New Era Healthcare Heart-to-Heart Service

Ms. Lin of Jinxiang Town, Lufeng City, is seriously ill and has been hospitalized 12 times in 2021, with a total medical expense of nearly 270,000 yuan. Although the basic medical insurance reimbursement was 135,700 yuan and the supplementary medical insurance reimbursement for major illnesses was 61,300 yuan in the early stage, it still brought a lot of economic pressure to Ms. Lin's family. At this time, the village's major disease patrol medical insurance service grid staff visited her home, explained and told her that she complied with Shanwei City's expenditure-based medical assistance policy. At present, Ms. Lin has applied for the minimum living guarantee with the assistance of town and village cadres and implemented a "one-stop" settlement of medical assistance.

Medical security is a major people's livelihood project related to the health and well-being of the people, and plays a key supporting role in ensuring and improving people's livelihood. In recent years, the Shanwei Municipal Medical Insurance Bureau has adhered to the principle of integrity and innovation, actively promoted the participation of the whole people in accordance with the law, fully implemented the policy of medical insurance to benefit the people, issued a dividend for the people's livelihood, the masses have obtained more benefits and conveniences, and continued to enhance the people's sense of gain, happiness and security in the field of medical security.

●Author: Mo Fan Feng Jiade

Enhance well-being

Build a multi-level medical security system

In response to people like Ms. Lin who are in urgent need of medical assistance, in November this year, the Shanwei Municipal Medical Insurance Bureau established a medical insurance service mechanism for major disease visits. Relying on the national medical security information platform, the information of insured persons who have spent more than 50,000 yuan (including 50,000 yuan) in medical expenses since 2020 but have not yet enjoyed medical assistance treatment is screened out from the system every month, and pushed to the Shanwei "Public Sentiment Map" platform. After the information is matched, the grid staff will visit and verify one by one, and after preliminary judgment that they meet the conditions for medical assistance, they will take the initiative to inform the patient of the medical assistance policy and application process, and provide assistant agency services.

At Shanwei People's Hospital, the author learned that ms. Chen's baby, a citizen, needed hospitalization due to congenital heart disease. "At the beginning, I thought that the baby could not participate in the insurance without household registration, and could only pay the medical expenses by himself, which was very stressful. Later, the doctor told me that the newborn could pre-register for medical insurance, and the reimbursement of medical expenses could be settled when discharged, and I was immediately relieved. At the hospital medical insurance service station, Ms. Chen took less than 10 minutes to complete the insurance registration procedures and complete the online payment through the "Guangdong Tax Pass".

As of December 13, a total of 1,226 newborns in Shanwei had prepaid urban and rural medical insurance, and 543 people had applied for neonatal medical insurance reimbursement, with a reimbursement rate of 73%. It is understood that this is the first newborn pre-insurance payment service launched by the Shanwei Municipal Medical Insurance Bureau in the province.

In accordance with the work ideas of "guaranteeing the basics", focusing on "protecting major diseases" and comprehensively "guaranteeing the bottom", the Shanwei Municipal Medical Insurance Bureau has formed a medical security system with basic medical insurance as the main body, major illness insurance as the supplement, medical assistance as the foundation, and commercial supplementary insurance for common development, built a more perfect multi-level medical security system, and actively responded to the higher pursuit of health by the masses entering the new stage of development.

In recent years, Shanwei has continuously improved the level of medical security and people's livelihood projects to benefit the people. The proportion of hospitalization reimbursement for urban workers and urban and rural residents has increased by 5% and 10% respectively, and the minimum payment line for urban and rural residents' serious illness insurance has been reduced to 10,000 yuan, and the payment ratio has reached more than 60%. In January this year, the Shanwei Municipal Medical Insurance Bureau guided the launch of the inclusive commercial supplementary medical insurance "Shanmei Insurance", with a maximum guarantee of 3.3 million yuan, seamlessly docking the basic medical insurance policy and alleviating the problem of the people's "expensive medical treatment".

Convenient for the people

Realize "one-stop" settlement of medical assistance

The Shanwei Municipal Medical Insurance Bureau has provided the most solid guarantee for the general public by improving the medical insurance system, including the comprehensive protection implemented in response to the new crown epidemic. As of the end of June this year, in accordance with the unified deployment of Guangdong Province, Shanwei City has budgeted 362 million yuan for the cost of new crown vaccination to the special financial account of the provincial social security fund, providing a financial guarantee for the stage of victory in epidemic prevention and control. Timely reduction of employee medical insurance rates, reducing the burden of enterprises by 72.27 million yuan, contributing to the prevention and control of the epidemic.

In the battle against the epidemic, party members and cadres charged ahead and faced difficulties, so that the party flag flew high on the front line of the fight against the epidemic. Shanwei Municipal Medical Security Bureau was awarded the "Shanwei Advanced Collective in Fighting the New Crown Pneumonia Epidemic", and 1 person was awarded the "Advanced Individual in the Fight against the Epidemic in the Medical Insurance System of the National Medical Insurance Bureau".

Medical insurance poverty alleviation work is an important part of the "two worries and three guarantees" for poverty alleviation. To this end, the Shanwei Municipal Medical Insurance Bureau has always taken the medical insurance poverty alleviation work as the primary political task on its shoulders, adhered to the party building as the starting point, further improved the monitoring and support mechanism to prevent returning to poverty, actively implemented relevant policies and measures, solidly promoted the consolidation and expansion of the effective connection between poverty alleviation and rural revitalization, ensured that the medical insurance policy for the benefit of the people was effective, polished the happy background of the people in Shanwei with pragmatic measures, and ensured that no household was left behind and no one was left behind on the road to common prosperity.

Shanwei achieves "one-stop" settlement of medical assistance for people in need, and the recipients of assistance do not need to apply, do not need to advance funds, and do not need to be hospitalized deposits, they can enjoy medical assistance and achieve "zero errands". Adhering to the principle of bottom-up, the proportion of assistance to urban and rural people in need in Shanwei has reached 100%, the secondary medical assistance has set different assistance ratios according to the population, 100% assistance has been given to the extremely poor people, and the ladder assistance has been implemented for other assistance recipients, and the proportion of medical expense assistance has been reasonably increased, and the level of protection has been improved. According to statistics, in the past two years, Shanwei's medical assistance funds have reached 560 million yuan, funded 439,000 people in need to participate in urban and rural basic medical insurance, and helped families in need to reduce medical expenses by 450 million yuan.

Innovative mechanisms

The first national medical insurance information platform to be launched

In July this year, Shanwei took the lead in the province to implement regular monitoring and information release of conventional drug prices in medical insurance designated retail pharmacies, guiding the market to set reasonable prices, effectively reducing drug prices, and effectively allowing the people to enjoy the results of the reform of the medical security system.

"In addition to regularly collecting drug prices, it is also necessary to reasonably choose the object of release, so that the masses can choose to buy drugs." According to the relevant person in charge, the Shanwei Municipal Medical Security Bureau selected 18 medical insurance designated retail pharmacies and brand chain pharmacies in the city as the objects of regular monitoring and release of conventional drug prices. Every month, drug price information is regularly announced through the official website of the Shanwei Municipal Medical Insurance Bureau, the official WeChat public account and other channels, guiding pharmacies to compete fairly and adjust prices reasonably.

The Shanwei Municipal Medical Insurance Bureau focused on management innovation, deeply promoted the reform of key areas of medical insurance, vigorously leveraged the "five doctors" linkage reform, and took the initiative to answer the answer sheet of medical security reform in the new era. As a pilot reform of the payment method according to disease diagnosis related groups (DRG) in Guangdong Province, Shanwei has steadily implemented the reform of payment by disease diagnosis related groups (DRG) to promote the rational allocation of medical resources; build a "1+1+N" management system model to improve the level of refined management of medical insurance; and reduce the purchase price of drugs by purchasing with quantity, reducing the purchase price of drugs, and saving "drug purchase money" for the people.

On November 1, 2020, Shanwei successfully launched the national medical insurance information platform, becoming the first prefecture-level city in China to launch the platform. In just 3 months, it has provided the people of Shanwei with unified, efficient, compatible, convenient and safe medical insurance services, and provided replicable and scalable Shanwei experience for the launch of other cities. To this end, the National Medical Insurance Bureau has visited Shanwei twice to investigate, and many prefectures and cities inside and outside the province have carried out study and exchange work in Shanwei City.

"There is no end to the reform of people's livelihood, only a continuous new starting point." Wu Chengxin, director of the Shanwei Municipal Medical Insurance Bureau, said that 2021 is the beginning of the "14th Five-Year Plan", the beginning of a new journey of comprehensively building a modern socialist country, and the third year of the establishment of the Shanwei Municipal Medical Insurance Bureau. The medical security system of Shanwei City is taking the comprehensive deepening of the reform of the medical security system as the core, accelerating the improvement of the medical security system system construction, comprehensively consolidating the foundation of medical insurance public management services, promoting the high-quality development of medical security, and using an excellent "medical insurance answer sheet" to contribute to the construction of Shanwei into a beautiful pearl in the coastal economic belt.

【Transcript】

Since 2019, the city's designated medical institutions have been inspected with full coverage, 66 designated medical institutions have been dealt with in violation of laws and regulations, and the service agreements of 11 designated retail pharmacies have been suspended, and the medical insurance fund has been recovered for a total of 60.9569 million yuan

As of the end of November 2021, a total of 29.0087 million yuan of the five batches of centralized procurement tasks of the national drug have been completed, with a cumulative saving of 53.5578 million yuan, involving 218 varieties of drugs; to promote the joint centralized procurement of drugs across regions, 70 medical institutions in the city have participated in the procurement amount of 256.94 million yuan on the Shenzhen platform, and 64 medical institutions have participated in the procurement amount of 460.1988 million yuan in Guangzhou

Realize the high-frequency service items of medical insurance on the line of 46 "Guangdong medical insurance", 32 "Guangdong provincial affairs", 19 "Shanmei village residences", 36 government all-in-one machines, 45 online applications for the provincial government service network business, 33 "city-wide general offices", and 18 "inter-provincial general offices and provincial general offices"

Launched the national medical insurance information platform, covering nearly 3 million insured persons, 94 designated medical institutions and 250 designated retail pharmacies, collecting and solving more than 800 system problems, outpatient settlement of 0.7 seconds, hospital settlement of only 1 second, the performance of the old system of 4 to 5 times

In the past three months, the city's specific outpatient qualifications for diabetes and hypertension have increased from the original 3390 and 3152 to 23322 and 44319 respectively, an increase of 6.9 times and 14 times respectively