Main Duties
Developing draft laws and regulations, policies, planning and standards for medical insurance, maternity insurance, medical aid and other medical security systems, formulating departmental regulations and organizing their implementation.
Organizing the formulation and implementation of supervision and management measures for the medical insurance fund, establishing and improving the safety prevention and control mechanism of the medical insurance fund, and promoting the reform of the payment method of the medical insurance fund.
Organizing the formulation of policies on medical insurance financing and treatment, improving the dynamic adjustment and regional transfer and balance mechanism, integrating urban and rural medical insurance treatment standards, and establishing and improving the treatment adjustment mechanism in line with the financing level. It organizes the formulation and implementation of reform plans for the long-term care insurance system.
Organizing the formulation of unified urban and rural medical insurance catalogs and payment standards for medicines, medical consumables, medical service items and medical service facilities, establishing a dynamic adjustment mechanism, and formulating rules for negotiating access to medical insurance catalogs and organizing their implementation.
Organizing the formulation of policies on the prices of medicines, medical consumables and charges for medical service items and medical service facilities, establishing a mechanism for reasonably determining and dynamically adjusting the prices of medical services paid for by the medical insurance, promoting the establishment of a market-led mechanism for the formation of the prices of social medical services, and setting up a system for the monitoring of price information and the release of information.
Developing bidding and procurement policies for drugs and medical consumables and supervising their implementation, and guiding the construction of bidding and procurement platforms for drugs and medical consumables.
Developing and organizing the implementation of agreement and payment management methods for designated medical institutions, establishing and improving the medical insurance credit evaluation system and information disclosure system, supervising and managing medical service behaviors and medical expenses included in the scope of medical insurance, and investigating and dealing with violations of laws and regulations in the field of medical insurance in accordance with the law.
Responsible for medical insurance management, public **** service system and information construction. It organizes the formulation and improvement of policies on the management of medical care in other places and the settlement of expenses. It establishes and improves the system of transferring and continuing medical insurance relations. Carrying out international cooperation and exchanges in the field of medical insurance.
Completing other tasks assigned by the Party Central Committee and the State Council.
Functional transformation. The State Medical Security Bureau shall improve the unified basic medical insurance system for urban and rural residents and the major disease insurance system, establish and improve a comprehensive multi-level medical security system covering all people in urban and rural areas, continuously improve the level of medical security, ensure that the medical insurance funds are reasonably utilized in a safe and controllable manner, and push forward the reform of the "three-medicine linkage" among medical care, medical insurance and medicine, so as to better safeguard the people's medical needs and reduce the costs of medical care. The people's demand for medical care and reduce the burden of medical costs.
Division of responsibilities with the National Health Commission. The National Health Commission, the National Health Security Bureau and other departments have strengthened the convergence of systems and policies in the areas of medical care, medical insurance and medicine, established a mechanism for communication and consultation, and collaborated to promote reforms and improve the efficiency of medical resource utilization and the level of medical security.
Medical insurance, like other types of insurance, collects medical insurance premiums in advance from people threatened by illness, establishes a medical insurance fund, and provides some financial compensation from medical insurance organizations when the insured falls ill and incurs medical expenses by visiting a medical institution.
Medical expenses that are in line with the basic medical insurance drug list, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, are paid out of the basic medical insurance fund in accordance with national regulations.
Drugs reimbursement is included in the scope of basic medical insurance benefits, which are divided into two categories: Class A and Class B drugs. Class A drugs are those that are basically uniform throughout the country and can ensure the basic needs of clinical treatment. The cost of these drugs is included in the scope of payment of the basic medical insurance fund, and the cost is paid according to the standard of payment of the basic medical insurance.
The catalog of Class B drugs is adjusted by provinces, autonomous regions and municipalities directly under the central government according to their own situation. These drugs are first paid for by employees at a certain percentage, and then included in the scope of the basic medical insurance fund and paid for according to the standard of payment of the basic medical insurance.
The reimbursement of basic medical insurance medical service facilities covers the living service facilities provided by the designated medical institutions, which are necessary for the participants in the process of receiving diagnosis, treatment and care, including hospitalization beds or outpatient (emergency) observation beds.