Medical network February 3 - the 24 audit released announcement no. 1, 2017, announced the basic medical insurance and urban and rural residents in China a serious illness insurance and medical insurance fund special audit results. The party member, deputy audit audit ChangSunBaoHou had an interview with xinhua news agency reporters on the same day, to the authoritative interpretation of this announcement.
▍ q: why the auditor audit fund of medical treatment insurance?
Answer: the CPC central committee and state council have always attached great importance to people's health, the fifth plenary session of the party 18 determines the promotion of the construction of health of China. In August 2016, the CPC central committee and the state council convened the national health and the health assembly, to pay special attention to the basic medical insurance system construction further put forward clear requirements. For the medical insurance fund raising, management, distribution, and usage, as well as the implementation of medical insurance policies, the social from all walks of life are concerned. In order to promote to implement the party central committee under the state council decision deployment and pushing forward the construction of the health of China to deepen reform of national basic health care system, to ensure the safety of medical insurance fund, improve the medical insurance fund use efficiency, safeguard the people's vital interests, audit from August 2016 to September, organizing local audit institutions to carry out the medical insurance fund audit.
▍ q: from the audit, since the party's 18 what are the main achievements have been made in the medical insurance work?
A: since the eighteenth congress, medicine and health care system reform continued to deepen, has achieved remarkable achievement of medical treatment insurance, fund running smoothly as a whole.
In terms of health care system, established the system of urban and rural residents a serious illness insurance, disease contingency system, actively promote the integration of urban and rural residents basic medical insurance system, cover the cut with a shorter time to establish the urban and rural basic medical and health care network, provides institutional guarantee for implementing all sickness.
In terms of security level, financial support for residents' basic medical insurance for mounting, 2015 financial investment subsidy funds at all levels and government subsidy standard per capita than in 2012 increased by 67.69% and 62.19% respectively. Residents in hospital of insurance of primary medical treatment charge policy to further improve the reimbursement ratio. Urban and rural residents in patients with serious illness insurance actual reimbursement ratio, on the basis of basic medical insurance by about 12%, the masses go to a doctor to further reduce the burden.
In huimin policy to promote, remarkable progress was made in different medical settlement work in the province, according to the disease of composite health care payment method is fast, in controlling the excessively rapid growth of medical expenses of medical treatment insurance, the action of regulating medical behavior, etc.
In terms of fund operation, in 2015, the audit area at the end of the basic medical insurance fund income and expenditure, balance respectively from 2012 increased by 57%, 58% and 68%, overall security fund running smoothly, to further strengthen fund of medical treatment insurance against the risk ability.
▍ ask: this audit still find part of the designated institution or individual diddle show the medical insurance fund, these problems will not affect the rights and interests of ordinary people?
A: you can look at the issue from two levels.
First of all, on the whole, the medical insurance fund is ultimately out by the government. When the payment difficulties the medical insurance fund itself, by the government allocated funds make up the shortfall, guarantee the legal ginseng protect people's health rights and interests are not affected.
Second, the medical insurance fund is to defraud arbitrage, refers to the worker health care as a whole fund or residents medical insurance fund, there is no loss of individual account funds as a matter of fact; For those people personally, under the established health policies, health care treatment level is not affected. Diddle taking health care as a whole of fund problem, if not effectively, is the question of whether fund long-term sustainable impact. Although the government to fund out responsibility, but for the erosion of diddle medical insurance fund arbitrage behavior, cannot be tolerated, must crack down on.
On April 24th, 2014, the 12th session of the standing committee of the National People's Congress passed the 8th meeting of the National People's Congress on "criminal law of the People's Republic of China > the interpretation of article two hundred and sixty-six of the, put forward" to fraud, forged documents, or other means to defraud pension, medical treatment, inductrial injury, unemployment, birth and other social insurance or other social security benefits, public or private property belongs to the provisions of article two hundred and sixty-six of criminal law fraud behavior ", to specifically insurance fraud behavior punishment, stepped up to the violation of insurance fraud, this is the best maintenance for the citizen rights.
▍ asked: the medical insurance fund audit found illegal problem of 1.578 billion yuan, does that mean funds unsafe?
A: want to combine specific situation perspective on the issue. Ought to say, the current funds are generally safe. The medical insurance fund audit were found from embezzling, diddle arbitrage, illegal violation problem such as charge 1.578 billion yuan, although in absolute Numbers look bigger, but from the point of the relative, only about 0.46% of our audit sampling cost, if the medical insurance fund income over the same period of audit area, compared to the total number of accounts for less than.
Looked from the overall, medical insurance fund management or a more orderly, the reason will appear these problems, mainly has the following several reasons:
A is one of the few people viewpoint of discipline is weak, there is no strict rules, this kind of situation in primary relatively bullish. Not for violations, illegal behavior surveillance in place, punishment is not strong enough.
The second is related policies to promote fast enough. As most provinces has a health care in the province beyond the direct settlement, but its coverage, there are few medical institutions and some criminals is using the loopholes in the system, through false other invoices to defraud insurance funds.
Three is to related reform measures is not enough. Such as public hospitals at the county level in our country and government grass-roots medical institutions should be in accordance with the provisions, cancel the drug price, but due to finance the investment is still not fully in place, also failed to timely adjust medical service price, leading to problems such as "taking medicine cure" still exists in a certain extent.
▍ q: pass the medical insurance fund audit, you have a good idea for deepening the health care system?
A: health care audit found some problems, system execution problem, there is also the question of reform of the system is not in place. Should intensify efforts to promote the reform of the following areas.
One is to speed up the health care system and the integration of management institutions. To resolutely according to the requirements of the central, accelerate the basic health care integration between urban and rural areas, in the realization of coverage, financing policy, to ensure treatment, medical insurance directory, fixed management, fund management, on the basis of "six reunification", speed up the integration of the basic medical insurance management institutions.
Second, the reform of medical insurance payment. Shall be by advancing the reform of medical insurance payment and reversed transmission medical institutions to strengthen cost management, on the premise of guarantee quality of medical services to strengthen cost control.
Three is the implementation of "3 d" linkage policy force into full play. Medical treatment, health care, medical reform, are closely related. Inadequate finance to public hospitals, drug prices and circulation management chaos, etc., to the health care system and medical insurance fund has an important influence. Can't talk on health care, must be overall coordination, strengthen the reform of "3 d" collaborative, systematic, standard to ensure the medical insurance fund management. |
