10 measures in Guangdong to do a good job of medical insurance for urban and rural residents

Recently, the Guangdong Provincial Medical Security Bureau, the Guangdong Provincial Department of Finance, and the Guangdong Provincial Taxation Bureau of the State Administration of Taxation jointly reposted the "Notice of the State Administration of Taxation of the Ministry of Finance of the Ministry of Finance of the State Medical Insurance Bureau on the Basic Medical Guarantee Work of Urban and Rural Residents in 2022," The basic medical security work of urban and rural residents proposes 10 specific measures. It is reported that in 2022, Guangdong has increased the publicity and expansion of publicity to ensure that the basic medical insurance participation rate is stable at more than 95%, and the data sharing between departments will be strengthened. Personnel employment in the province is involved in basic medical insurance for employees and is not restricted by household registration.

The 10 specific measures include: consolidate the coverage of the coverage of insurance, rationally improve the funding standards, improve the guarantee guarantee mechanism, focus on promoting the system standards, weave the bottom line of people's livelihood protection, continue to deepen medical insurance payment management, promote the collection of drug consumables and prices Management work, strengthening fund supervision and operation analysis, improving public management services of medical insurance, promoting standardization and information construction. For the support policy of supporting the three -child fertility, Guangdong's request, the cost of fertility for female employees for three children in the insured female employees is incorporated into the scope of fertility insurance benefits, and the guarantee of maternity medical expenses and newborns participation in urban and rural residents will be done.

Uniformly unified the three -weight guarantee system framework and name by the end of 2022

It is worth noting that Guangdong implements national bidding requirements and rationally improves the financial subsidies and personal payment standards for basic medical insurance for urban and rural residents. No less than 350 yuan each year. In 2021, the former is not less than 580 yuan, and the latter is not less than 320 yuan. Guangdong has also implemented the "Interim Regulations on Residence Permits" to hold a residence permit participation policy regulations. For those who hold the cities 'residence permits to participate in local residents' medical insurance, finances at all levels shall be subsidized in accordance with the same standards of local residents.

Guangdong will stabilize residents' medical insurance hospitalization level, ensure that the fund payment ratio within the scope of the policy is stable at about 70%, and simultaneously promotes outpatient guarantee and personal account reform, improves the management service policy of specific diseases for outpatient diseases, further implements high blood pressure and diabetes outpatient drugs for drugs. The guarantee mechanism, implement the provisions of the specific diseases of the outpatient clinic into the scope of major disease insurance insurance, coordinate the use of outpatient clinics and inpatient rescue funds, and share the annual rescue limit.

Guangdong will also establish a sound medical security treatment list system. By the end of 2022, it will uniformly regulate basic medical insurance, supplementary medical insurance and medical assistance system frameworks and institutional names, uniformly standardize various policy project names and settings, adjust medical insurance in accordance with regulations Annual, fundraising policies and treatment standards. According to the requirements of national and provincial deployment, Guangdong has steadily promoted the provincial -level overall planning of basic medical security, and gradually promoted the unified unity of the basic system framework, basic funding policies, basic treatment payment policies, and fund payment scope.

The implementation of Chinese medicine advantages and outpatient diseases are paid according to the disease

In terms of improving the inpatient and outpatient rescue mechanism, Guangdong emphasized that it will continue to consolidate the results of the expansion of medical security for poverty alleviation, and resolutely keep the bottom line of not returning to poverty due to the scale of disease, and fully implement the eligible medical assistance objects to participate in the residents' medical insurance funding funding policy , Consolidate the guarantee function of medical assistance to ensure that it should be fulfilled and rescued.

In terms of deepening medical insurance payment management, Guangdong implements the province's unified "dual -channel" drug scope and explores the establishment of negotiated drug payment policies. At the same time, improve the multi -compound medical insurance payment method based on the types of disease scores, and promote DRG/DIP payment comprehensively; improve the medical insurance payment system that meets the characteristics of traditional Chinese medicine, implement the score database of the dominance of traditional Chinese medicine, and to the advantages of traditional Chinese medicine for outpatient clinics The implementation of the disease is paid according to the disease type, and formulates the grassroots diseases that are suitable for the grass -roots level at the grassroots level; support the construction of a tight county medical community with the county traditional Chinese medicine hospital as the leader; carry out the reform of outpatient medical insurance payment methods, and study and explore the payment of paid by the first age group. Work.

In terms of normalization and institutionalization and promotion of drugs and medical consumables, Guangdong implemented 2022 drugs and high -value medical consumables collection tasks. above. In addition, implement supporting policies such as prepayment and balance of medical insurance funds; improve the online procurement rate of drugs and medical consumables in public medical institutions, and promote online settlement; steadily and orderly promote the evaluation and dynamic adjustment of medical services in 2022; strengthen drugs and medical and medical The price of consumables is normalized, and the implementation of medical prices and recruitment credit evaluation systems continuously.

Encourage newborns to participate in the insurance institution to handle

The specific method of continuously strengthening the daily supervision of medical insurance in Guangdong is: carry out joint supervision of departments, deepen the special rectification operation of the "three fakes"; promote the implementation of the intelligent monitoring system, establish and improve the medical insurance credit evaluation system, and standardize credit management; "Regulations on the Supervision and Administration of Fund", punish the use of medical insurance funds in violation of laws and regulations in accordance with laws and regulations; strengthen the supervision and propaganda of the medical insurance fund, increase the exposure of typical cases, and implement the reporting and reward system; improve the management of revenue and expenditure budgets, solidly promote the integration of fund budget performance integrated work. ; Establish and improve fund operation prediction analysis and emotional reporting system to ensure the security of the fund.

In order to vigorously promote the sinking of medical insurance services, Guangdong will participate in the first level of the township (street) to participate in the registration of insurance registration, information inquiry and change, medical record filing in different places, sporadic reimbursement (handicraft) reimbursement.(Community) The first -level processing, also actively opened the national medical insurance service platform, the online insurance payment service channels such as the Guangdong Medical Insurance, and the Guangdong Provincial Mini Program, and optimize the level of convenience services, and encouraged the newborn to participate in insurance.The matters are decentralized to the designated medical institution.In addition, Guangdong continues to promote the deepening application of the national unified medical insurance information platform, comprehensively deepen the application of 15 medical insurance information business coding standards; establish a sound information system operation management and security management system, explore the establishment of information sharing mechanisms; give full play to the whole country's integrationThe role of government service platforms, commercial banks, government affairs applications and other channels, explore cooperation mechanisms in the fields of cross -province medical treatment, medical insurance electronic vouchers activation application.

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