The first five-year planning in the field of medical insurance in Shandong Province
Hen Bingyu introduced that "Planning" is a comprehensive summary of "13th Five-Year" work, and analyzes the "14th Five-Year" situation, and is issued on the basis of research and comment on suggestions; including basic situations, overall requirements, and improve Improve the multi-level medical security system, optimize the medical security synergistic governance system, build 6 chapters of the medical security management service support system, safeguard measures, is the first five-year plan in the field of medical insurance in Shandong Province. "Plan" proposes that by 2025, Shandong will basically complete the reform tasks of the key areas such as treatment guarantee, funding, medical insurance payment, fund supervision and medical services, medical services, and medical services, the basic medical insurance is 97%. More than five years, the basic medical insurance fund spending is ≤10%, and the proportion of hospitalization costs in accordance with the key rescue objects is stable at around 80%, and the hospitalization cost is packetized by disease diagnosis or paying for the proportion of hospitalization expenses. ≥75%, credit supervision coverage rate reached 100%, the coverage of medical insurance intelligent monitoring system for designated pharmaceutical institutions reached 100%, and the "one card pass" coverage of fixed-point pharmaceutical institutions reached 100%, and the medical insurance government service matters can achieve 100%. %.
By 2035, the Chinese characteristic medical security system system was completed, and the modernization of medical security management system and governance capacity in Shandong Province. Heilly Bingyu said that according to the "Plan" goal, Shandong Medical Insurance Bureau will focus on the construction of the three major systems: First, improve the multi-level medical security system. Comprehensively improve the quality of basic medical insurance, establish basic medical insurance insured monitoring mechanism in 2025, and realize the permanent population should be safe.
Optimize the health care financing mechanism, resident medical insurance maintains financial subsidies, personal payment is stable in 2: 1.
Consolidating the level of coordination, fully realizing the municipal-level harvesting branch by the end of 2021, actively exploring the establishment of provincial overall management mechanisms.
Improve the medical security treatment mechanism, establish a list of medical insurance treatment in 2021, and the long-term nursing insurance for employees is fully covered.
Establishing an outpatient security mechanism, by 2025, the ordinary outpatient reimbursement amount increased by about 50% on the basis of 13 or five, and the proportion of clinic slow disease payment was not less than 65%, and the long-term care insurance for residents achieved full coverage.
Improve the medical assistance system, promote the effectiveness of the poverty of medical insurance and the revitalization of rural revitalization, establish prevention and resolution, due to poor return to poor, poor. The fifth is to encourage the development of commercial health insurance, and promote the integration of "medical insurance + business protection". The second is to optimize the medical care collaborative governance system. Improve the medical insurance payment mechanism, 2021 Basic unified Shandong Medical Insurance "three major directories" Improve the medical price formation mechanism, strengthen drugs, medical supplies price monitoring, deepen drugs, medical consumables centralized quantity procurement system reform, 2025 to achieve 500 varieties of national and provincial tissue quantities procurement drugs, high-value medical consumables 15 or more , Fully implement the medical insurance funds and pharmaceutical companies.
Optimize the medical service supply system, accelerate the construction of a modern medical service system, support high quality imitation drug development and use, promote drug, medical consumables traceability supervision.
Improve the health insurance fund supervision system mechanism, in 2021 "Shandong Medical Security Fund Supervision Management Measures, Built into Shandong Province Unified Medical Structures Medical Insured Intelligent Monitoring System, Medical Insurance Credit Management System.
The third is to build a solid health care management service support system.
Optimize the public service of medical insurance, implement high-frequency service matters, and cross-province, in 2021, the medical insurance card province and cross-provincial "one card pass"; 2022 medical insurance convenience service site covers all villages (community), promoting medical insurance Service is included in grid service management.
Realization of the full coverage of medical security standardization services in 2023.
Promote smart medical insurance, digital medical insurance development, end the construction of the provincial information platform at the end of 2021 and run it online, and the unified medical security information platform in Shandong Province was built at the end of 2022.
Deepen the application of medical insurance electronic voucher, in 2021, the fixed-point pharmacies are fully covered, and in 2022, it is fully covered by fixed-point medical institutions in accordance with the eligible level. In 2025, the activation rate of the Shandong Province is not less than 80%. In addition, continuously promote the construction of the medical security talents and promote the construction of medical affair disciplines.
(Editor: Liu Yingwei, Xing Manhua) Sharing let more people see recommendation reading.