Every day after work, Li Hua, head of the comprehensive business reception section of the Beijing Haidian District Medical Insurance Bureau, will spend at least half an hour to check the work ledger of the day with his colleagues - which ones have been properly handled, which ones have not yet had time to give solutions, which ones need to be coordinated and promoted by other departments, and which ones need to be given detailed feedback to the masses...... One by one, as long as the problems that could not be done smoothly in the first time on the day and the masses reported to the "can't do things" window in the service hall, Li Hua and his colleagues would record them, sort them out one by one, list the progress, review them afterwards, and use sticky notes of various colors to separate different matters.
"The comprehensive business reception department serves more than 3 million insured people in the whole region, and is the most important medical insurance external service window in Haidian. To this end, we have set up a special 'can't do it' window to deal with various medical insurance 'problems'. Li Hua told "China Medical Insurance", because the medical insurance business and other departments and units of a number of work interlocking, it is inevitable to encounter the masses can not be successfully completed, at this time, she and the colleagues in charge of this window business will be in accordance with the Municipal Affairs Bureau's "on the municipal affairs service center to solve the problem of the masses "can't do things" work plan and Haidian District Medical Insurance Bureau "on the work plan to solve the problem of the enterprise masses "can't do things" related work requirements, truthfully recorded and solved within a time limit. "Whether it has been resolved or needs to be promoted, the purpose of recording these situations is, on the one hand, to avoid omissions and advance in a timely manner; On the other hand, it is also to analyze the reasons and continuously improve to ensure that when similar situations arise again, they can provide satisfactory solutions to the public in the first time. ”
“绝不会轻易对办事人Say No”
The so-called "can't do things" refers to the difficulties in the process of communication with the unit or hospital, the need for coordination and handling by the medical insurance department, or the inability of the masses to enjoy the normal medical insurance treatment due to problems in other business links. At the beginning of the establishment of the Beijing Haidian District Medical Insurance Bureau, there was a similar special affairs window. In June 2021, in order to better provide services for the insured, the Haidian District Medical Insurance Bureau set up a window at the consultation desk in the service hall to reflect the "can't do things", and established a "problem sheet" registration system, which is responsible for handling all kinds of difficult problems of the insured within a limited time.
Long-term hospitalization is unable to apply for manual reimbursement in time, resulting in financial difficulties, and due to poor physical condition, it is impossible to return to Beijing in time to do special disease filing...... In the past, the demands of these insured people who were difficult to solve at the general acceptance window have now been satisfactorily resolved through this "can't do anything" window.
Li Hua's office is located in the innermost part of the medical insurance service hall. On the desk, which is not very spacious, there are several thick piles of materials - blue clips contain the materials that have already been done; The red folder is full of all kinds of things to follow up; In the yellow folder are the materials that have been jotted down at work and have not yet had time to be seriously archived.
With more than 20 years of work experience in the medical insurance window, she has trained a pair of "tailwind ears" and two sets of "brain information processing systems". Every day, in addition to routinely inspecting the hall and solving difficult problems at the consultation desk, Li Hua is also responsible for handling the receipt of documents from various committees and bureaus in a timely manner. When dealing with desk work, she also has an important task, "stand up" her ears to pay attention to all kinds of movements in the service hall at any time, and resolve emergencies in the hall at all times.
"Medical insurance is a terminal link, and many people only find out that their medical insurance has such and such problems when they see a doctor, and some of them may be problems in the insurance link, which are exposed when they see a doctor for reimbursement." As long as he heard that someone outside suddenly raised his voice due to emotion, Li Hua would immediately put down his work and rush out to understand the situation as soon as possible.
"I'm in a hurry when I'm sick, and if I can't reimburse the expenses normally, I'm definitely on fire. If the problems encountered cannot be solved for a while, it is inevitable that everyone will lose their temper. "Comparing heart to heart is the attitude that Li Hua has been adhering to for more than 20 years." Regardless of the insured's emotions, we must first listen carefully and then find a way to provide solutions. If you can deal with it as much as possible to coordinate and solve it on the spot, we will also carefully record it if you can't deal with it on the same day. ”
As the second municipal district in the country with an economic aggregate of more than one trillion yuan and the first prefecture-level district in the country to exceed one trillion yuan, the concentration of various enterprises is a major feature of Haidian District in Beijing. Creating a medical insurance service that does not say "no" to enterprises and the masses is the purpose of Li Hua and his colleagues.
In November 2023, Mr. He, the corporate manager of a cultural media company, came to the medical insurance service hall in Haidian District for help. When he was helping the company to handle the cancellation of the unit, he received a pop-up window from the online office of the District Industrial and Commercial Bureau that "there is an objection to medical insurance for simple cancellation", so he came to the hall to inquire.
According to previous experience, after the national medical insurance information platform was launched, the unit received similar prompts when it was cancelled, most of which were related to social security registration. After confirming with Mr. He that there were no unreimbursed expenses in the enterprise, the shift leader of the medical insurance service hall that day contacted the District Market Supervision and Administration Bureau to understand the situation.
"There is a 20-day publicity period for enterprise deregistration, and once there is an abnormality, it is necessary to first lift the objection and then re-apply for cancellation. Because he had never found the 'crux' and had to wait for another 20 days every time he submitted materials, he was somewhat emotional at that time. In order to help Mr. He solve the problem as soon as possible, the shift leader on duty comforted Mr. He and contacted the system operation and maintenance technicians at the same time to investigate the cause of the objection through the background system.
It turned out that when Mr. He's company first applied for industrial and commercial registration, it used English half-width brackets, but when handling social security registration, it used Chinese full-width parentheses, so there was an error of information mismatch; Not only that, Mr. He's company also has a retiree hanging under the unit, and all personnel need to be emptied before deregistration.
After detecting these two anomalies, the shift leader accompanied Mr. He to the social security hall downstairs to change the name of the unit, and instructed him to discuss with the retiree and transfer the social security relationship to the street.
"After knowing the problem, we quickly helped him contact the social security hall to apply for expedited business processing. After completing the change of enterprise information and the push of socialized personnel, Mr. He used our computer to re-apply for simple cancellation of the enterprise on the industrial and commercial system. Li Hua remembers that the whole process from understanding the situation, investigating the cause to satisfactorily solving it took no more than two hours. Although it turns out that this error is not due to medical insurance, as long as we can help you really solve the problem, we will definitely work hard to move forward and will not easily say no. ”
"Specialized in solving all kinds of 'incurable diseases'"
Handling business in the medical insurance service hall will inevitably encounter a situation where it will be "not good" or even "unsuccessful" for a while. In order to continuously enhance the convenience and friendliness of the masses, in recent years, including Beijing Haidian, many medical insurance service halls across the country have opened "can't do things" windows, focusing on difficulties, prescribing the right medicine, making timely improvements, breaking down the invisible barriers that hinder the masses from doing things, and turning the original "can't do" and "can't do well" business into "want to do it" and "do it well", until the business is "really done" and "done well".
"In the past, when the people encountered some 'undone' businesses, most of them would choose to come back another day, and even a small number of people simply chose to give up because they were afraid of trouble. The establishment of the 'can't do things' window has given people who come to do things a channel to talk with confidence. In the view of Li Leilei, deputy director of the Medical Insurance Center of Shizhong District, Zaozhuang City, Shandong Province, the "can't do things" window should not only do things for the masses, but also let everyone feel the sincere attitude of medical insurance services.
In order to smooth the channels for enterprises and the masses to report problems, and solve the problems of "difficult work", "multi-head running", "running back and forth" and "poor experience", on February 23, 2022, the Medical Insurance Bureau of Shizhong District took the lead in setting up a "can't do things" reflection window in the district-level medical insurance service hall in the city.
The medical insurance "can't do anything" window in Shizhong District is set up in the position of the first entrance hall. "We don't have a lot of space here, so of course the counter used to solve the problem should be placed in the most prominent place. We have to make sure that every business that is not done has a place to ask and someone to receive it. Li Leilei told "China Medical Insurance" that as long as the masses come to handle the business related to medical expenses and medical insurance reimbursement, they are likely to come here to inquire first.
Not so long ago, she had just received a disabled serviceman.
"The government stipulates that disabled servicemen who meet the relevant conditions can enjoy additional Medicaid, but this subsidy is the responsibility of the Veterans Affairs Bureau. Because of the medical expenses involved, people often come to us to handle the number directly, and if they find that they can't do it, they come to the 'can't do it' window to report the situation. In order to give the masses a better answer, Li Leilei and her colleagues specially learned relevant business knowledge, and when they encountered something that could not be answered, they recorded the problem, and reported it to the leaders in charge as soon as possible and coordinated with other relevant departments.
"It just so happened that I just went to the Veterans Affairs Bureau to attend a meeting a few days ago, and I had the contact information there, so I understood the relevant policies clearly on the phone from beginning to end, and then called the disabled soldier back." Li Leilei said that she explained clearly and clearly what materials needed to be prepared, where to handle them, and how to handle them, so as to ensure that the masses could do everything at one time in the past.
"Of course, we can also directly tell the disabled soldier the phone number and ask him to contact him for consultation. But you also know that sometimes ordinary people may not think of the problem so comprehensively, and the communication will be much more difficult than our perennial business people, it is better for me to talk to him face-to-face about the specific needs, and help him communicate with other departments, so that the problem can be understood more thoroughly. In her opinion, as long as she can provide more efficient and convenient services for enterprises and the masses, it is natural for her to be a little more "troublesome".
The main purpose of setting up the medical insurance "can't do things" window in Shizhong District of Zaozhuang City is to focus on solving three types of problems: first, the problems that need to be coordinated by the medical insurance agency to promote the collaborative solution of other departments; Second, the masses have needs, but the problems that cannot be solved under the current policy are recorded by the "can't be done" window, and will be solved after the introduction of relevant policies; The third is special affairs, such as enterprises or citizens who need to speed up the progress of matters that need to be urgent.
"Thanks to your staff for taking the trouble to help with it, it solved my big problem and saved me from running several times!" Last summer, the Shizhong District Medical Insurance Center received a pennant from Mr. Li, a Hong Kong compatriot, a new resident medical insurance insuree.
On July 18, 2023, Mr. Li, who has settled in Shizhong District, came to the medical insurance service hall to inquire about the recognition of chronic disease treatment. Mr. Lee is a Hong Kong resident suffering from a mental illness requiring long-term medication. He learned from the neighborhood and neighborhood committees that he could enjoy the treatment of chronic diseases by participating in the residents' medical insurance, which could greatly reduce the burden of medical expenses, but because he did not have a local household registration and did not have a mainland ID number, the neighborhood could not register him for insurance.
"This is the first case of Hong Kong, Macao and Taiwan compatriots received since the establishment of our hall." Li Leilei recalled that the staff immediately reported the situation to the relevant departments and reported to the corresponding departments of the Municipal Bureau. In the end, the solution given by the city was to enter the Mainland Travel Permit number for Hong Kong and Macao residents in the system, and through a special case, Mr. Li successfully registered for the insurance.
Not only that, the staff also accompanied Mr. Li to the tax window to pay the medical premiums and explained to him how to handle outpatient chronic disease related matters. After a 30-day waiting period for the non-centralized payment period of resident medical insurance, Mr. Li began to enjoy the relevant medical insurance benefits on August 17.
"Most of the daily handling of this window is the situation that the process is not smooth enough, the material requirements are not clear enough, or the communication and coordination between departments are required. We dare to promise to enterprises and the masses that as long as they come to the window of 'can't do things', these 'incurable diseases' will definitely be properly handled. Li Leilei said.
"Experience points grow very fast"
The "can't do things" window set up by the Shanghai Jiading District Medical Insurance Center in September 2023 is also located at the information desk at the entrance of the service hall.
"As a window unit, as long as everyone enters this door of our service hall, people will not be left empty." Zhang Yingchao, director of the social service department of the Jiading District Medical Insurance Center, is the person in charge of all the service windows of the center. How to better serve the people and serve the society is a problem she thinks about every day.
"In addition to daily business consultation, in the past six months, most of the problems received by this window are encountered for the first time, whether for the insured or for us staff. Most of the units and institutions that coordinate and contact in the process of solving problems are also places that have never been dealt with before. Zhang Yingchao regards the process of solving the problem of "can't do things" as solving problems and doing tasks - ask here first, ask there if it is not right, and move forward step by step in exploration. "Looking back, it's actually quite interesting, compared to mechanically accepting general business, helping everyone solve these 'can't do' things, and the experience value grows faster."
Keeping the phone in her hand is Zhang Yingchao's daily state, and communication and coordination are the "main theme" of her work. To make sure everything was left out, she made an Excel spreadsheet to record every "can't be done" that needed to be promoted. The first thing Zhang Yingchao does when he goes to work every day is to sort out today's "To do list" against the form.
"It's much easier for us to carry out the same business than for the insured to figure it out on their own. Whether it's contacting a hospital or a local health insurance bureau, it's actually very difficult for them to go to these departments themselves, especially to find the right person. Zhang Yingchao was deeply touched by this.
On August 25, 2023, a sad-faced mother came to the Jiading District Medical Insurance Center. Her son, Xiaoyu, was diagnosed with uremia despite being under the age of 22. In order to recuperate with peace of mind, Xiaoyu quit his job in Shanghai and returned to his hometown of Xining, Qinghai for treatment. Unexpectedly, when handling the transfer and continuation of medical insurance, due to the omission of the unit, the staff of the Xining Medical Insurance Bureau told Xiaoyu's mother that the system prompted him to stop paying the medical insurance for employees in Shanghai for two months; Xining's policy stipulates that you must pay premiums for 6 consecutive months in order to enjoy the local critical illness insurance benefits. This also means that if it can't be done within August, Xiaoyu will have to wait for at least another half a year before he can enjoy medical expense reimbursement.
Although Xiaoyu's mother contacted the unit for the first time to make up the payment, the Xining Medical Insurance Bureau was never able to obtain the relevant data. To this end, she rushed from Xining to Jiading, where her son's former employee medical insurance was insured, to seek a solution.
"When this mother came, her voice was already hoarse, and everyone could see that the child's illness and the medical insurance that could not be turned around made her physically and mentally exhausted." After understanding the overall background, Zhang Yingchao first contacted the Shanghai Medical Insurance Center and found that the social security department had not yet transmitted his supplementary payment data to the medical insurance department. She hurriedly contacted the Jiading District Social Security Center, which handled the supplementary payment procedures for her, and confirmed that Xiaoyu's unit had made up for the two months of premium he had not paid. This time, Zhang Yingchao called the Shanghai Social Security Center again, and learned that the supplementary payment record needs to be manually filled in by the District Social Security Center and manually uploaded to the Municipal Social Security Department, and the Municipal Social Security Department will issue a business contact form to the Municipal Medical Insurance Department, and regularly handle the entry in the middle of each month. So Zhang Yingchao called back to the district social security center again, explained the reason, and hoped that the other party would expedite the coordination and handling. On the same day, the District Social Security Center filled in the business contact form and transmitted Xiaoyu's relevant supplementary payment data to the Municipal Medical Insurance Center.
Three days later, Xiaoyu's relevant information was finally uploaded to the national medical insurance information platform, and the transfer and continuation of the medical insurance relationship was successfully completed.
"I'm really grateful to all the brother units for their support to me, everyone helped to expedite the processing, and the green light was given all the way." Zhang Yingchao promised the mother who was anxious to go back to take care of her son, "You can go home with confidence, I will definitely help you do it!" ”
The confidence of the commitment comes from the special affairs of the medical insurance departments in various places. The so-called "can't do things" window does not mean that what can't be done in the ordinary window can be done here, but that there can be a special person here who is responsible for coordinating and dealing with it, and gnawing down the hard bones of this difficult matter.
Zhang Yingchao also took the lead in solving the first case in Shanghai where the medical insurance electronic voucher could not be used normally due to the name change of the insured.
Because it was the first case in the city, the staff of the "can't do it" window of the Jiading District Medical Insurance Center immediately reported the situation to the "Municipal Medical Insurance Center Online Security WeChat Group" after receiving the situation reported by the insured. Offline, the network management staff of the Jiading District Medical Insurance Center and the insured went to the nearest designated retail pharmacy to try to use the medical insurance code to settle; Online, the engineers of the Municipal Medical Insurance Center check the error situation in real time in the background. After many debuggings, the insured's medical insurance electronic voucher was finally able to be used normally.
A few days later, Zhang Yingchao encountered a similar situation again. This time, the solution is much simpler - the insured only needs to unbind and cancel the National Medical Insurance Service Platform App, WeChat or Alipay Mini Program that has applied for medical insurance electronic vouchers, and then log in again.
"Because I don't have any experience, I must have had a lot of battles when I first encountered problems. We're figuring everything out there right now. I always feel like everything can be solved, it just depends on how far you want to go, right? Zhang Yingchao said with a smile.
"Don't find a reason for not doing it, just find a way to do it"
In Tianjin, the city's 21 medical insurance sub-centers have set up "can't do things" reflection windows, and help the "things that can't be done" of the medical insurance handling windows to the end.
These "can't do things" windows are set up in the hall on duty at the post, and there are special personnel responsible for the relevant consultation and reception tasks every day, and the "can't do" matters reflected by the masses are registered and established in real time, and in accordance with the principle of who receives the visit and who is responsible, the whole process is supervised and solved within a time limit.
"Generally speaking, if the business to be handled by the enterprise or the insured is in accordance with the relevant provisions of medical insurance and can be handled normally, the handling window will accept it normally. When we encounter problems such as 'difficult to do' and 'slow to do', we will take over and deal with them. In the eyes of colleagues, Wang Yan, the person in charge of the "can't do things" window of the Hangu Branch of Tianjin Medical Insurance Center, specializes in receiving "hot potatoes" and treating "incurable diseases".
The medical insurance sub-centers in Tianjin have not only set up a window for "things that cannot be done", but also established a window for "negative reply and reporting mechanism", and in principle, they cannot say "no" to the masses who come to do things. If the needs of the masses do not conform to the relevant policies and are difficult to satisfy, it is also necessary to patiently do a good job of explaining the work in detail to the masses.
It is not only Tianjin that will not easily say "no" to the medical insurance public.
"Even if we encounter a situation that we can't do because it is beyond the scope of the policy, we will not just leave a sentence of 'not acceptable' to the public, but will actively find ways to find other ways to solve the problem for everyone." Xie Hengxian, director of the Medical Insurance Center of Qujing City, Yunnan Province, told "China Medical Insurance" that Qujing will fully implement the "can't do" explanation system for medical insurance services from February 2023, and set up "can't do" acceptance windows in 147 medical insurance agencies at the city, county and township levels in the city. Completely put an end to the occurrence of the phenomenon of "pushing, procrastinating, lazy and slow" in government services, and truly "not find reasons for not doing it, but only think of ways to do it well".
Qujing City stipulates that if the requirements are incomplete, the information is incomplete or does not conform to the statutory form, the staff must inform the public of all the materials to be submitted or accept the defects at one time, and list the required materials for the applicant, and provide a sample of the form that needs to be filled in; If the rules and regulations clearly stipulate that it cannot be handled, the practical reasons for not handling it must be clearly and promptly informed; When encountering matters that cannot be handled clearly due to unclear laws, regulations, and medical insurance policies, and are currently "difficult to handle", the staff must record the record, report for approval step by step, clarify the handling opinions, and reply to the processing results in a timely manner.
"Our purpose is to ensure that the masses have someone to manage, someone to help them, and someone to do what they can't do, and someone to answer what they can't do." Xie Hengxian said.
Use the temperature of medical insurance to improve the happiness index of the masses
In reality, the issue of urgency, hardship, sorrow and longing is the most concerning, urgent, and emotional issue of the masses of the people. In recent years, medical insurance departments at all levels across the country have focused on the outstanding problems of "difficult and slow work" and "multi-head running, running back and forth" reflected by enterprises and the masses, and have continuously increased reform and innovation, and successively launched a number of powerful measures such as "running at most once", "one-window service", "one-network service", "handling complaints immediately" and "15-minute medical insurance service circle", making every effort to break through the "obstruction" and make medical insurance services increasingly convenient.
The people's happiness depends on the effectiveness of the government's service to the people, and the satisfaction of the masses and enterprises with the government's work is closely related to specific government service matters. In order to make the government's work closer to the actual feelings of the people, and truly achieve the expectations of the people and the government, in January 2024, the State Council issued the "Guiding Opinions on Further Optimizing Government Services, Improving Administrative Efficiency, and Promoting "Efficient Completion of One Thing", which requires further optimization of government services, improvement of administrative efficiency, and realization of "efficient completion of one thing" in more fields and on a larger scale.
In February 2024, the National Health Insurance Administration issued the Notice on Promoting "Efficient Completion of One Thing" in the Field of Medical Security Services (hereinafter referred to as the "Notice"), requiring the medical insurance system to integrate the concept of "Efficient Completion of One Thing" into the whole process, all aspects and all links of medical insurance work, so as to achieve diversified service methods, optimize service processes, simplify service materials, and minimize service costs, so as to benefit enterprises and facilitate the people to the greatest extent.
The so-called "efficient operation" means that the medical insurance system must comprehensively improve service efficiency, reduce all the links that can be reduced, eliminate all unnecessary and unnecessary materials, and strive to use the nearest service, the fastest speed, the fewest links, and the simplest materials to minimize the service time and cost of the service object.
"Clearing the blockages, promoting integration, and realizing 'getting one thing done' is also an important goal for us to set up a 'can't do something' window in the city." In the view of Sun Ying, deputy director of the Tianjin Medical Security Fund Management Center, deepening reform, optimizing processes, innovating models, and breaking down work bottlenecks and obstacles by integrating related matters and related services are the core essence of the "can't do things" window.
"Every person received by the medical insurance service window, every matter handled is related to people's livelihood, if you want to do it well, you must comprehensively innovate in terms of thinking concepts, methods and methods, and every thing that seems to be 'can't be done' and 'not easy to do' problems 'friction' to the end, one thing after another, and truly make the masses nod and enterprises satisfied." Sun Ying said. （ZGYB-2024.05）
Original title: A small window is a big way to do medical insurance "can't do things" window, it can really do things!
Author | Liu Yanqing
Source | China Medical Insurance
Edit | Yu Xinglin What to do
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