In 2015, according to people club department data of the urban workers and urban and rural residents to 11.57 million different ground treatment. At the end of December 2016, the national people's conference, one club, Yin weimin, minister, in 2016, our country has been achieved in the province of 30 provinces long-distance medical card settlement.
For inter-provincial long-distance medical treatment and settlement, the recent consecutive people club department post and working sessions, started the work in an all-round way.
Journalists, in some areas, province docking with the province has achieved across different ground settlement.
Walk at the forefront of hainan provinces beyond direct settlement has to go to a doctor 28 provinces (autonomous regions and municipalities) and the xinjiang production and construction corps of the 221 area as a whole, the range of leading the country. Xinjiang and shanxi, hainan, sichuan, chongqing, jilin, zhejiang, guangdong, yunnan, implement different ground settlement.
The reporter learns from one club, at present the ministry has launched long-distance medical billing system with people club department at the provincial level system docking. System will be "provincial docking" in cities and into the net for the unit, "mature one, access". It also marks the ministry publicly clear across the province the settlement of substantive start long-distance directly go to a doctor.
At the same time, people club department, according to medicare drug directory adjustment work has been basically completed. This year, people club department will also modify the basic medicare drug management approach, and gradually establish a drug catalogue dynamic adjustment mechanism.
Inter-provincial long-distance medical settlement can benefit people?
1. The relocated retirees
That settled in long distance and household ingoing settled after retirement
2. Different long-term living people
That live in different places and meet the requirements of ginseng to personnel
3. The resident foreign workers
That unit of choose and employ persons in different works and ginseng in conformity with the provisions of personnel
4. Different referral people
Is meet the requirements of ginseng to referral
Long-distance medical reimbursement of direct settlement points a few steps?
1
Ginseng protect personnel to long-distance medical discharge settlement, the orgnaization of agency of medical treatment to charge list, according to the national unified categories to pass through the national long distance medical information such as hospitalization medical expenses settlement system real-time transmission to orgnaization of agency of ginseng.
2
Ginseng to agency orgnaization according to the categories of cost calculation of the local regulations, distinguish between ginseng protect personnel to individuals and the medical insurance fund should pay the amount.
3
Ginseng to orgnaization of agency of the settlement results by the long-distance medical settlement system back to the medical establishment that decide a dot, used in the medical establishment that decide a dot and ginseng protect personnel to direct settlement.
Done across provinces around the different medical insurance settlement progress
Beijing: realizing beijing-tianjin-hebei medicare settlement in 2017
Shandong: realize the basic meet the requirements of referral to 2017 long-distance medical treatment fee settlement directly
Anhui, hefei and changsha, wuhan, nanchang realize medical insurance settlement
Shanghai: with a jiaxing, hangzhou and huzhou city to establish a long-distance medical commissioned for collaboration
Guangdong: implementation and xinjiang, yunnan and other provinces of different ground settlement
Hainan: implementation and 28 provinces of the country's provinces beyond direct settlement
: Inner Mongolia and ningxia provinces different ground settlement
In ningxia, and xinjiang, Inner Mongolia and other places across the province for medical treatment
: in xinjiang and shanxi, hainan, sichuan, chongqing, jilin, zhejiang, guangdong, yunnan, implement different ground settlement
Sichuan and chongqing, xinjiang, yunnan realize long-distance medical settlement directly across the province
Yunnan, with guangzhou, chongqing long-distance medical networking and settlement
Guizhou: no, in the province and chongqing, realize long-distance medical network settlement in yunnan
Chongqing: nine provinces, such as hainan, yunnan, guizhou long-distance medical networking settlement agreement
Focal point 1
Referral by the end of long distance straight to the hospital bill go to a doctor
According to the people club department promote inter-provincial long-distance medical treatment and settlement arrangement, the end of 2016 will be the basic elements of a nationwide network, start the relocated retiree hospitalization medical expenses directly across the province settlement work. By the end of this year to expand to conform to the stipulations of the referral personnel of long distance medical hospitalization medical expenses directly and settlement.
Recently, people club department issued "about accelerating inter-provincial long-distance medical treatment and settlement system of the construction of the notice, request the establishment of our state long distance medical billing system. At present people club department has launched department provinces docking system. Provinces after completing system transformation in the province, apply to the people club department alignment testing, in accordance with the unified access process and testing standards, to carry out the transaction and the login function test, social security CARDS, performance and reliability testing.
People club department is introduced, the alignment test by provinces, the club will follow a "mature one, access" principle, in cities. It also means for settlement of long distance medical information exchange system will be built first.
For long-distance medical direct settlement money problems, people club department is clear, inter-provincial long-distance medical fees pay part in the regional medical insurance fund settlement after the first shall be paid in advance. Ministry-level agencies according to the usual inter-provincial long-distance medical insurance fund pays amount for approval in advance money to pay for two months. At the same time, the inter-provincial long-distance medical advance and by ginseng protect clearing funds to provincial fiscal revenue and go to a doctor to provincial fiscal revenue to transfer.
In addition, ginseng protect personnel must also be in front of the provinces beyond the medical, social security agencies shall register to join. Ginseng protects agency orgnaization according to local regulations for ginseng protect personnel to the long-distance medical registration formalities, establish a long-distance medical record personnel and implement dynamic management. At the same time, the long distance coverage to orgnaization of agency of medical personnel information reported to the club of orgnaization of social insurance agency, the formation of the national library of long-distance medical record staff, for the use of orgnaization of agency of medical treatment to and the medical establishment that decide a dot.
The focus of 2
Pay will change after medical insurance directory published standards
In fact, the answer to the question of the settlement is directly across the province medical experts also said not only is the country's health care network technical problems, also involves the settlement diseases, health care reimbursement ratio, price, payment standard. The CPPCC national committee sun fengyuan said in an interview with Beijing news reporter will develop and implement a nationwide provinces and settlement, need to have a unified standard of health care across the country, this determined to policymakers.
This time, in advancing across the province beyond the direct settlement landing, people club department also has been clear about the reimbursement list and the principle of the proportion of pay, clear across the province long-distance medical execution in principle to pay limits and other relevant provisions (basic medical insurance drug catalogue, diagnosis and treatment projects and medical services standard). As a proportion of reimbursement fu biao, payment and highest pay limitation, in principle, implementation of ginseng land policy.
At the same time, according to people club department, began in October 2016 in the national basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue adjustment work has been basically completed. This time drug directory adjustment and the last time apart for 7 years. Experts pointed out that 7 years without adjustment has resulted in many new drugs cannot be included in health care, patients need to be at his own expense. To this, people club department officials have said publicly that never again seven years without adjustment. , improve the basic measures for the management of health care medicine, 2017, gradually establish a standardized drug catalogue dynamic adjustment mechanism.
According to people club department relevant controller introduces, adjustment will adhere to the clinical demand oriented. In maintaining of drug use, on the basis of continuous and stable, therapy, according to the actual demand, supplement the protection board, optimization of the directory structure, improve the health care management measures.
According to the work of expert introduction, the directory publish to the society at the beginning of this year, is expected to have more than 300 kinds of medicines supplemented into the directory. For transfer into the principles of drug, people club department relevant controller introduces, will consider high clinical value in the new drug, local b adjustment increase more drugs as well as the major disease treatment, medicine, occupational medicine for children, urgent rescue special medicine, etc. And carries on the comparison to similar drugs in accordance with the principle of pharmacoeconomics, priority has sufficient evidence to prove the clinical required, safe, effective and reasonable price.
In addition, match the medical insurance directory adjustment to pay for health care standards will also is expected to introduce reforms this year, will involve medical services and drug reimbursement ratio, etc. It is understood that the main purpose is to control health care expenditures.
"Case"
A serious illness insurance is expected to be "one-stop" settlement
From hunan yongzhou ho, told the Beijing news reporter, her mother in the first half of this year due to breast cancer to changsha city of hunan province for medical treatment, the six months of hospital treatment, before and after surgery and hospitalization expenses to spend more than ten thousand yuan.
At present, the implementation of the province health direct settlement of foreign most provinces can only support the basic medical insurance reimbursement, health care this kind of supplementary health insurance for serious illness, also can't achieve real-time settlement.
"At that time we the reimbursement in changsha, but also can get a reimbursement of fees in accordance with the aid of a serious illness. But this charge can't direct settlement, still have to do procedure to yongzhou." Ho said he consulting relevant policy, can get the highest 150000 yuan expenses, because no direct settlement, however, he must first advances the tens.
Similar reported on the situation, the future will also be changed. Settlement is directly in the realization of inter-provincial long-distance medical reform, people club department specifically, conditional region, make full use of the medical insurance business management system, realize the long-distance medical personnel, serious illness insurance, medical treatment of insurance of primary medical treatment "one-stop" settlement services.
voice
In accordance with the basic health care across the province, after the first in the province first after the principle of supplementary insurance, in the future, have a condition, can be allowance of officeholder medical treatment, supplementary medical insurance, serious illness insurance and urban and rural residents of urban and rural medical relief into the "a list" settlement, etc. The relevant person in charge of -- people club department (Beijing news reporter Tachileik) |
