China News Service, September 4. The State Council Information Office held a press conference on September 4 on promoting the high-quality development of medical insurance and better serving the Chinese-style modernization drive.
At the meeting, Shi Zihai, deputy director of the National Medical Insurance Administration, introduced that during the "14th Five-Year Plan" period, my country's medical insurance industry has made positive progress. First, it has wide coverage. my country has built the world's largest basic medical insurance network, with the insurance participation rate stable at 95%; second, it has good protection, with 3,253 types of drugs included in the basic medical insurance drug catalog, new technologies and new projects included in the scope of reimbursement, and the reimbursement ratios within the scope of the employee and resident medical insurance hospitalization expense policies have reached about 80% and 70% respectively; The third is high efficiency. The reform of payment methods and centralized bulk purchasing have been fully implemented. All coordinated regions across the country have carried out instant settlement of medical insurance funds and designated medical institutions, and the direct settlement rate for cross-provincial medical treatment has reached 90%. Fourthly, the fund is stable. The operation and management of the fund have been continuously strengthened. The operation of the medical insurance fund is safe and sound, effectively guaranteeing the reimbursement of people for medical treatment and drug purchase.
Shi Zihai said that the "15th Five-Year Plan" period is a critical period for basically realizing socialist modernization and laying a solid foundation for all-round efforts. It is also a critical stage for improving the multi-level medical security system. The National Medical Insurance Administration thoroughly implements the spirit of the 20th National Congress of the Communist Party of China and the 20th Plenary Session. Based on the current development status, facing the new situation of changes in population structure and disease spectrum, rapid innovation in the supply side of medical services, and upgrading of people's health needs, it scientifically plans the development ideas of the medical insurance field and mainly promotes the reform and development of medical insurance from four aspects.
The first is to pay more attention to strengthening the system and making up for shortcomings. We will continue to lay a solid foundation for universal medical insurance, steadily improve the quality of insurance, build and make good use of the "one person, one level" universal insurance database, continue to optimize the structure of universal insurance, and expand the scale of employee medical insurance for key groups such as flexible employees, migrant workers, and people with new employment forms. Optimize the multi-level medical security system, improve the level of critical illness insurance and medical assistance, and support the complementary, complementary and misaligned development of commercial medical insurance and basic medical insurance. Continue to improve the level of maternity medical security and realize direct settlement of maternity medical expenses for insured persons and direct payment of maternity allowances to individuals. Comprehensively establish a long-term care insurance system, improve long-term care insurance service policies, and promote the improvement of long-term care insurance service capabilities and levels.
The second is to pay more attention to promoting reform and promoting coordination. We will deepen the reform of payment methods, implement more efficient medical insurance payments, and improve supporting mechanisms such as special case consultation, data working groups, advance payment, opinion collection, and negotiation to help medical institutions improve quality and efficiency. Deepen the governance of pharmaceutical prices, standardize, institutionalize and normalize the centralized and bulk purchase of pharmaceutical consumables, and comprehensively promote the application of drug price comparison mini programs in designated pharmacies. Standardize the management of medical insurance catalogs, increase support for innovative drugs and services, and promote Chinese medicine to go global. Promote the coordinated development and governance of medical care, medical insurance, and medicine, promote the balanced distribution of high-quality medical resources, support the construction of strong medical and health infrastructure projects, and promote hierarchical diagnosis and treatment.
The third is to pay more attention to refined management and excellent service. Implement refined management orientation, strengthen full-process fund management, and strengthen revenue and expenditure monitoring and early warning. We will continue to strengthen fund supervision, carry out unannounced fund inspections, daily verifications and intelligent supervision on a regular basis, severely crack down on fraud and insurance fraud, and ensure the safety of medical insurance funds. Improve handling service management, comprehensively expand the scope of instant settlement, and promote direct settlement with pharmaceutical companies and simultaneous settlement with commercial insurance. Deepen the goal of "getting one thing done efficiently" in the field of medical insurance and realize that high-frequency matters can be "handled in other places but nearby". Comprehensively deepen the application of facial recognition payment, one-code payment, mobile payment, and credit payment, realize the joint use of personal medical insurance accounts of employees, promote the convenience and diversification of the supply of medical insurance public services, and optimize the public medical insurance service experience.
The fourth is to pay more attention to laying foundation and strong support. Strengthen the construction of the rule of law, improve the medical insurance legal system, and promote the implementation of the "Medical Security Law". Continue to carry out medical insurance standardization construction, build and strengthen the medical insurance information system, expand innovative scenario applications, steadily promote the construction of personal medical insurance cloud, imaging cloud, and pathology cloud, and open more medical insurance intelligent services to insured persons in accordance with regulations.
