The medical insurance deductible line refers to the starting point of medical insurance reimbursement, that is, only the amount exceeding the deductible line will be reimbursed, and the part within the deductible line will be borne by the individual, and the expenses exceeding the deductible line will be reimbursed in proportion according to the provisions of the medical insurance catalogue.
Regarding medical security, the report mainly mentions the following aspects:
The first is to promote the provincial-level overall planning of basic medical insurance.
In 2020, the State Council, the Central Committee of the Communist Party of China put forward in the Opinions on Deepening the Reform of Medical Security System: "Explore and promote the vertical management of medical security departments below the prefecture level. Encourage qualified provinces (autonomous regions and municipalities directly under the Central Government) to promote provincial-level overall planning in accordance with the ideas of hierarchical management, hierarchical responsibility, overall adjustment and budget assessment. " 202 1 Premier Li Keqiang put forward "promoting the provincial overall planning of basic medical insurance" in his report at the Fourth Session of the 13th National People's Congress. In the same year, the Tenth Five-Year Plan further clarified the specific implementation path, that is, "in accordance with unified and standardized policies, balancing fund transfers, improving hierarchical management, strengthening budget assessment, improving management services, and promoting the direction of provincial overall planning." This year, Premier Li Keqiang once again emphasized in his report. It is certain that during the Tenth Five-Year Plan period, the work of "promoting the provincial overall planning of basic medical insurance" will be accelerated and substantial progress will be made.
Two, promote the centralized procurement of drugs and high-value medical consumables.
Since the establishment of the National Medical Insurance Bureau, * * * has carried out six batches of centralized procurement of drugs organized by the state, and * * * has purchased 234 kinds of drugs, involving 30% of the total annual procurement of chemicals in public medical institutions. According to the purchase amount before centralized procurement, the accumulated cost savings are more than 260 billion yuan. In the centralized procurement of high-value medical consumables, the results of coronary stent selection have been implemented for one year, and the annual procurement volume of selected products is 654.38+0.69 million, reaching nearly 654.38+0.6 times of the agreed procurement volume. The average price of artificial joints is reduced by 82%. The people's burden of drugs and medical consumables has been significantly reduced, which has been widely praised by all walks of life and the people. 202 1, 1 The General Office of the State Council issued the Opinions on Promoting the Normalization and Institutionalization of Centralized Drug Purchase (Guo Ban Fa [2021] No.2); In April of the same year, with the consent of the State Council, the National Medical Insurance Bureau and other eight departments jointly issued the Guiding Opinions on Organizing the Centralized Procurement and Use of National High-value Medical Consumables (No.31of Medical Insurance Fa [20265438]), which marked the normalization and institutionalization of centralized procurement of drugs and high-value medical consumables. This report once again reiterated that "promoting centralized procurement of drugs and high-value medical consumables" not only indicates the future development trend of drug and medical consumables procurement, but also means the state's affirmation and support for centralized procurement.
Third, deepen the reform of medical insurance payment methods.
Medical insurance payment is an important link in medical insurance management and deepening medical reform, an important lever to standardize medical service behavior and guide the allocation of medical resources, and an inseparable part of medical insurance system. In February, 2020, the Central Committee of the Communist Party of China, the State Council, demanded in the Opinions on Deepening the Reform of Medical Security System that "multiple and compound medical insurance payment methods should be promoted, and payment should be made in groups related to disease diagnosis. Long-term hospitalization such as medical rehabilitation and chronic mental illness is paid by bed day, and outpatient special chronic diseases are paid by head. " After three years of trial, by the end of 20021,30 national pilot cities and 7 1 regional pilot cities all entered the actual payment stage, and the trial results were remarkable. On this basis, on 202 1, 1 1, the national medical insurance bureau officially issued the "three-year action plan for DRG/DIP payment mode reform" (No.48 of Medical Insurance Fa [20021]), requiring all localities to fully complete the DRG/from 2022 to 2024. The report puts forward "deepening the reform of medical insurance payment methods", which means that the horn of deepening the reform of medical insurance payment methods has been blown in an all-round way, and the reform of medical insurance payment methods will be further promoted.
Four, strengthen the supervision of medical insurance funds.
The medical insurance fund is the "medical money" and "life-saving money" of the people. The Central Committee of the Communist Party of China the State Council clearly pointed out that "maintaining the security of the fund must always be the primary task. It is necessary to knit the institutional cage for the supervision of medical insurance funds, focus on promoting the reform of the supervision system, establish and improve the medical insurance credit management system, and severely crack down on fraudulent insurance with a zero-tolerance attitude to ensure the safe, efficient and rational use of funds. " Since the establishment of the National Medical Insurance Bureau, * * * has inspected medical institutions 708,000 times, handled 410.4 million times, recovered more than 23.4 billion yuan, and exposed 70,000 cases. 30 flight inspections were organized, and 68 designated medical institutions and 30 medical insurance agencies in 29 provinces were actually investigated, and 558 million yuan of suspected illegal funds were found. The achievements of fund supervision are obvious to all. With the promulgation and implementation of a series of policies and regulations, such as the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, the supervision system and mechanism of medical insurance funds have become increasingly sound and constantly improved, and the security of funds has been further guaranteed by the system. The "Report" once again reiterated that "strengthening the supervision of medical insurance funds" means that the supervision of medical insurance funds will be continuously strengthened and normalized and institutionalized.
Five, to achieve the basic unity of the national medical insurance drug range.
In the past, the policy stipulated that all localities were allowed to make appropriate adjustments according to the local economic level, medical needs and medication habits within the scope of the national basic medical insurance Class B drug list. With the development of economy and society, living in different places and floating employment have gradually become the norm of life, and the frequency of medical treatment in different places is getting higher and higher. The unfair treatment caused by inconsistent drug lists in different places has become more and more prominent, which has also triggered a series of contradictions. To this end, since 20 19, the state has clearly stipulated that "all localities should strictly implement the drug list, and may not make their own list or add drugs to the list in a flexible way, nor may they adjust the limited payment scope of drugs in the list themselves. Class B drugs added to the original provincial drug list according to regulations should be gradually digested within 3 years. " The "Report" puts forward that "the scope of medical insurance drugs in the whole country is basically unified", which can be regarded as a re-emphasis on the above policy provisions.
Six, improve the direct settlement of medical treatment across provinces.
For a long time, the CPC Central Committee and the State Council have always attached great importance to the inter-provincial direct settlement of medical expenses. Since the inter-provincial direct settlement of hospitalization expenses was started on October 6, 20/KLOC, at present, the inter-provincial direct settlement of hospitalization and general outpatient expenses and online filing of medical treatment in different places have been opened in all co-ordination areas. At the same time, by continuously optimizing the filing management, speeding up the construction of information systems, and strengthening the supervision of funds, it is more convenient and efficient for ordinary people to directly settle medical treatment in different places. In 20021year, 52,700 designated medical institutions directly settled hospitalization expenses across provinces, and 4.406 million people directly settled hospitalization expenses across provinces; There are 45,600 designated medical institutions and 82,700 networked retail pharmacies that have opened cross-provincial direct settlement of outpatient expenses, and the cumulative cross-provincial direct settlement of outpatient expenses has been realized 1.25 1.440 person-times. The cross-provincial medical service experience of ordinary people continued to improve steadily. The "Report" proposes to "improve the direct settlement method for cross-provincial medical treatment in different places". For the medical insurance department, it is necessary to further improve the service quality of direct settlement of cross-provincial medical treatment in different places, further reform and optimize the filing process and management system of cross-provincial medical treatment in different places, make the policies more unified and simpler, make the policies and filing regulations of cross-provincial medical treatment in different places more concise and easy to understand, make it more convenient and smooth for ordinary people to seek medical treatment in different places, continuously improve the direct settlement rate of cross-provincial medical treatment in different places, and strive to improve the service experience of people in different places.
legal ground
* * * Central Committee's proposal on formulating the 14th Five-Year Plan for national economic and social development and the long-term objectives of the 2nd to 3rd Five-Year Plan.
12. Develop strategic emerging industries. Accelerate the expansion of a new generation of information technology, biotechnology, new energy, new materials, high-end equipment, new energy vehicles, environmental protection, aerospace, marine equipment and other industries. Promote the deep integration of the Internet, big data and artificial intelligence, promote the development of advanced manufacturing clusters, create a number of strategic emerging industry growth engines with distinctive features, complementary advantages and reasonable structure, and cultivate new technologies, new products, new formats and new models. Promote platform economy and enjoy healthy economic development. Encourage mergers and acquisitions of enterprises to prevent low-level redundant construction.
13. Accelerate the development of modern service industry. Promote the extension of producer services to specialization and high-end value chain, promote all kinds of market players to participate in service supply, accelerate the development of R&D design, modern logistics, legal services and other services, promote the deep integration of modern services with advanced manufacturing and modern agriculture, and accelerate the digitalization of services. Promote the life service industry to upgrade to high quality and diversification, accelerate the development of health, pension, childcare, culture, tourism, sports, housekeeping, property and other service industries, and strengthen the supply of public welfare and basic services. Promote standardization and branding of service industry.