┃Source: Huzhou Medical Security Service Center, Zhejiang Province
The party's century-old history is a history of practicing the party's original mission and mission, and a history of the party and the people connecting hearts, breathing together, and sharing a common destiny. The study and education of party history has guided the whole party to have a deeper understanding of the nature and purpose of the party, persist in doing everything for the people and relying on the people in everything, always put the people in the highest position in their hearts, and regard the people's yearning for a better life as the goal of struggle. The medical insurance department of Huzhou City adheres to the guidance of party history study, with the goal of creating the "most convenient city" for medical insurance services, and is committed to improving the ability of medical insurance grass-roots management services with high quality.
First, the basic situation
Huzhou city has a total of 2.8428 million basic medical insurance participants, the city's medical insurance agencies to verify the establishment of 143 people, for a long time, the huge total amount of medical insurance business and the limited medical insurance handling personnel strength, the insured demand for access to convenient medical insurance services and the limited medical insurance grass-roots management outlets and service capabilities between the contradiction for a long time. In accordance with the requirements of the national and provincial medical insurance departments, Huzhou medical insurance agencies have continuously enhanced their sense of responsibility and mission in medical insurance work, focused on the needs of the masses for more convenient, efficient and high-quality services, and gradually narrowed the gap between urban and rural areas in medical insurance services and improved the convenience of the people by doing a "15-minute service circle".
Second, the main practices and results
(1) Focus on the needs of "nearby office" and build a "15-minute service circle".
Extend medical insurance handling services to the grass-roots level, to banks, to hospitals, and to schools, and promote the equalization of medical insurance services in urban and rural areas. The first is to build a four-level handling service network. Adopt the linkage method of cities and counties (districts) and cities and counties (districts) to establish a four-level medical security service system for cities, districts and counties, townships (streets), and villages (communities). 20 government service matters will be extended to 73 townships (streets) in the city, and 13 high-frequency matters will be extended to 1278 villages (communities), and the main framework of convenient medical insurance services will be established. The second is to promote the "Baoyin Unicom". In full cooperation with the Municipal Rural Commercial Bank, the cooperation between Baoyin has covered 47 townships (streets) and 185 bank outlets, involving 11 matters in 5 categories, such as the approval and payment of maternity insurance treatment and the change of personnel information. The third is to strengthen the "service extension". Take the initiative to extend services to schools, "medical insurance windows" stationed in colleges and universities; extend services to medical institutions, and directly provide services such as referral and filing of special chronic diseases by medical institutions above the second level.
(2) Pay close attention to the requirements of the "standardization office" and further promote the standardization construction.
Efforts should be made to carry out standardization construction and greatly improve the standardization capacity of grass-roots handling services. The first is to set standards. In the context of the lack of norms and guidance for the operation of grass-roots business below the district and county level, the organization formulated and issued the first medical insurance grass-roots management standard in Zhejiang Province- Huzhou City's "Medical Security Business Grass-roots Management Specification", which regulates 4 categories and 20 medical security service matters such as insurance participation on grass-roots platforms and the transfer and continuation of basic medical insurance relationships. The second is to implement standards. The city's medical security agencies at all levels regard the implementation of standards as an important task, focusing on strengthening the training of grass-roots management outlets to ensure that the handling of the same matter by different grass-roots management outlets meets the requirements of the standard from process to quality. The third is to strengthen guidance. On the basis of organizing unified training for the staff of grass-roots handling outlets, a business guidance team composed of the backbone of the municipal, county and district handling agencies is formed, and a dynamic and immediate guidance mechanism is established.
(3) Tap the potential of "intimate office" and continue to strengthen the construction of travel style.
Through continuous strengthening of the construction of travel style, enhance the internal driving force of cadres and workers to intimately serve the masses. The first is to set up a model and lead by example. Pay attention to the selection of advanced trees, and give play to the exemplary and leading role of excellent models. Construct grassroots demonstration sites for medical insurance business, and select 2 township (street) and village (community) medical insurance service demonstration sites in each district and county. Organize and carry out the "most beautiful window" and "most beautiful medical insurance person" tree selection activities of Huzhou Medical Security System, allocate more than 90% of the quota to the district and county and the following grass-roots management outlets, and the district and county will select the best to participate in the tree selection, and encourage the grass-roots level to strive for excellence and create enthusiasm. The second is to clarify responsibilities and strengthen evaluation. The service capability of improving the "15-minute service circle" will be included in the assessment of district and county target responsibilities. Include the business materials handled by the grass-roots platform into the scope of internal control inspections, regularly carry out sampling inspections, implement problem rectification, and use relevant circumstances as the basis for various year-end assessments and selections. The third is to collect opinions and respond positively. Attach importance to the collection of opinions of the masses, carry out "good and bad evaluation" evaluation, and actively respond to the concerns of the masses, such as Wuxing District to provide door-to-door services for the needy people with limited mobility and bedridden; Anji County to carry out a basic medical insurance accident injury "video live broadcast" investigation, shorten the time limit for the investigation of accidental injury cases, streamline the process, so that the insured people can enjoy the treatment earlier.
(4) Give play to the effectiveness of the "intelligent office" and help promote the "digital" reform.
Explore ways to better play the supporting role of intelligent systems in handling, and achieve the joint improvement of service efficiency and quality of grass-roots handling platforms. The first is to promote the "network office" and "palm office". Publicize and promote the "online office" and "palm office" matters, improve the online handling rate, such as Wuxing District, Nanxun District township (street), village (community) grass-roots service outlets to carry out on-site guidance, to help the masses complete the annual resident medical insurance payment online, widely praised by the masses. As of the end of June, the rate of "palm office" and "online office" in Huzhou City (2.0 receiving rate) reached 92.88%. The second is to strengthen the intelligent internal control of business management. Introduce an intelligent internal control platform for medical insurance business management, realize the "intelligence" of internal risk control, and focus on the control of the operation behavior of personnel business systems such as service halls, townships (streets), villages (communities) grass-roots service windows, bank agencies, and system development and operation and maintenance. Launched the sporadic reimbursement intelligent audit system, through digital scanning and entry, quickly completed the review and settlement of sporadic reimbursement invoices and lists, greatly reduced the time limit for business circulation, and realized that the process was fully traceable and traceable. The third is to strengthen the use of data. Promote the activation and use of medical insurance electronic vouchers, widely mobilize the city's medical insurance departments, designated medical institutions, third-party cooperation channels and other forces, and continuously improve the activation rate and utilization rate, so that more insured people can enjoy the convenience of medical treatment brought by medical insurance electronic vouchers. Explore the innovation of data application, such as Anji County taking the lead in establishing an Anji people's livelihood data (medical assistance accurately supporting the weak) platform in the province, and dynamic detection ensures that the self-help participation rate and rescue rate of the rescue targets reach 100%.
In August 2021, Huzhou City proposed to take the lead in creating an "undifferentiated urban and rural area" with people's "undifferentiated sense of happiness, sense of gain, and sense of security" as the core, and Huzhou Medical Insurance Agency will take this as an important standard, continue to improve the ability of medical insurance grass-roots management services, and strive to provide better services for the insured people in the city.
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