(1) Expand coverage and realize the goal of universal health insurance as soon as possible. Main measures: First, comprehensively solve the problems left over from history. On the basis of bringing all retirees from closed and bankrupt state-owned enterprises into the medical insurance for urban workers, we will strive to solve the insurance problems of retirees from other closed and bankrupt enterprises and employees from difficult enterprises on 20 10 as a whole. The second is to promote college students to participate in insurance. All newly insured college students are included in the medical insurance for urban residents, and they have participated in commercial insurance to ensure their basic medical care. The third is to increase the participation of flexible employees and migrant workers, implement the policy of insurance selection, and improve the participation rate. Fourth, the participation rate of the new rural cooperative medical system continued to maintain a high level. At the same time, according to the goal of national health insurance, explore the establishment of a mechanism to guide all kinds of personnel to participate in the insurance for a long time, and reduce the "adverse selection" of participation and disease-free surrender.
(two) to improve and balance the level of medical security benefits, to protect the people's basic medical care. Main measures: First, raise the capping line. In 20 10, the maximum payment limits of urban workers' medical insurance, urban residents' medical insurance and new rural cooperative medical fund in all overall planning areas were raised to more than 6 times of the average annual salary of local workers, the per capita disposable income of farmers and the national per capita net income respectively, and will continue to increase with the economic and social development in the future. The second is to increase the proportion of reimbursement for hospitalization medical expenses. 20 10 the reimbursement rate of hospitalization expenses within the scope of urban residents' medical insurance and the new rural cooperative medical system policy has reached more than 60%, and the reimbursement rate of hospitalization expenses within the scope of employees' medical insurance policy should also be improved. At the same time, consider balancing the treatment levels of employee medical insurance, resident medical insurance and the new rural cooperative medical system, continuously narrowing the gap and promoting social equity. The third is to further reduce the personal burden of patients with serious diseases. On the basis of standardizing the corresponding treatment guidelines and disease treatment service packages, we will gradually explore and solve the problem of excessive personal burden for children with major diseases such as leukemia and congenital heart disease. The fourth is to broaden the scope of protection. In 20 10, the outpatient service of medical insurance for urban residents will be expanded to 60% of the overall planning area, and the outpatient service of the new rural cooperative medical system will reach 50% (strive to reach 60%). Strive to use 2-3 years to promote it all over the country, and gradually solve the burden of medical expenses for common diseases and frequently-occurring diseases of the people. The fifth is to increase medical assistance. On the basis of subsidizing all urban and rural low-income residents and five-guarantee households, we will subsidize the medical expenses that are still unbearable after medical insurance reimbursement. Gradually carry out outpatient assistance and cancel the restrictions on hospitalization assistance. Explore ways to help serious diseases.
(3) Strengthen the management of medical insurance and improve the efficiency of fund use. Main measures: First, starting from 20 10, the social insurance budget, including medical insurance, was compiled to make the fund management more scientific and standardized. In areas with more fund balances, the coverage will be expanded, the treatment level will be improved, and the excess balance will be released within a time limit through the preparation of "deficit budget". Second, improve the level of medical insurance co-ordination, basically achieve municipal co-ordination in 201/kloc-0, and enhance the fund's economic capacity. Provinces with a small number of participants and poor economic ability will gradually explore the realization of provincial overall planning. The third is to strengthen the management of medical services, implement the hierarchical management system of designated medical institutions, and give full play to the supervision and restriction of medical insurance on medical services. The fourth is to improve the payment method, and implement payment by head, payment by disease, and total prepayment. 20 10 will select some diseases with clear clinical pathways to be piloted and gradually popularized in conditional areas.
(four) improve medical insurance services, convenient for the insured. The main measures are as follows: First, direct settlement is implemented to reduce the medical expenses paid by individuals, and efforts are made to solve the problems of "running errands" and "paying in advance" of insured persons. Focus on "one card" and improve the medical insurance information system. In 20 10, 80% of the overall planning areas realized direct settlement of medical expenses between medical insurance institutions and hospitals, and individuals did not advance medical expenses. The second is to focus on resettling retirees in different places and improve the management services of medical treatment settlement in different places. Reduce the frequency of medical treatment in different places by improving the overall planning level; Promote intra-network settlement in the province and realize direct settlement of medical treatment in different places in the province as soon as possible; Explore the establishment of regional cooperation mechanism, and gradually solve the problem of cross-provincial medical settlement of insured persons. The third is to do a good job in the transfer and continuation of the basic medical insurance relationship, so that the procedures are simple, the process is standardized and the data is shared, which is convenient for the insured to continue the basic medical insurance relationship and enjoy the treatment. Fourth, make full use of social resources, explore entrusting qualified commercial insurance institutions to provide medical security services, and maximize the convenience of insured persons.