Authoritative release 丨 Shandong Province to improve the medical insurance and rescue system for major diseases, and further build the bottom line of people's livelihood protection

This afternoon, the Provincial Government News Office held a press conference to interpret our province's "Implementation Opinions on Implementing Medical Insurance and Rescue System of Heavy Health Diseases".

Recently, the Provincial Government General Office issued the "Implementation Opinions on Implementation of Medical Insurance and Rescue System" (hereinafter referred to as the "Implementation Opinions"), which is the province's in -depth implementation of the Party Central Committee and the State Council's decision -making and deployment, further consolidating medical assistance entrustment The bottom guarantee function, building a "safe network" of basic medical security, promoting the long -term, basic, and systemic policy arrangements of common prosperity. Measures. Below, briefly introduce the relevant situation.

"Implementation Opinions" introduced background

In October 2021, the General Office of the State Council issued the "Opinions on Improve the Medical Insurance and Rescue System" of major diseases, and to the construction of medical insurance and rescue systems for unified major diseases, strengthen the comprehensive guarantee of basic medical insurance, major disease insurance, and medical assistance. , Enhance the bottom -up guarantee function, make system arrangements. The Provincial Party Committee and the Provincial Government attach great importance to the medical security work of the people of difficulties and patients with major illnesses. In 2022, the Provincial Government Work Report lists this work as a key task. Make clear requirements.

In order to thoroughly implement the decision -making and deployment of the Party Central Committee and the State Council, in accordance with the requirements of the Provincial Party Committee and the Provincial Government, the Provincial Medical Insurance Bureau will be based on the classification survey of difficult people in difficult people, the medical expenses expenditure expenditure of major diseases in various cities, and the support capabilities of the medical insurance fund. The relevant departments of the Department of Finance and the Rural Revitalization Bureau have studied the "Implementation Opinions". The "Implementation Opinions" is consistent with the requirements of social assistance and rural revitalization work goals. Pay attention to the institutional results of transforming medical insurance's poverty alleviation experience into the strategy of promoting the strategy of rural rejuvenation, further building the bottom line of people's livelihood guarantee, and effectively enhance the sense of gain and happiness of the people in difficulties. ,sense of security.

The main content of "Implementation Opinions"

The "Implementation Opinions" from the scope of the target of medical assistance and the standards for participation in insurance, strengthen the function of basic medical insurance and major illness insurance, consolidate the support function of medical assistance support, establish a sound prevention and resolution mechanism for poverty and poverty due to illness, standardize the management of the menstrual management Management services and actively guiding social forces to participate in the protection of rescue guarantees, etc., and put forward 17 policies and measures, which are mainly reflected in the following 8 aspects.

The first is to clarify the scope of medical assistance objects and achieve full coverage of residents and employees in difficulties. The medical assistance system determined by the "Implementation Opinions" is fairly covered with difficult residents and employees with heavy medical expenses, including special difficulties, subsistence allowance objects, returning poverty -poverty -poverty population, members of the minimum -living family members, preventing targets for returning poverty monitoring, and failure The scope of the above rescue objects but patients with serious difficulties in the family's basic life due to high medical expenses caused by high medical expenses, and poverty -cause diseases are poverty -stricken. Other special difficulties stipulated by governments at or above the county level will give corresponding assistance according to the category of rescue objects.

The second is to implement the subsidy of the classification of insurance participation to reduce the personal payment burden of the rescue target. The "Implementation Opinions" clearly stipulates that the personal payment of the basic medical insurance for the residents' basic medical insurance shall be fully funded by medical assistance funds. Funding and consolidating the difficulties of difficulties should guarantee all the results.

The third is to improve and improve the system of general outpatient and outpatient clinics. The "Implementation Opinions" proposes that on the basis of consolidating the treatment of hospitalization reimbursement, before the end of this year, the cities will comprehensively establish a general outpatient system for residents and employee medical insurance to further improve the inclusiveness of medical security. Uniformly standardize the basic diseases and identification standards of slow special diseases in the province. The basic diseases of the first batch of slow special diseases of the first outpatient clinic are not less than 50, which further improves the level of maintenance of slow special diseases.

The fourth is to focus on key rescue targets and reduce the burden of medical expenses of major illnesses. The "Implementation Opinions" stipulates that for the three key rescue targets of special difficulties, subsistence allowance objects, and poor people who return to the poor and poor, the annual starting line of residents and employees' illness insurance will be reduced by 50%, and the proportion of reimbursement in section will increase The highest payment limit of the year, cancel the use of major disease insurance special effects drugs.

Fifth, the scientific design rescue system, further enhance the function of medical assistance. For people with special poverty, subsistence allowances, and poor people who return to the poor, medical assistance does not set up a line of payment, the proportion of personal burdens within the scope of the policy is not less than 70%, and the annual rescue limit is increased from not less than 10,000 yuan to no less than less than less than less than less than less than less than 10,000 yuan to not less 30,000 yuan, further enhance the bottom of the support. For members of the subsistence allowances and the targets of preventing poverty -relief monitoring and assistance, the proportion of rescue ratios of more than 3,000 yuan within the scope of the policy is not less than 50%. After the above -mentioned rescue objects are guaranteed by the triple system, if the personal burden fee is still heavier within the scope of the policy, re -rescue is given at a ratio of not less than 70%. The annual limit can reach up to 20,000 yuan. For patients with poverty due to illness, the individual burden fees within the scope of the policy are more than 25%of the per capita disposable income of residents within the scope of the policy, and the rescue is given at a ratio of not less than 60%.

Sixth, the innovative dynamic monitoring mechanism is used to prevent poverty due to illness. The "Implementation Opinions" stipulates that after reimbursement of basic medical insurance and major illness insurance, the annual individual burden and expenses within the scope of the policy will exceed the skeleton edge family members of the minimum -fidelity in the province's per capita disposable income of the province, and the target of helping the poverty monitoring and assistance. As well as the annual personal burden of personal burdens, the annual cumulative insured persons who have exceeded the per capita disposable income of the residents of the province in the province are included in the scope of early warning and monitoring, and early warning screening is implemented to ensure the help of people in need. The medical insurance department analyzes the comparison monthly analysis, and promptly push the early warning information to the civil affairs and rural revitalization departments to confirm in accordance with relevant regulations, so as to timely discover, accurate identification, and accurate assistance. Seventh, to promote integrated service services, and improve the convenience of medical settlement for the people difficulties. Relying on the national unified medical security information platform, the integration of basic medical insurance and medical assistance services, on the basis of achieving a network of medical expenses in the city in the city, actively promote the "one -stop" service in the province and cross -provincial medical expenses settlement, " The handling of one window to improve the service capabilities of grass -roots medical insurance, and facilitate the reimbursement of the people for medical treatment.

Eighth is to strengthen comprehensive policies and build a multi -level guarantee system. The "Implementation Opinions" requires that relying on charitable and social donations to raise funds to form an effective connection between government assistance and charity assistance. Support trade union organizations to actively carry out medical mutual assistance to employees, and give help to suffer from major illnesses in difficult workers. Promote the innovation and development of commercial medical insurance, properly tilted the people in difficulties in terms of product pricing and compensation policies, and jointly reduce the burden of individuals in difficult people.

In the next step, the Provincial Medical Insurance Bureau will conscientiously implement the requirements of the 12th Party Congress of the Provincial Party Congress, anchor "walking in front, opening a new bureau", and in -depth implementation of medical security expansion and bidding operations. The policy has been implemented, and the bottom line of the medical security of the people in need is held, and the 20th National Congress of the Party will be held with excellent results.

(News Office of the People's Government of Shandong Province)

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