, consumption details and other businesses.

Two, the application of medical insurance electronic certificate

At present, the activation of medical insurance electronic certificate is very convenient and fast. Insured people can activate and use medical insurance electronic certificate through WeChat, Jining medical insurance applet in Alipay and national medical insurance service platform APP. You can also bind family account with his family.