The "Notice" proposes that the scope of centralized treatment of childhood leukemia, congenital heart disease in children, esophageal cancer, gastric cancer, colon cancer, rectal cancer, end-stage renal disease and other serious diseases should be covered to all rural poor patients, and urban poor patients suffering from congenital heart disease and childhood leukemia should be included in the scope of special treatment. At the same time, we will comprehensively promote the reform of compound payment methods, such as paying by disease, paying by head and paying by bed day, and carry out the trial of collecting and paying by disease diagnosis related groups (DRGs), further expand the coverage of payment method reform to designated medical institutions and participating patients, and change the total amount control of individual medical institutions into total amount control in the region, and explore the point-based payment method.
In addition, the "Notice" once again emphasizes actively promoting the nationwide networking of the new rural cooperative medical information platform, and improving the construction, compensation policy and management and operation mechanism of medical information systems in different places. Comprehensively promote the settlement of medical treatment in different places in the province, effectively improve the convenience and timeliness of the settlement of medical treatment in different places for participating patients, accelerate the settlement of medical treatment in different provinces, and ensure the direct settlement of medical treatment for inpatients referred by the new rural cooperative medical system by the end of 20 17.
Notice on Doing a Good Job in New Rural Cooperative Medical System in 20 17 Years
Guowei grass-roots development [2017] No.20
All provinces, autonomous regions and municipalities directly under the central government, health and Family Planning Commission, Finance Department (bureau), Fujian Medical Insurance Office:
According to the requirements of deepening the reform of the medical and health system, we hereby notify you of the new rural cooperative medical system (including the basic medical insurance for urban and rural residents managed by the health and family planning departments, hereinafter referred to as the new rural cooperative medical system) for 20 17 years as follows:
First, raise the standard of financing
In 20 17, the per capita subsidy standard of financial departments at all levels to the new rural cooperative medical system was raised from 30 yuan to 450 yuan on the basis of 20 16, in which: the central government subsidized the newly-increased part according to the proportion of 80% in the western region and 60% in the central region, and subsidized the provinces in the eastern region according to a certain proportion. On the basis of 20 16 years, the individual payment standard of farmers will be raised in 30 yuan, and in principle, the national average will reach about 180 yuan. Explore the establishment of a stable and sustainable financing mechanism that is compatible with the level of economic and social development and the affordability of all parties.
Second, improve the guarantee performance
Within the scope of the policy, the reimbursement ratio of outpatient and inpatient expenses will be stabilized at about 50% and 75% respectively, and the gap between the policy reimbursement ratio and the actual reimbursement ratio will be gradually narrowed. Expand the scope of day surgery included in the payment, include eligible hospital delivery expenses in the scope of reimbursement, and include qualified medical institutions in old-age care institutions and social medical institutions in the designated scope according to regulations. Actively promote chronic diseases such as hypertension, diabetes, and severe mental disorders, and implement chronic disease compensation policies that are different from ordinary outpatient clinics.
Third, improve the serious illness insurance policy
Continue to increase investment, a certain proportion of the new financing of the new rural cooperative medical system should be used for serious illness insurance, and further adjust and improve the overall compensation plan for serious illness insurance. Reduce the deductible line of major illness insurance for poor people by 50%, and promote more poor people to benefit from major illness insurance. We will improve the linkage reimbursement mechanism of the new rural cooperative medical system, serious illness insurance, medical assistance, disease emergency assistance and commercial supplementary insurance, and promote the "one-stop" settlement service. We will do a good job in the special treatment of serious diseases among the rural poor, and cover all rural poor patients with childhood leukemia, congenital heart disease, esophageal cancer, gastric cancer, colon cancer, rectal cancer and end-stage renal disease, and include urban poor patients with childhood congenital heart disease and childhood leukemia in the special treatment scope. Support all localities to adopt the policy of "first diagnosis and treatment, then payment" for the poor, and pay the reimbursement funds advanced by medical institutions in the county in full and on time.
Fourth, deepen the reform of payment methods
We will comprehensively promote the reform of compound payment methods, such as paying by disease, paying by head, and paying by bed day, and carry out the trial of charging and paying by disease diagnosis related groups (DRGs) to further expand the coverage of payment method reform to designated medical institutions and participating patients. The total amount control of individual medical institutions will be transformed into total amount control in the region, and the point method will be explored to pay. Establish and improve the working mechanism of contact points for payment mode reform, and strengthen the guidance, evaluation and summary of payment mode reform. Help the construction of graded diagnosis and treatment system, and include the contracted service fees of family doctors that meet the requirements into the scope of medical insurance payment. Support the reform of regional medical service integration, explore the guidance and regulation of payment policies such as total prepayment, and promote the standardized service, up-and-down linkage, division of labor and cooperation, and active fee control of medical institutions at all levels in urban compact medical associations and county medical institutions. Initiate the implementation of the new rural cooperative medical service payment standard according to the generic name of drugs, cooperate with the reform of medical service price, explore the formulation of the new rural cooperative medical service payment standard, and jointly promote the price reform of drugs and medical services.
Five, speed up the remote medical network report
Accelerate the nationwide networking of the new rural cooperative medical information platform, and improve the construction of medical information systems in different places, compensation policies and management and operation mechanisms. Comprehensively promote the settlement of medical treatment in different places in the province, and effectively improve the convenience and timeliness of the settlement of medical treatment in different places for participating patients. Accelerate the work of cross-provincial medical treatment in different places, and ensure the direct report of cross-provincial designated medical treatment for inpatients referred by the new rural cooperative medical system before the end of 20 17. Encourage social forces to participate in the work of closing newspapers in different places, give full play to the role of the market mechanism, and improve the efficiency and level of handling. All kinds of designated medical institutions at all levels should timely connect the information system, strengthen internal management, improve the relevant working mechanism, and cooperate to do a good job in the service of medical treatment in different places. Actively promote the application of medical insurance intelligent monitoring system, and extend the supervision of medical institutions to medical personnel.
Sixth, promote institutional integration
Implement the State Council's "Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents" (Guo Fa [2016] No.3) and the "Several Opinions of the Leading Group for Deepening the Reform of the Medical and Health System in the State Council" (No.36 [2016]). In the process of system integration, the lowest level of individual contributions shall not be lower than the national standard in the overall planning area where grading financing is implemented and the insured voluntarily chooses the payment grade method. Strengthen the monitoring and analysis of policy continuity and fund operation before and after integration to ensure the smooth operation of the fund and the sustainable development of the system. Accelerate the rationalization of the basic medical insurance management system, carry out the pilot work of setting up a medical insurance fund management center, undertake the functions of fund payment and management, drug procurement and expense settlement, medical insurance payment standard negotiation, agreement management and settlement of designated institutions, and give full play to the supervision and restriction of medical insurance on pharmaceutical production and circulation enterprises, hospitals and doctors. We will continue to promote the separation of management and management, deepen the participation of social forces such as commercial insurance institutions in handling services, and promote the establishment of a fair, open and orderly competitive service pattern for urban and rural residents' basic medical insurance.
Seven, to ensure the safety of the fund
Do a good job in monitoring and analyzing the fund operation in the process of integrating the medical insurance system for urban and rural residents, and effectively prevent fund risks. Strengthen organizational leadership, implement regulatory responsibilities, and form a working pattern of departmental linkage and joint management. Health and financial departments at all levels should take the initiative in conjunction with auditing, public security, supervision and other departments to strictly guard against and severely crack down on the behavior of defrauding the new rural cooperative medical fund, and timely investigate and eliminate the hidden dangers of fund security. Improve the accountability system, and increase penalties for illegal acts such as corruption, misappropriation, misappropriation and fraudulent use of the new rural cooperative medical fund according to law.
Ministry of Finance, National Health and Family Planning Commission
201April 7 13
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