Summary of the work of the Medical Insurance Bureau in the first half of the year and the work plan for the second half of the year
I. Progress of the main work
(a) Progress of the expansion of the three types of insurance
(b) Income and expenditures of the three types of insurance funds
II.
(a) actively promote the expansion
In order to grasp the expansion of the work, at the beginning of the year we formulated a work plan for the expansion of the expansion of the task of the layered decomposition, the implementation of the plan, in accordance with the plan, classified to do a good job of difficult business retirees, flexible employment, normal production enterprises and private, private enterprises, expansion of work. The work to do half of the time and half of the task.
2, strengthen the publicity and service, do a good job of flexible employment personnel to participate in the insurance, insurance renewal work. In order to do a good job of flexible employment personnel to participate in insurance, renewal of insurance work, we are to strengthen publicity, through newspapers, television, radio and other media to widely publicize the policy, many times issued notices, through the city laid-off re-employment service center, street offices, community service stations and other service windows posted, issued leaflets, the policy to the hands of the flexible employment personnel; the second is to carry out convenient service, internal optimization of the operation process, provide one-stop service Secondly, we carry out convenient services, optimize the operation process internally, provide one-stop service, open additional windows for insurance procedures, and operate bi-directionally with the bank network externally, so as to reduce the time of the flexibly employed. At present, the city's flexible employment has reached 31,000 people insured.
3, do a good job of unit insurance work. One is to do a good job of not yet insured normal production and operation of enterprises and financial units of the expansion of insurance work, the first half of the Agricultural Bank of 82 units such as 2,718 people participated in the medical insurance. The second is to increase the expansion of private, private enterprises, through the Social Insurance Bureau, the Fund Clearing House and other relevant units to keep abreast of the new social insurance registration of private, private enterprises, door-to-door publicity policy, patience to do the work, in the first half of the year has been the birth of Mao Special Steel and other 47 enterprises, 988 employees included in the scope of the medical insurance co-ordination.
(2) Improve medical management
1, improve the agreement management. Agreement management is the basis of medical management, at the beginning of each year we have to modify and improve the health insurance service agreement based on the implementation of the previous year's agreement. This year, we mainly do three aspects of the perfect: First, the medical violation of a clear definition, and accordingly refine the penalty provisions; Second, the agreement on the actual cost of medical care to do a detailed measurement, adjusted some of the unreasonable agreement on the settlement of the base; Third, according to the fund's ability to bear the reality of the development of medical technology, the appropriate addition of a number of new medical technology into the integrated medical insurance fund settlement The third is that according to the fund's affordability and the actual development of medical technology, some new medical technology has been added to the settlement of the medical insurance fund.
2, do a good job of "two" organizations annual assessment. In the first half of the year, we will work with health, drug supervision, pricing and other relevant departments, the city's designated medical institutions and designated pharmacies in 2006 the implementation of the health insurance policy provisions of the assessment, the overall view of the "two" institutions of the health insurance policy provisions of the further understanding of the implementation of the situation is good. However, there are a few units do not have a deep understanding of the implementation of laxity, and even in order to make profits deliberately illegal operation, these units have made a deadline for rectification of the treatment.
3, improve the fund analysis, targeted to strengthen supervision. In the first half of this year, we used for the first time in the form of chart analysis of 1-4 months of the medical insurance fund to carry out a detailed analysis of the operation of the situation, through the analysis of the agreement we have identified the proportion of diseases accounted for by the rapid growth of the operation of the fund of the key issues and their reasons for us to target
Sexually take measures to strengthen the supervision provides the basis.
(C) strengthen the prevention of work-related injuries
In the practice of work-related injuries insurance, we have gradually realized that the past work-related injuries and compensation for work-related injuries insurance mode of operation, can not adapt to the situation of the requirements of the development of work-related injuries insurance mode should be gradually to the prevention of work-related injuries and treatment and compensation for the transition of the mode of equal importance. To this end, in the first half of the year, we have increased efforts to prevent work-related injuries. First, we strengthened publicity. We opened columns in newspapers and radio stations to regularly publicize the knowledge of work injury insurance and work injury prevention; on the occasion of the third anniversary of the promulgation of the Work Injury Insurance Ordinance and during the safety production publicity month, we organized two voluntary consultation activities on the streets, made 14 publicity boards and distributed more than 5,000 copies of publicity materials. Second, the implementation of floating rates. In the first half of the year, we measured the payment rate of the Work Injury Insurance Fund and the incidence rate of work-related accidents (occupational diseases) of the insured units in the previous year, and prepared to start floating the contribution rate of each insured unit in the second half of the year accordingly, which is better than the downward floating rate, and worse than the upward adjustment, so as to motivate the insured units to strengthen the prevention of work-related injuries and reduce the number of work-related accidents. Third, the development of incentives. In the first half of the year, we drafted the "safe production and work injury prevention incentives", according to the insured unit of the workers' compensation insurance fund payment rate and the incidence of work accidents, those who do a good job of production safety units and related individuals to be rewarded, to be formally introduced in the second half of the year to implement.
(4) Increase publicity
To popularize the general knowledge of medical insurance, and to promote the correct implementation of medical insurance policies and regulations, we continue to increase publicity. First, the expansion of the East Chu Evening News on the opening of the health insurance column page, increased the column settings, in a more flexible way to the insured to promote health insurance policy; second is to cooperate with the Yan'an Road community in the community to set up health insurance bulletin boards, the community health insurance publicity pilot; third is the timely through the major media to the insured to publicize the new policy, the latest trends in health care insurance; fourth is to go into the designated health care institutions to the front-line medical staff to explain the new year's medical staff. The first is to explain the new year's medical, workers' compensation insurance service agreement and health insurance policy; the fifth is to edit and print the "Huangshi urban workers' health insurance document compilation", to facilitate the insured units and insured persons to fully understand the city's health insurance policy.
(E) to strengthen theoretical and business learning
In the first half of the year, the Bureau in accordance with the spirit of the higher party organizations and the unified deployment of the organization to seriously organize the study and implementation of the party's constitution and "a law and a regulation" activities, to strengthen the theoretical and business learning, and has achieved certain results. First, in-depth study and implementation of the party constitution, the study and implementation of the party constitution and maintain the party's advanced construction, and medical insurance and the actual work of the combination; Second, the study and application of Deng Xiaoping Theory, study and practice of the "Three Represents" important thought, study and implementation of the scientific concept of development; Third, the study of the sixteenth party congress and the sixteenth session of the third, fourth and fifth plenary sessions of the spirit; fourth, the study of the sixteenth party congress and the sixteenth session of the third, fourth and fifth plenary sessions, Fifth Plenary Session of the 16th CPC Central Committee; four is to learn the "Chinese People's *** and State Security Administration Punishment Law" and "Hubei Province, the Regulations on Letters and Visits"; five is to learn the business knowledge of medical insurance, medical insurance policy and theoretical knowledge, learning microcomputer application knowledge. Through the study, our staff firmly *** production broad ideal faith, strengthened the purpose of serving the people's consciousness, improve the theoretical and operational level of medical insurance, and promote the overall progress of the work.
Third, there are major problems
(a) the agreement on the cost of disease accounts for the proportion of the total cost of expenditure has grown too fast, resulting in a faster rise in per capita integrated payment
(b) the phenomenon of flexible employment personnel out of insurance is more serious
31,000 insured flexible employment in the city, there are currently nearly 3 Of the 31,000 flexible employees in our city, there are nearly 3,000 who have not renewed their insurance premiums due to breakage, and nearly 1,000 who have not yet renewed their insurance premiums even though they have reached the premium payment period. It is understood that this part of the personnel to break the insurance . There are two main reasons, one is due to go out to work, work is busy, the thought does not pay attention to the health status is still good and other reasons to forget to renew the insurance premiums on time; two is because of the economic difficulties, a year of 1,034 yuan of health care costs are difficult to bear, have the intention to renew the insurance, can not afford to pay the premiums.
Fourth, the second half of the work intends
(a) serious investigation, properly solve the problem of difficult enterprise retiree medical insurance
In order to conscientiously implement the province, the city on the solution to the difficult enterprise retirees to participate in the spirit of the document of the problem of medical insurance, the proper solution to the problem of difficult enterprise retiree medical insurance according to the municipal arrangement, we will be in July. Municipal government arrangements, in July we will work with the financial, Economic Commission, the State-owned Assets Supervision and other relevant departments of the city's difficult to participate in the basic medical insurance retirees to conduct a mapping survey. After the completion of the survey, will be based on the grasp of the specific circumstances of the study of the city's difficult to develop the participation of retirees, to take a practical approach to the difficult to include retirees in the medical insurance co-ordination.
(B) accelerate the expansion of work injury and maternity insurance
Work injury insurance expansion, one is to grasp the migrant workers to participate in the work injury insurance work; the second is to actively promote the participation of high-risk industries in the work injury insurance; the third is the implementation of the WISCO in the yellow enterprises in the large state-owned enterprises in the participation of the work; the fourth is to do a good job in the management of the enterprise of the participation of the work of the institutions.
Maternity insurance expansion, focusing on non-ferrous and fifteen metallurgical and other large enterprises to participate in maternity insurance; explore flexible employment and other special groups to participate in maternity insurance approach.
(C) innovative management tools to strengthen medical management
First, to accelerate the real-time transmission of medical insurance information in designated medical institutions, and strive to achieve real-time transmission of the main designated medical institutions in the second half of the real-time monitoring; second, to improve the analysis system of the fund's operating conditions, and regularly carry out the analysis of the fund's operating conditions on a monthly basis, at any time to grasp the situation, and targeted management; third, to try to implement The medical insurance information of designated medical institutions will be publicized, and the medical expenses of the same disease type of each designated medical institution will be published in the media
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