Reimbursement for medical expenses in different places, and it is more convenient in the future.
The medical expenses in different places has always been the topic of the people.
Recently, the State Council executive meeting reviewed and approved through the "14th Five-Year" national medical security planning, deploying improved medical insurance system, and proposing cross-provincial unicasts such as basic medical insurance insured registration, realizing in different medical hospitals, outpatient cost lines.With the continuous acceleration of population, it is increasingly increasing medical groups in different places. The new employment-based laborer is based on flexible employees, or to support the children’s business to leave their hometown to move to the old people, they are all medical treatment.The main crowd.
"Wang Zhen, deputy director of the Chinese Academy of Social Sciences, said in an interview with the" strong observation "column of the People’s Network, continuously improved the direct settlement policy of differently medical treatment, and promoting the development of medical resources to be more equalization of the" 14th Five-Year Plan " One of the key tasks, is also a positive response to the people’s yearning for a better life. What standard reimbursement is made in different places? In July this year, the "Opinions on Optimizing the Optimized Medical Security Service" issued by the State Medical Security Bureau clearly proposed, accelerated advancement Basic medical insurance cross-province is directly settled in different places, realizing the national unified medical record, expanding the direct settlement scope of different medical doctors. Before the end of 2021, there were at least 1 general outpatient cost cross-provincial networking medical institution, all-in-law. The region is basically realized in general outpatient costs, cross-provincial direct settlement; 2022 The medical settlement of the payment includes two parts of the payment range and the reimbursement standard. The scope of payment refers to the basic payment scope of the drug catalog, medical service projects and medical supplies of basic medical insurance. In principle, it is generally implemented in accordance with the medical regulations; and the reimbursement standard is pressed Insured policies, Yuan Tao, examples, for example, Hebei, Guizhou and other insured patients, they can enjoy projects in Beijing’s basic medical insurance services through the national unified medical treatment platform, can enjoy projects within the scope of Beijing Basic Medical Insurance services, but reimbursement criteria Rebound in the policy policy.
Yuan Tao said that in order to adjust the medical treatment in different places, promote grading diagnosis and treatment, most of the medical insurance policy of most coordinated regions stipulates that the proportion of foreign reimbursement is reduced compared to local reimbursement ratios. In terms of specific reimbursement, it applies for a recorded patient through the national different medical platform. It is directly settled by the information system when handling the medical treatment in different places; the required self-end is paid by the record, and then returns to the original manual reimburse.
For patients who want to make a record, Yuan Tao said that it can carry materials such as social security cards, ID cards, and proof of long-term residence related certificates, and go to the social security bureau where the household registration is located, and can also handle it on the spot in the air. . What is the progress of the outpatient cost cross-provincial direct settlement? Direct settlement of medical expenses in crossing provinces is usually divided into outpatient and hospitalization.
At the end of 2016, my country’s cross-provincial medical treatment direct settlement system began to run, and the patient can be directly reimbursed when the patient is settled, and only pays the self-payment part. Wang Zhen said that in terms of hospitalization, the direct settlement of medical treatment in different places is more convenient, but the direct settlement of outpatient costs is currently being advanced. Since 2018, the Yangtze River Delta, Beijing-Tianjin-Hebei, and the five provinces in Southwest have successively launched a direct settlement pilot in the province within the region.
"Compared to hospitalization costs, inter-provincial direct settlement, the difficulty of inter-provincial direct settlement is much larger than hospitalization. At the same time, the outpatient cross-provincial direct settlement for the support capabilities of the national medical insurance information system, run stability and service capabilities It has been put forward higher requirements. "Wang Zhen said. Talking about the specific reasons, Wang Zhen said that the frequency and settlement of the first doctor is much higher than hospitalization; secondly, the medical insurance outpatient reimbursement policy has differently, cross-place direct settlement is greatly tested on settlement rules and settlement services; A direct settlement requires multiple links of different institutions, and any problem will affect direct settlement.
Jiang Chengjia, the head of the National Medical Insurance Bureau, the head of the State Council Policy, held in July, said that from the current perspective, progress is basically in line with expectations, 29 provinces and Xinjiang Production and Construction Corps have already had 315 co-ordline regions. It has opened a direct settlement of ordinary outpatient expenses and covered 70% of the country. Among them, 18 provinces such as Beijing, Tianjin, and Hebei and Xinjiang Production and Construction Corps have realized all coordinated regions in the region. How to deal with medical accounting in different places is increasing? Recently, the State Council of State Council pointed out that since a new round of medical reform, my country has built the world’s largest, basic medical insurance network, and the basic medical insurance during the "13th Five-Year Plan" period covers 100 million people, and the coverage is stable in more than 95%. During the "14th Five-Year Plan" period, we must deeply promote the reform of the medical insurance system, do our best to do our best.
At the same time, although the medical insurance system has made breakthroughs in the problem of cracking "seeking medical treatment", the problem is not balanced, and the problems such as multi-guarantee is still existed. In adapting to normalized population flowing and medical treatment, adapt The new business and new economic development need to have a short slave. "In the context of population flow and urbanization, with the continuous growth of medical resources, the regional and large hospitals in medical resources will be more obvious, which will not be conducive to the balanced layout of medical resources and basic medical and health. The service is equal. "Yuan Tao said.
For the medical insurance department and medical institutions at all levels, this is also a big challenge. Yuan Tao emphasizes that medical insurance is in different medical management, fund supervision, cross-site collaborative services, etc., urgently need to establish medical institutions at different regions. Division of duties, refund standards and refund procedures, to address more and more intermittent districts, inter-provincial medical settlement issues. In addition to improving the grading diagnosis and treatment system, speeding up the balanced layout of medical resources, Yuan Tao also suggests to improve the medical insurance coordination level, such as transition from the municipal-level coordination to provincial-level overall; Strengthen technology innovation, promote more and more advanced "Internet + medical protection" technology; improve the employment settlement work mode, method, simplify the processes; establish cross-regional medical insurance collaborative governance mechanisms and risk adjustment mechanisms; improve joint law enforcement supervision and management Service level, etc.
(Editor: Wang Shao Shao, He Yingchun) Sharing let more people see.