Medical security is related to the health and well-being of the people, and is a key part of realizing that the people have access to medical treatment. General Secretary Xi Jinping pointed out: "It is necessary to continue to intensify the reform of medical insurance, carry out centralized drug procurement in a normalized and institutionalized manner, improve the medical insurance and assistance system for major diseases, deepen the reform of the medical insurance fund supervision system, and guard the people's 'life-saving money' and 'life-saving money'." The "Decision" of the Third Plenary Session of the 20th Central Committee of the Communist Party of China proposed to "improve the social security system" and comprehensively deploy major reform tasks in the field of medical security. In order to thoroughly study and implement the spirit of the Third Plenary Session of the 20 th CPC Central Committee, this reporter interviewed Zhang Ke, secretary of the leading party group and director of the National Medical Security Bureau.
Promoting universal medical security has entered the fast lane
Reporter: Since the 18th National Congress of the Communist Party of China, what remarkable results have been achieved in the reform of medical security?
Zhang Ke: Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with Comrade Xi Jinping at the core has adhered to the people-centered development philosophy, attached great importance to protecting and improving people's livelihood, continued to strengthen the overall leadership and overall planning of medical insurance work, and established the world's largest basic medical security network. In 2018, the National Medical Security Administration was established to rationalize the medical insurance management system and promote the work of universal medical security into the fast lane.
We have resolutely implemented the major decisions and arrangements of the CPC Central Committee, unswervingly deepened the reform of medical security, continuously improved the level of medical insurance management services, and promoted the coordinated development and governance of the "three medical services", realizing the transformation of medical insurance coverage from small to large, the level of security from low to high, and management services from existing to excellent, and the health and well-being of the people have been steadily improved.
The institutional system is gradually standardized. The "Opinions on Deepening the Reform of the Medical Security System" is a major decision made by the CPC Central Committee and the State Council on the reform of medical security. Integrate the basic medical insurance system for urban and rural residents, and gradually establish a basic medical security system with three tiers of basic medical insurance, serious illness insurance, and medical assistance to reduce the burden. Establish a medical insurance treatment list system, unify the national medical insurance drug catalog, innovate and carry out negotiation access to the medical insurance catalog, promote the access management of the medical insurance medical consumables catalog, and promote the gradual standardization and unification of the medical insurance system, policy and protection scope nationwide. Persist in doing our best and doing what we can, steadily improve the level of medical insurance financing, and seek truth from facts to determine the scope and standards of protection.
Ensure the steady improvement of connotation and quality. Consolidate and improve the level of inpatient protection, and generally carry out outpatient chronic disease and special disease protection. Steadily promote the pilot of the long-term care insurance system, and implement measures to support active childbirth. The list of medical insurance drugs is dynamically adjusted every year, and the number of drugs reimbursed by medical insurance has increased to the current 3,088. Since 2018, the basic medical insurance (including maternity insurance) fund has paid 14.7 trillion yuan for medical expenses for the masses.
Reforms in key areas have been carried out in an orderly manner. Coordinate to promote the healthy development of the pharmaceutical industry, and guide and promote the coordinated development of the medical and health field. Institutionalize and normalize the centralized procurement of drug consumables, and continue to compress the inflated price of the circulation link. Carry out pilot projects to deepen the reform of medical service prices, and establish a dynamic adjustment mechanism for medical service prices. Deepen the reform of medical insurance payment methods, and more than ninety percent of the overall areas will carry out payment according to the disease group or according to the value of the disease type.
The system governance capacity has been gradually enhanced. Build a unified national medical insurance information platform and strengthen the application of medical insurance data. Promote the governance of drug prices on the Internet, and strengthen the monitoring of drug prices and risk disposal. Strengthen the supervision of medical insurance funds, continue to carry out unannounced inspections and special rectification, promote the application of intelligent monitoring and big data supervision, and promote the normalization of supervision of the use of medical insurance funds.
Improve the quality and efficiency of medical insurance handling services. Focus on the blocking points and difficult problems reported by the masses, and optimize medical insurance management services. Continue to improve and improve the management service system to make medical insurance business more convenient. Consolidate and expand the cross-provincial direct settlement of inpatient expenses, and gradually realize the cross-provincial direct settlement of general outpatient expenses and five types of outpatient chronic disease-related treatment expenses at the county level. Establish a "dual-channel" management mechanism for the supply guarantee of negotiated drugs to improve the accessibility of negotiated drugs. Realize the "online office" and "handheld office" of medical insurance services, and actively promote medical insurance codes (medical insurance electronic vouchers), electronic prescriptions, and mobile payment applications.
Accurately grasp the principles and requirements of deepening the reform of medical security
Reporter: What principles and requirements should be adhered to in deepening the reform of medical security?
Zhang Ke: The "Decision" of the Third Plenary Session of the 20th Central Committee of the Communist Party of China (CPC) pointed out the direction for further deepening reform in an all-round way. In the next step, we will insist on the party's leadership throughout the whole process of medical security reform in all aspects, and promote medical security reform in depth.
We must always adhere to the people-centered development philosophy and earnestly ensure that the masses have something to call for and reform to respond. Consolidate and expand the achievements of universal insurance, continue to give full play to the function of the triple security system to reduce the burden of cascades, consolidate and improve the level of inpatient and outpatient protection, guard the people's "life-saving money" and "life-saving money", and strive to provide the people with all-round and full-cycle high-quality medical security.
It is necessary to focus on the main line of system construction, systematically plan and promote it as a whole, further enhance the unity, standardization and fairness of the medical insurance system, effectively reduce the economic burden of the masses to seek medical treatment, and help promote the common prosperity of all people.
It is necessary to plan the timetable and roadmap for medical security reform with high standards and a high starting point, and actively and steadily promote the reform of key areas and key links. We will continue to deepen the reform of medical insurance payment methods, medical service prices, and fund supervision systems, and strive to break the bottlenecks and constraints on the high-quality development of medical insurance.
It is necessary to establish systematic thinking and give full play to the important role of medical insurance in the coordinated development and governance of the "three medicines". Make good use of policy tools such as access to the medical insurance catalog, bidding and procurement, and payment mechanisms to further regulate the supply of medical services, standardize medical service behaviors, promote the reform of public hospitals, and support pharmaceutical innovation, so as to promote the healthy development of the pharmaceutical industry.
It is necessary to give full play to the multiplier effect of data elements, rely on the national unified medical insurance information platform, and promote the wide application of medical insurance big data in pharmaceutical price monitoring, medical insurance fund supervision, medical insurance handling services, etc., so as to realize the transformation from "having data" and "using data" to "having good data" and "using good data".
Continuously improve the people's sense of access to medical insurance
Reporter: How will the National Health Security Administration do a good job in implementing the reform measures deployed by the plenum?
Zhang Ke: The "Decision" of the Third Plenary Session of the 20th Central Committee of the Communist Party of China (CPC) has made comprehensive arrangements for major reform tasks in the field of medical security and put forward clear requirements. The National Medical Security Administration will systematically plan to promote the reform of medical security, promote the high-quality development of medical insurance, and continuously improve the people's sense of access to medical insurance.
The first is to improve the multi-level medical security system. Promote the establishment of a "1+3+N" multi-level medical security system, where the "1" is to build a unified national medical insurance information platform and medical insurance big data as the core of medical insurance infrastructure and service capabilities; "3" is to improve the basic medical security system of basic medical insurance, serious illness insurance, and medical assistance; "N" means to guide and support other security forces such as commercial health insurance, charitable donations, medical mutual aid, and mutual aid for trade unions and employees. Accelerate the implementation of the long-term care insurance system, and gradually include flexibly employed persons and urban and rural non-employed residents in the coverage of maternity insurance.
The second is to consolidate and expand the achievements of universal insurance. Implement the incentive and restraint mechanism for participating in insurance. Implement the participation of flexible employment personnel, migrant workers, and new forms of employment in basic medical insurance in their places of employment, and promote the participation of primary and secondary school students and preschool children with household registration in other places of permanent residence in their places of permanent residence. Improve the database of national insurance participation and realize the management of "one person, one file". Expand the scope of mutual aid in employees' medical insurance personal accounts, and accelerate the realization of cross-provincial mutual aid.
The third is to improve the operation and management mechanism of medical insurance. Comprehensively implement the city-level overall planning of basic medical insurance, and actively and steadily promote provincial-level overall planning. Explore the establishment of a long-term financing mechanism that links residents' medical insurance contributions with the level of economic and social development and the per capita disposable income of residents. Formulate the fund budget scientifically and rationally, and strengthen the monitoring of the operation of the fund and risk early warning. Strengthen the normalized supervision of medical insurance funds, deepen the application of intelligent supervision systems, explore the establishment of a credit management mechanism for medical insurance fund supervision and a "supervision to person" mechanism, and resolutely prevent medical insurance funds from "running and leaking".
Fourth, we will work together to promote the linkage reform of the "three medicines". Deepen the reform of medical insurance payment methods, and comprehensively promote the reform of payment according to disease groups or disease types in all overall regions across the country, so as to empower the development of medical institutions. Improve the dynamic adjustment mechanism of the medical insurance catalogue to support the development of innovative drugs and medical devices. Deepen the reform of medical service prices, improve the dynamic adjustment mechanism of medical service prices, and study and improve the mechanism for the formation of drug prices. Promote the "expansion and quality improvement" of centralized pharmaceutical procurement, and strive to achieve a total of more than 500 national and provincial centralized procurement drugs by the end of this year.
Fifth, continue to optimize medical insurance public services. Promote the application of digital services such as medical insurance codes (medical insurance electronic vouchers) and mobile payment, and promptly include eligible village clinics in the scope of medical insurance settlement. Strengthen the management service of direct settlement for medical treatment in other places, and expand the scope of chronic diseases in outpatient clinics with direct settlement across provinces in a steady and orderly manner. Steadily promote the key matters of "efficiently completing one thing" in the field of medical insurance, optimize the process of insurance payment, transfer and continuation, and provide more convenient medical insurance services for the insured people, designated medical institutions and pharmaceutical enterprises.
People's Daily (October 14, 2024 Edition 03)
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