Uniform policy, promote fairness. Improve and perfect the city's unified basic medical insurance policy for employees and urban and rural residents, unify and improve the scope of coverage, financing standards, treatment guarantee, fund supervision, management services and other policies, and strive to crack the fragmentation of the system to promote a more equitable basic medical insurance system.
Fund coordination, risk **** bear. The basic medical insurance fund to implement the municipal collector, establish and improve the city and county fund risk sharing mechanism, reasonable balance of the burden of the fund within the city and county, and improve the fund mutual assistance *** relief and risk-resistant ability.
Improve the mechanism, strengthen management. Balance the interests of all parties, in accordance with the requirements of municipal integration, hierarchical management, the establishment of incentives and constraints mechanism linked to management performance. Clearly define the responsibilities of cities and counties in the collection of insurance, financing and subsidies, total budget management, fund supervision, etc., to achieve accurate and efficient management of the whole process of fund income and expenditure.
Positively and steadily, and advance in an orderly manner. Adhere to the problem-oriented, focus on cracking the problem, from the improvement of the unified system and do a solid fund integration, in accordance with the stock of funds gradually in place, the incremental fund in one step to the principle of fund unity, to ensure that the overall treatment of the participants will not be lowered, to ensure that the health insurance fund is safe and sustainable, and to ensure that the smooth operation of the basic medical insurance system.
Major objectives
Since January 1, 2022, in accordance with the standards of unified system policy, unified fund collection and expenditure, and integrated management and services, the basic medical insurance municipal coordination has been comprehensively implemented, realizing the citywide high-quality medical insurance with equal financing responsibilities and rights, fair treatment enjoyment, and non-discriminatory management services. A fair and unified policy system will be established to enhance basic and bottom-up protection for people in difficulty, further narrow the gap between urban and rural areas, and achieve a high level of uniformity in treatment policies. Establishing a scientific and efficient governance system, rationally dividing management responsibilities between the municipal and county levels, and exploring a new mechanism for the governance of medical insurance at the municipal and county levels under municipal coordination. Strengthen the functions of policy formulation and overall management at the municipal level, and emphasize the functions of fund supervision and specific management at the county level. Establish an efficient and convenient service system, focus on solving the difficulties and blockages in the public health insurance, and promote the standardization, informatization, and convenience of the public health insurance services with high quality.
Major tasks
System policy unification
1. Unification of the scope of participation. The city will implement a unified scope of coverage for employees' and residents' health insurance; active employees participating in employees' health insurance will simultaneously participate in maternity insurance; individual industrial and commercial households with no employees, part-time workers who do not participate in employees' health insurance with their employers, and other flexibly employed workers will be encouraged to participate in employees' health insurance; and the resident population will be included in the scope of coverage based on consolidation of the participation of the household population in the insurance scheme.
2. Unified financing standards. The city's implementation of a unified employee health insurance contribution base, contribution ratio. The total wages of the employees of the employing unit are determined by the sum of the contribution wages of the insured employees of the unit, and the contribution wage base of the employees is determined by their average monthly wages in the previous year. Employee's contribution salary is lower than 60% of the average monthly salary of the employed person in the whole social unit of Zhejiang Province in the previous year, determined in accordance with 60%; higher than 300% of the average monthly salary of the employed person in the whole social unit of Zhejiang Province in the previous year, determined in accordance with 300%. Implementing the city's employer-employee health insurance contribution rate of 7.5%, the individual contribution rate of in-service employees of 2%, and the basic medical insurance contribution rate of 9% for flexibly employed persons. Implementing a unified method and standard for individual account transfer. Implementing unified individual contribution standards for residents' medical insurance and policies for subsidizing the participation of people in difficulty; the individual contribution standards for residents' medical insurance are determined in accordance with the basic medical insurance methods of Jinhua City. The implementation of unified financial subsidy policy for residents' medical insurance, the city will determine three financial subsidy levels according to the level of economic development from 2022, and realize the unified financial subsidy standard for the city in three years' transition. 2022 financial subsidy standard for residents' medical insurance will in principle be determined to be RMB 1,100 yuan per person per year in Yiwu, RMB 980 yuan per person per year in urban areas, Dongyang and Yongkang, and RMB 930 yuan per person per year in Lanxi, Pujiang, Wuyi and Panan, and counties and cities may also determine the subsidy standard according to Jinhua basic medical insurance. 930 yuan per person per year, counties and cities can be based on the level of economic development and fund balance of payments, in the current grade in the higher to determine the standard. For those with residence permits to participate in the insurance, financial subsidies at all levels according to the same standards for local residents.
3. Unification of protection treatment. Strictly implement the medical insurance treatment list system. The implementation of the city's unified outpatient, hospitalization and other treatment coverage and standards, unified transfer of medical treatment, medical treatment. Implement the province's unified basic medical insurance drug catalog and medical service item catalog. Continuously deepen the hierarchical diagnosis and treatment system and the construction of county medical **** body, further improve the differentiated payment policy of medical insurance, give full play to the regulation of medical insurance fund on the structure of diagnosis and treatment and medical expenses inside and outside the county, and guide the hierarchical diagnosis and treatment and the participants to seek medical treatment in a reasonable and orderly manner.
4. Unified payment method. The city's implementation of a unified payment method, to deepen and improve the city's total budget management, inpatient medical costs according to the diagnosis of diseases related to the subgroup payment, improve the bed payment according to the "PDPM points method" payment, outpatient medical costs combined with the contracting of the family doctor, the headcount package combined with the "APG points method "Payment. Actively exploring specific areas, specific groups of people health insurance payment methods.
5. Unified medicine prices and bidding and procurement management. Comprehensively implement the national, provincial and municipal joint centralized procurement policy for drugs and medical consumables, and health and medical insurance departments at all levels should supervise medical institutions to strictly implement it. Implement the unified medical service price and medical insurance payment standard in the city, reasonably refer to the price of public hospitals at the provincial level, and strive to improve the price of medical service items reflecting the value of medical personnel's technology and labor, and comprehensively promote the standardized development of medical institutions and the improvement of service quality. Jinhua City public hospital medical service price reform program by the city health insurance department in conjunction with the city health department to develop separately.
Fund unified collection and expenditure
From January 1, 2022, the basic medical insurance fund to implement the city's unified collection and expenditure, unified collection, unified payment, unified liquidation.
6. Unified fund budget management. Jinhua City, the development of basic medical insurance fund budget management methods. According to the relevant provisions of the social insurance fund budget management and the principle of determining expenditure on the basis of income and expenditure, balancing income and expenditure with a slight surplus, the city will unify the preparation of the fund's budget and final account, strictly regulate the content, standard and scope of the fund's income and expenditure, and strengthen the binding force of the implementation of the budget.
7. Unify the fund revenue and expenditure management. Unify the main body of fund collection, adjust the income level, and unify the rules of income transfer, fund use and payment management. Further improve the collection mechanism and enhance the effectiveness of collection and management. Strengthening interdepartmental data*** sharing and comparison, expanding coverage accurately, and realizing that all should be insured and all basic medical insurance premiums should be paid. Harmonize the transfer and deposit of funds. A comprehensive audit of the pre-coordination fund of each county was conducted, and the rolling gap of the fund formed by the problem of overspending and underreceiving confirmed by the audit and the rolling gap of the fund's revenues and expenditures formed by the pre-coordination of the principle of the accrual system shall be borne by the counties themselves.Starting from January 2022, the cumulative balances of the medical insurance fund of each county shall be implemented as a citywide co-ordination, and, in addition to the imputation fund, they shall be temporarily retained in counties and cities and be used by the municipal level to unify the management and dispatch of the fund and be used mainly to make up for the local It will be used mainly to make up for the shortfall of the local fund in the following years. According to the operation of the city's fund, it will be gradually pooled into the special account of the city's finance. The accumulated balance of the fund temporarily deposited in the counties and cities, by the local requirements for competitive deposit to carry out value-added, competitive deposit results reported to the Municipal Finance Bureau for the record.
8. Unified responsibility sharing. The development of Jinhua City, the basic medical insurance municipal co-ordination of responsibility sharing approach. In accordance with the unified fund income and expenditure, responsibility for graded responsibility, shortfall reasonable sharing principle, the establishment of the rights and obligations relative to each other, the right to match the financial rights, incentives and constraints of the combination of municipal and county governments to share the responsibility of the mechanism.
Management and service integration
Systematization and standardization of digital reforms, improve management, optimize health insurance services, promote the upward centralization of data and downward extension of services, and achieve citywide homogenization of management services.
9. Unified agreement management. Improve the entry, exit and service agreement management of fixed-point qualifications, implement the city's unified agreement management methods for medical insurance fixed-point medical institutions, and unify the assessment methods for fixed-point medical institutions.
10. Unify service regulations. Strengthen the medical insurance public **** service standardization, informationization and convenient construction, the implementation of the city's unified medical insurance business handling process and service norms. Strengthen the vertical connection, improve the city, county, township, village four-level management and service network, deepen the medical insurance handling "15-minute service circle" construction, and promote the sinking of services; strengthen the horizontal interconnection, realizing the medical insurance matters of high-quality "city-wide" and "first place to do". "first place to finish" "*** enjoy mutual recognition"; continue to deepen the "most run once" reform, promote the "Palm Office ", "Online Office". Realize 3+N one-stop settlement services for basic medical insurance, major disease insurance and medical assistance. Explore one-stop settlement of the city's maternity medical expenses.
11. Unified information system construction. Relying on the integrated intelligent public **** data platform, promote business process reengineering, data and information **** enjoyment, accelerate the centralized management of health insurance data, departmental linkage to establish a new mechanism of public **** service quality **** enjoyment, to support the city's basic health insurance municipal integration of the various services and management work, to achieve the integration of business and finance. Strengthen the security management of health insurance information network, provide the necessary personnel and technical support to ensure the smooth operation of the basic health insurance municipal integration services.
12. Unified division of labor management. Establishment of a medical insurance governance mechanism that is compatible with the municipal integration of basic medical insurance. The municipal government and its relevant departments, within the authority determined by laws, regulations and relevant norms, study and formulate the city's medical insurance policy, strengthen the supervision and management of fund use, build a comprehensive management platform for the universal health insurance city, carry out dynamic monitoring of the city's fund operation, deepen the construction of the health insurance fund supervisory credit system, and push forward the integration of the city's fund supervision, and do a good job of coordinating the assessment of the county's work. The county governments and their relevant departments should strictly implement the unified medical insurance policy, strengthen the supervision and management of the fund use, and improve the management service capacity and level.
Organizational guarantee
Strengthen organizational leadership. The establishment of a comprehensive to do the basic medical insurance municipal coordination work leading group, by the municipal government as the main leader of the group, the leaders in charge of the deputy leader, health insurance, editorial office, education, civil affairs, finance, health, veterans affairs, audit, market supervision, big data, disability federation, tax, the People's Bank of China and other departments and the main person in charge of the county government as a member. The office of the leading group is located in the Municipal Health Insurance Bureau, set up a task force, specifically responsible for the daily work of the leading group. The counties to establish a joint meeting system of medical insurance to carry out the work of medical insurance integration reform.
Strengthen departmental responsibility. All relevant departments must unify their thinking, raise awareness, their respective roles and responsibilities, closely cooperate, and increase their efforts to steadily promote the work of basic medical insurance municipal integration. Medical security departments to take the lead to do a good job of basic medical insurance municipal integration of the organization and implementation of the work, in conjunction with the relevant departments to develop municipal integration of supporting policies, and to strengthen the county business work guidance and supervision. The finance department is responsible for implementing the financial burden funds and allocating them in accordance with the regulations, strengthening the budget management of the medical insurance fund, guaranteeing the working funds, and working with the relevant departments*** to do a good job of supervising the fund. Health departments take the lead in the work of hierarchical diagnosis and treatment, medical **** body construction, family doctor contracting and upgrading the service capacity of primary medical and healthcare institutions, strengthening the management of medical institutions, standardizing the behavior of diagnosis and treatment services, and supervising the implementation of medical insurance policies. The tax department performs the duty of collecting and managing basic medical insurance premiums in accordance with the law, does a good job of adjusting the level of collection and collection, and cooperates in the preparation of the annual budget and final account of the medical insurance fund. Audit departments do a good job of auditing the medical insurance funds across the city before the municipal-level coordination in due course, and strengthen special audits. The preparation department is responsible for doing a good job of the institutional establishment guarantee work of the municipal level co-ordination. The market supervision department is responsible for the quality management of medicines in designated medical institutions. The big data management department is responsible for the supervision and security of the e-government cloud platform. The departments of education, civil affairs, veterans' affairs, and the Federation of Disabled Persons are responsible for the confirmation of relevant students in difficulty, people in difficulty, key beneficiaries, and eligible persons with disabilities, and for doing a good job of information***sharing with the health insurance departments***. People's Bank in accordance with their responsibilities to do a good job.
Strengthening assessment and incentives. Since 2022, the implementation of policy implementation, participation expansion, contribution level, fund collection, budget management, financial subsidies, responsibility, total budget, handling services, fund supervision and other implementation of a comprehensive assessment, and included in the work of the counties of the system of work objectives and responsibilities assessment, the establishment of rewards and punishment mechanism linked to the assessment results.
Strengthening publicity and guidance. The counties should give full play to the role of newspapers, radio, television, Internet, microblogging and other media, the municipal integration of the relevant policy practices and significance of a wide range of publicity, in-depth interpretation, and effectively improve the rate of knowledge of the policy. Responding to the concerns of the insured about contributions, entitlements and transfer of relationships in a timely manner, to create a favorable public opinion atmosphere for the smooth implementation of the municipal coordination of basic health insurance. Summarize and publicize good practices in a timely manner to ensure the smooth progress of the municipal coordination of basic health insurance.
This program is effective from January 1, 2022 onwards. Previous provisions inconsistent with this program, in accordance with the implementation of this program.