"Jiangsu medical insurance 1" insured people have more than 2.9 million
Jiangsu province medical insurance bureau director Zhou Ying introduced, as of the end of last year, Jiangsu province, the number of basic medical insurance enrollment amounted to 80,638,000 people, the enrollment rate of more than 98%, the number of employee health insurance enrollment accounted for more than 40%; employee health insurance The proportion of hospitalization medical expenses paid by the fund within the policy scope of employee medical insurance and resident medical insurance reached 86% and 72% respectively.
Last December, Jiangsu Province for the first time in the province to launch the province, and the basic health insurance connected to the universal commercial supplemental medical insurance products - "Jiangsu Medical Benefit Insurance No. 1". At present, the number of insured people has exceeded 2.9 million, as of February 25, a total of 1,529 users to provide claims service, the total amount of compensation 8,484,400 yuan, per capita 5,548.99 yuan, the largest single claim amount of 122,000 yuan.
In 2022, Jiangsu will continue to improve the health insurance system system. Improve the medical insurance and assistance system for serious illnesses, improve the timely and accurate identification mechanism for assistance recipients, and build a long-term mechanism to prevent poverty due to illness. The full implementation of the policy of encouraging flexible employment, new industry practitioners to participate in the employee health insurance policy, to guide more people to participate in the higher level of protection of the employee health insurance.
Continuously deepening the reform of the medical insurance payment method
All-out efforts have been made to build a high-pressure situation for the supervision of the medical insurance fund. A province-wide unified platform for receiving and enforcing complaints and reports has been set up to realize unified acceptance, hierarchical processing, sunshine enforcement, social supervision and full tracking.
Continuously deepen the reform of medical insurance payment method. Comprehensively promote the total control of the pluralistic composite health insurance payment method, focusing on promoting the DRG / DIP payment method reform three-year action plan, to promote the province's comprehensive medical institutions above the second level to carry out the actual payment of DRG / DIP, the establishment of multi-party participation in the determination of the core elements of the DRG / DIP payment and adjustment of the negotiation and negotiation mechanism, the dispute handling mechanism. The reporter learned that the so-called DRG refers to the payment by disease diagnosis-related grouping, and DIP refers to the payment by disease score.
Deeply promote the reform of the drug and medical supplies recruitment and procurement system. The company's products and services have been widely recognized as the best in the world. Normalization of the institutionalization of standardization to promote the centralized purchasing of drugs and consumables with quantity. Comprehensive construction of the province's unified medicine procurement and pricing system.
Actively promoting medical service price reform. Comprehensively implement the requirements of the central reform, promote the pilot reform of medical service prices, consolidate the foundation of price management work, establish a dynamic adjustment mechanism for medical service prices, and select projects for dynamic adjustment in batches.
Comprehensively standardizing the total management of the medical insurance fund. Focusing on three-tier medical institutions, the company will implement supporting measures such as negotiation and performance evaluation, establish a scientific, reasonable, open and transparent total budgeting mechanism, a fine and practical total management mechanism for the whole process, a standardized and efficient performance evaluation and incentive and constraint mechanism, and a synergistic mechanism between total management and health insurance system reform, so as to comprehensively improve the efficiency of fund use.
Cross-provincial designated pharmacies card purchase of drugs within the year to achieve full coverage of the county
Strongly promote the "intelligent health insurance" construction. The full online health insurance fund intelligent supervision, drugs and medical supplies procurement, health insurance big data and other business sub-systems. The company is also pushing forward the digitalization reform of public **** services and expanding the application of e-vouchers for health insurance.
Comprehensively optimizing the level of public health insurance services. A three-year action plan for full coverage of the "15-minute medical insurance service circle" has been launched, with 132 provincial-level demonstration sites and about 350 municipal-level demonstration sites completed within the year. Improvement of cross-location medical care service protocols, by the end of the year to realize the province and cross-provincial designated retail pharmacies to purchase medication card direct settlement of county coverage, hypertension, diabetes and other five outpatient slow special disease-related costs of cross-provincial direct settlement of the municipalities of the region coverage.
Strongly support the innovative development of the pharmaceutical industry and the high-quality development of public hospitals. Research and development of medical insurance policies and reform initiatives involving the innovative development of the pharmaceutical industry and the high-quality development of public hospitals, fully listen to the views and suggestions, and fully promote the three medical linkage.
Source: Yangzi Evening News