"Suzhou City, the development of medical security undertakings "14th Five-Year Plan" is a key special plan of the Suzhou Municipal Government, compiled by the Bureau of Medical Security in charge of the preparation of the municipal government's 149th executive meeting was considered and passed on September 30, 2021 was issued and implemented. The planning period is 2021-2025, mainly to clarify the "14th Five-Year" period of the city's health care development of the overall thinking, development goals, major tasks and major policy measures.
First, the idea of planning
"14th Five-Year" period is the first five years since the establishment of the health insurance sector, is the transformation and upgrading of the health insurance business, the reform and development, maturity and stereotypes of the critical period.
The goal of planning is to meet the spirit of national reform, the actual development of Suzhou, and the expectations of the masses, and to make a good start for the development of Suzhou's medical insurance business.
The main idea of the preparation of the plan is: in the "13th Five-Year Plan" has been the initial construction of a multi-level medical insurance system based on the opportunity to seize the development of the medical insurance cause, and actively respond to the fund to increase pressure on the increase in expenditure is expected to rise and other challenges to identify the development of positioning, clear development goals, major tasks and major policy measures.
The main content of the plan
The content of the plan a *** four chapters, 15 sections, about 20,000 words.
The first part: the basis for the development and situation
From the medical insurance system, multi-level medical insurance system, municipal integration, health insurance payment reform, medical service price reform, drug and consumable supply management, health insurance fund supervision, health insurance information technology level, health insurance public **** services and health insurance organization reform 10 areas Summarizes the achievements of Suzhou's medical insurance development in the "13th Five-Year Plan" period and the development foundation of the "14th Five-Year Plan" period. It also analyzes the external environment and internal situation of the development of the medical insurance business in Suzhou from five aspects: increasing uncertainties in economic growth, the deep development of population aging, the continuous growth of medical costs, the in-depth advancement of the medical insurance reform, and the reform of the institutions not yet in place, and points out the main problems and the situation facing the development of the medical insurance business.
The second part: the guiding ideology, basic principles and development goals
The planning of the clear "14th Five-Year" period of the guiding ideology of the development of health care is: around the implementation of the "Central *** State Council on deepening the reform of the health care system," and the provincial party committee and provincial government "the reform of the health care system," and the provincial party committee and provincial government "the reform of the health care system. and the Provincial Party Committee and Provincial Government's "Implementation Opinions", with fine management as the grip, standardization, normative, digital construction as the support, the full implementation of the requirements of high-quality development of medical insurance, and further improve the coverage of the whole population, the rights and responsibilities of the clear, the protection of the appropriate, sustainable multi-level medical insurance system, to build the most beautiful window for the modernization of socialism in Suzhou. "Writing a chapter of medical insurance. At the same time, the plan identifies four basic principles and 16 major development indicators.
The four basic principles identified in the plan are: adhere to the overall leadership of the party, adhere to the people's health as the center, adhere to the best efforts, according to their means, adhere to the municipal coordination, regional integration.
Major Indicators and Expected Targets
Part III: Key Development Tasks
In order to implement the major development targets of the "14th Five-Year Plan," the plan specifies that In order to implement the "14th Five-Year Plan" main development goals, the plan specifies the specific work initiatives and tasks of the medical insurance business in Suzhou during the "14th Five-Year Plan" period. *** Set 9 key development tasks, 13 key projects.
Key development tasks
Improve the treatment guarantee mechanism. The plan is clear that by the end of 2022, the full realization of the basic medical insurance municipal integration, and continue to promote the standardization and unification of medical insurance treatment, fairness and moderation. The implementation of the basic medical insurance outpatient ****ji protection mechanism, enhance the outpatient ****ji protection function, improve the medical insurance and assistance system for serious illnesses, and steadily promote the pilot work of long-term care insurance.
Improve the financing mechanism of insurance. The plan puts forward, according to the relevant national reform ideas, the establishment of the city's socio-economic development level with the affordability of the parties to match, and basic health needs in coordination with the financing mechanism, and appropriately reduce the proportion of unit contributions. The residents of the medical insurance in a steady increase in the standard of government subsidies at the same time, a moderate increase in the weight of individual contributions, financial subsidies and individual contributions to the ratio of about 2:1.
Continuously promote the reform of medical services. The plan proposes to implement a more efficient health insurance payment method, improve the total budget method of the health insurance fund, and focus on promoting the reform of payment according to the diagnosis-related grouping of diseases (DRG), and by the end of the "14th Five-Year Plan", the proportion of hospitalized co-ordinated fund costs paid according to the DRG to the total hospitalized co-ordinated fund costs will reach 70%, so as to improve the efficiency of the use of the health insurance fund. The utilization efficiency of the medical insurance fund will be improved.
Improve the supervision mechanism of medical insurance fund. The plan makes it clear that during the "14th Five-Year Plan" period, the long-term system of fund supervision will be further improved and standardized, and on-site inspections, remote monitoring, intelligent audits, expert reviews, big data screening and other supervisory means will be comprehensively applied, as well as agreement, administrative, judicial and other disciplinary means to combat fraudulent insurance behavior in accordance with the law. The company is also working to improve the credit evaluation mechanism of medical insurance.
Promote the digital transformation of medical insurance with all efforts. The company is also promoting the construction and online operation of the national health insurance information platform, strengthening the support of information technology for the reform of key areas of health insurance, and enhancing the digital and intelligent level of health insurance.
Synergizing the supply-side reform of medical services. The company has also launched a pilot project to reform the price of medical services and optimize the price structure of medical services.
Explore the establishment of medical security classification evaluation system. The plan proposes that during the "14th Five-Year Plan" period, we should explore the establishment of a medical security sector evaluation system, carry out classification evaluation of policy measures, administrative services and medical services, and promote the rational application of evaluation results, so as to promote the continuous improvement of policy measures, the continuous improvement of administrative services, and the rational standardization of medical services.
Continuously optimize the medical insurance public **** management services. Vigorously promote the standardization, standardization, information technology, integration as the core of the medical insurance public **** service "four" construction, continue to optimize the direct settlement of foreign medical treatment, promote the "15-minute medical insurance service circle" construction, improve the people's experience and satisfaction with the medical insurance public **** service. *The company's website has been updated and is now available for download.
Support the development of Suzhou's biomedical industry. We will make full use of and bring into play the advantages of regional medical resources, continue to optimize the business environment, promote the promotion and application of innovative products, guide the empowerment of the commercial insurance industry, assist the high-quality development of the biomedical industry, and create a new landmark for the biomedical industry with Suzhou characteristics.
Key Projects
Part IV: Safeguards
The safeguards for the implementation of the plan are clearly defined in five aspects: organizational leadership, rule of law safeguards, team building, financial safeguards, and publicity and guidance.