The "triple injection" boosts the medical and health industry to achieve practical results in the system governance of prominent problems

"Please briefly introduce the development of the system governance of prominent problems in the medical and health industry since the beginning of this year, the main problems and shortcomings, and the next step," said Ding Xiaobing, head of the health discipline inspection and supervision team in the city.

On November 10, in order to implement the spirit of the recent conference on the promotion of the system governance of prominent problems in key industries and fields in the city, and to promote the deepening and solidification of the system governance of prominent problems in the field of medical and health industry, the discipline inspection and supervision team of the Municipal Health Commission organized the municipal health commission, the leaders in charge of the Municipal Medical Insurance Bureau and the heads of relevant departments to hold a special scheduling meeting, aiming to strengthen coordination and linkage with the departments stationed in the city, form a regulatory synergy, and effectively promote the effectiveness of the system governance work.

Special Dispatch Meeting on System Governance of Prominent Problems in the Medical and Health Industry (Photo by Yang Jiao)

Since the beginning of this year, the Municipal Medical Insurance Bureau has paid close attention to the problems in the field of medical insurance, continued to deepen system governance, resolutely tightened the "safety valve" of the fund, and guarded the "life-saving money" of the masses. Since 2021, 43 designated medical institutions have been interviewed, 19 have been notified and criticized, 2 medical institutions have been lifted from the designated medical insurance, 2 clues have been transferred to judicial organs, 79 cases of violations of medical insurance agreements have been exposed, and 87 people have been guided to take the initiative to clarify the problem. In the next step, in view of the problems of different degrees of medical violations, the supervision team and the low degree of informatization, solidly carry out the provincial spot check and review of the special governance of the medical insurance fund, steadily promote the reform of DRG payment methods, strengthen the coordination mechanism with health, public security, market supervision and other departments, and effectively improve the supervision level of the city's medical insurance funds. The head of the Fund Supervision Section of the Municipal Medical Insurance Bureau said.

At the meeting, all relevant units through in-depth search for problems and shortcomings in the field of prominent problems in the medical and health industry system governance work, to carry out discussion and exchange, consolidation measures, the establishment of medical insurance fund revenue and expenditure notification, medical institution arrears communication, medical cost operation analysis, problem case investigation and handling cooperation and other four mechanisms, and constantly promote the system governance work to go deeper and more solid.

In the next step, the health discipline inspection and supervision team stationed in the city will take responsibility as the guide and consolidate the main responsibility. Strictly implement weekly reports and monthly scheduling, supervise and urge the departments stationed in the department to report the work carried out every week, carry out monthly scheduling meetings, discuss and study the completion of system governance work, so that information sharing, problem consultation, and result sharing are achieved, and the main responsibility of the compaction is further tightened. Take synergy as the path to form a joint force of supervision. The discipline inspection and supervision team plays the role of "probe", together with the departments stationed in time to carry out supervision and inspections such as unreasonable inspections, irrational use of drugs and consumables, and "three false" special rectification, focusing on problem-oriented, goal-oriented, and result-oriented, collecting typical cases of system governance, increasing the intensity of notification and exposure, and further standardizing diagnosis and treatment behavior. Take the system as the foundation and improve the level of governance. In view of the discovery of problems, profoundly analyze the causes, strengthen the study of one example and three lessons, combine the treatment of symptoms with the treatment of the root causes, change from "passive reform" to "active reform", effectively improve the system and mechanism, weave a tightly woven system cage, and effectively enhance the people's sense of medical treatment and happiness.