In order to thoroughly implement the Party Central Committee's decision to improve the basic public service system and consolidate and improve the medical security handling service system and comprehensive capacity, Chenzhou City, Hunan Province adheres to the people-centered development ideology, and in accordance with the requirements of the Hunan Provincial Medical Security Bureau's "Guiding Opinions on Strengthening the Provincial Medical Security Handling Service System and Comprehensive Capacity Building" (Hunan Medical Security [2021] No. 69), through the full implementation of effective measures such as grid extension, standardized construction, digital transformation, and family services, it has comprehensively built a standardized, unified, and family-oriented service. The medical security management service system with linkage up and down, high-quality service and efficient operation realizes more unified, efficient, high-quality and convenient medical insurance management services, and achieves good social benefits.
First, the construction of the service system
(1) Grid extension to build a "15-minute service circle" for medical insurance management. It took two years to build a five-level service system with provincial-level agencies as the leader, municipal-level agencies as the center, county-level agencies as the position, township (street) medical insurance service stations as the hub, and village (community) medical insurance service points as outlets. At present, the city has built 159 township (street) medical insurance service stations and 2,406 village (community) medical insurance service stations, covering 100%. On this basis, promote the extension of medical insurance handling services in multiple fields, make use of the resource advantages of various industries, and establish 1,376 extension service outlets with different characteristics in designated medical institutions, cooperative financial institutions, industrial parks, large-scale factories and mines, schools, Hunan and Jiangxi border areas, migrant work concentrations, residential communities, scenic spots and other places, carry out direct or help agency medical insurance services, and handle more than 100,000 medical insurance matters for the masses throughout the year.
(2) Standardize construction and create "eight haves" configuration standards for grassroots outlets. In the construction of medical insurance service outlets, the city in accordance with the "eight haves" standard of "special windows, special personnel, logos, signs, equipment, systems, systems, and lists", standardize the construction of medical security service sites, and strengthen the standardization of windows. On this basis, the list of medical insurance service items and the list of authority are further clarified, 23 items are delegated to the township (street) and village (community) medical insurance service sites to be handled directly or on behalf of the agency, and 20 items are empowered to the diversified service sites to help the agent, so that the masses can experience convenient and efficient medical insurance services without leaving home. At the same time, to improve the ability and level of grassroots management services as the focus, establish and improve the medical insurance handling service training mechanism, carry out city, county, township (street), village (community) medical insurance policy, business operation, information security and other training, guidance, to ensure that the decentralization of matters "can be received and managed well". In 2023, the city will carry out more than 290 training sessions for medical insurance handling teams, with more than 10,000 people trained.
(3) Digital transformation and promote the construction of "smart" medical insurance on grassroots platforms. The construction of smart medical insurance provides technical support and endogenous power for improving the quality and efficiency of medical insurance handling services. Relying on the national medical insurance information platform, Chenzhou City has continuously improved the digital level of medical insurance services, opened online and offline service channels such as windows, networks, telephones, and mobile terminals in medical insurance service agencies (outlets) at all levels, and promoted the application of "grassroots service platforms", "unit network halls", "Hunan medical insurance" App, WeChat public accounts and small programs to carry out medical insurance services according to the different needs of the insured objects, and promoted more medical insurance services to achieve "handheld", "online", "self-service" and "code". Take the lead in the province to realize the circulation of medical insurance electronic prescriptions, realize the interconnection and real-time sharing of hospital prescription information, medical insurance settlement information, and drug consumption information, implement the "zero meeting" online signing of medical insurance fixed-point agreements, promote the online handling of sporadic reimbursement, strengthen the docking of medical insurance handling and government affairs integration, and comprehensively improve the level of medical insurance handling information services through the deep integration of medical insurance handling service innovation and information technology such as the Internet and big data, so that data can run more and the masses can run less errands.
2. Main experiences and practices
(1) Adhere to government leadership. In June 2022, the Provincial Medical Insurance Bureau identified Chenzhou as the only pilot city in the province to carry out the pilot work of the provincial and municipal joint construction of a five-level medical insurance management system. The Chenzhou Municipal Government attaches great importance to the implementation plan for the pilot work of the five-level medical insurance management system jointly built by Chenzhou provinces and cities, and set up a special class headed by the deputy mayor in charge of medical insurance, health care, civil affairs, finance, human resources and social security, administrative examination and approval, taxation, education, financial management and other departments to strengthen linkage and close cooperation, build a working mechanism of unified government leadership and close cooperation of various departments, and form a work pattern of joint participation in the construction of the medical insurance management system. At the same time, the construction of the medical insurance handling service system was included in the comprehensive performance appraisal content, and special promotion meetings were held many times to promote the implementation of the five-level medical insurance management system jointly built by provinces and cities.
(2) Innovate systems and mechanisms. Chenzhou City continues to innovate working methods, build a vertical to the end, horizontal to the edge of the medical insurance management service system, smooth service network channels, for the province to build a five-level medical insurance management system to provide a "Chenzhou model" and "Chenzhou ideas". The first is to set up a "medical insurance + bank" convenient service station for the first time. Make full use of the breadth and service of financial institutions, expand the "medical insurance + bank" convenient medical insurance service model, and boldly explore the new form of "medical-bank cooperation". The second is the first to extend the tentacles of medical insurance services to residential communities. Empowering residential communities to improve the service capacity of grassroots medical insurance, so that residents can easily and quickly handle medical insurance services at the "doorstep", and handled more than 800 businesses for residents in the community throughout the year, smoothing the "last mile" of serving the masses. The third is to take the lead in setting up medical insurance service points in scenic spots. Focusing on the service quality improvement target requirements of the 2nd Hunan Tourism Development Conference, we will take the initiative to perform our duties, innovate services, and set up medical insurance service points in the city's 4A-level and above scenic spots, so as to provide tourists with accessible, convenient and fast medical security services, and contribute to the medical insurance force for Chenzhou to establish a caring and warm image of cultural tourism.
(3) Establish a long-term mechanism. In the construction of the five-level medical insurance management system, Chenzhou City adheres to the problem-oriented, demand-oriented, and goal-oriented, focuses on the urgent and difficult problems of the masses, strengthens research, and formulates relevant policies and measures to improve the quality, convenience, accessibility and other aspects of medical insurance services, solidifies the effectiveness of rectification and reform into the system construction, and promulgates the "Implementation Plan for the Pilot Work of Chenzhou Provincial and Municipal Co-construction of Five-level Medical Insurance Management System" and "Notice on Further Promoting the Construction of Provincial and Municipal Five-level Medical Insurance Handling Service System" and a number of other institutional documents for the construction of the medical insurance handling service system, continuously improve the handling service system and the long-term mechanism of comprehensive capacity building, and effectively improve the standardization level of the medical insurance governance system and governance capacity.
3. Arrangements for the next step
(1) Further standardize the construction of grassroots medical insurance work points. On the basis of consolidating the existing work results, accelerate the establishment and improvement of the grass-roots service network, vigorously promote the sinking of services, gradually increase the number of grass-roots things that can be done, comprehensively improve the coverage of grass-roots services, and further extend the medical insurance service outlets in financial institutions, industrial parks, large-scale factories and mines, Hunan and Jiangxi border areas and migrant workers' concentration areas, optimize and improve the "15-minute medical insurance service circle", vigorously promote the direct handling of medical insurance handling services or help agents, and create a number of grass-roots handling and helping agents "Chenzhou model", and putting "people's livelihood hope" It has become "the praise of people's livelihood", so that the masses have a sense of gain, happiness and security.
(2) Further promote the establishment of medical insurance standardization demonstrations. According to the requirements of the national and provincial medical insurance bureaus on the medical security handling service system and comprehensive capacity building, focus on the pain points, difficulties and blocking problems reported by the masses, further strengthen the standardization and standardization of medical security handling services at the city, county (urban area), township (street) and village (community) levels, fully implement the "six unifications" and "four most" requirements of handling government services, unify service specifications and service standards, improve the service mechanism, and better promote the "one thing at a time" and "one network for all" and effectively improve the standardization level of medical insurance public services. Fully implement the one-time notification system, the first question responsibility system, the time-limited handling system, "good and bad reviews" and other service mechanisms, and actively build the Chenzhou medical security service brand.
(3) Further improve the level and ability of grassroots medical insurance. In view of the problems of weak primary medical insurance infrastructure, aging equipment allocation, insufficient staffing, and shortage of work funds, we will further optimize the operation of the grassroots platform of the system and improve the relevant functions, so that the majority of grassroots medical insurance operators will feel more convenient, easy to use and practical when operating the grassroots system platform. At the same time, we will continue to optimize the construction of the team of grassroots medical insurance handling agencies, strengthen the policy and business training of handling personnel, strengthen the management assessment and supervision, and improve the efficiency of medical insurance at the grassroots level.
Author | Chenzhou Medical Security Bureau
Source | China Medical Insurance
Edit | Fu Meiru buys Xiaofei
Hot Article
• The "Two Excellences" special action promotes the quality and efficiency of the medical insurance handling matters in the whole region
• Improve quality and efficiency with intelligence and promote the transformation of management into "fine management"
• Birth "one thing" is handled through one network, and there is "medicine" to rely on when traveling...... In this way, all localities have improved the people's medical experience →