Hebei Yongnian: Deepening Reform To Help Medical Security Strict crackdown on fraud and insurance benefit social and people's livelihood

Since 2021, in accordance with the overall requirements of "guaranteeing basic, sustainable, benefiting people's livelihood and promoting reform", the Yongnian District Medical Security Bureau has focused on the problems of "difficulties, blockages and pain points" in the field of medical security and people's livelihood, continued to carry out anti-fraud and insurance fraud actions, focused on continuously improving the level of medical insurance governance, effectively reduced the burden of medical treatment, and enhanced the people's sense of gain, happiness and security.

The coverage of insurance coverage has increased year by year, and the operation of the fund is safe and stable

A total of 801,000 people participated in basic medical insurance in Yongnian District, and 769,600 people participated in medical insurance for urban and rural residents, with an insurance participation rate of 100.2%, exceeding the task of expanding the coverage of insurance. Among them, 28,073 special personnel in the whole district were given full subsidies to participate in the insurance, with a subsidy amount of 7.8604 million yuan; 31,400 people participated in the medical insurance for employees, and the number of insured units reached 445. The district medical security bureau strictly follows the principle of "fixed income and expenditure, balance of income and expenditure, and slight balance", to ensure that the expenses payable are disbursed in full and in a timely manner, and the balance rate and accumulated balance rate of the fund for the current year are reasonably controlled, and the fund operates safely and smoothly.

Continue to crack down on fraud and insurance fraud and purify the regulatory environment of the fund

In order to tighten the "money bag" of medical insurance and keep the people's "life-saving money", the District Medical Security Bureau took the opportunity of the special rectification of the case of the Xucun Branch of the Xinyi Township Health Center in Cheng'an County to defraud the medical insurance fund, and made a heavy punch and a fierce hand, focusing on the purchase and sale of drugs and consumables in designated medical institutions, stacked bed hospitalization, traditional Chinese medicine physiotherapy, Western medical examination, laboratory testing, medical record verification and other violations, conducted interviews with medical institutions involved in violations, deducted points from doctors, and required rectification in place. Establish a long-term mechanism. The District Medical Security Bureau has always taken the fight against fraud and insurance fraud as the primary task, adhered to the treatment of both symptoms and root causes, comprehensively implemented policies, and built a long-term supervision mechanism, so that designated medical institutions do not dare, cannot, and are unwilling to participate in fraud and insurance fraud, and resolutely act as the gatekeeper of medical insurance funds.

Deepen the reform of medical security and promote the high-quality development of medical security

First, strictly implement the centralized procurement of drugs, a variety of commonly used drugs to implement the national procurement, price negotiations, prices significantly reduced. On time, the state-negotiated drug hanging net, the fourth batch of state-organized drug centralized procurement, the second batch of state-organized drug centralized drug procurement renewal, the "Sanming Alliance" with quantity drug renewal procurement and use, and the provincial chemical drug network work were completed on time. On the basis of the implementation of the medical insurance fund settlement system for the drugs in the centralized procurement catalog, the medical insurance fund with the centralized procurement of medical consumables has been increased, which has greatly shortened the payment collection cycle of the enterprise. The second is to continue to promote the reform of medical insurance payment methods, and invite experts from the Municipal Bureau to train the first and second hospitals of the district that simulate the reform of the payment method according to the disease diagnosis related grouping (DRG), laying a good foundation for the operation of the DRG payment method. The third is to further strengthen the construction of informatization, we successfully completed the province's unified medical security information platform switching work in May this year, laying a solid foundation for the realization of humanization of public services, integration of business management, intelligent supervision and management, and data-based decision-making.

Optimize convenient services and continuously enhance the happiness of the insured people

Since July 1, the district has realized the online declaration of chronic disease, patients with chronic disease can complete the declaration of chronic disease at any time directly through the WeChat Mini Program, since the opening of the online declaration, the online platform has declared a total of 1375 people for chronic diseases; 324 people have been declared for special diseases; since September 1, the transfer to the hospitalization "no place in the province" has been realized, and the insured personnel have selected the designated medical institutions and designated retail pharmacies that have opened off-site medical treatment in all the coordinating areas of the province, and the outpatient expenses are directly settled to purchase drugs at designated medical institutions and designated retail pharmacies, without filing, Realize direct settlement of medical treatment in different places in the province.

In the next step, the Yongnian District Medical Security Bureau will firmly grasp the supervision of the medical insurance fund, deepen the reform of medical security, optimize the medical insurance handling services, further do a good job in people's livelihood, continue to solve the problems of the masses " difficult to see a doctor " and "expensive to see a doctor", truly solve the people's worries, warm the people's hearts, and make outstanding contributions to building a prosperous, strong, civilized and beautiful modern New Yongnian! (Wang Gendong, Wang Wenhao, Zhang Hongjun)