On the afternoon of September 4, the State Council Information Office held a regular briefing on the State Council's policies, introducing the "Social Insurance Management Regulations" and answering questions from reporters. According to Long Xuewen, head of the Medical Security Management Center of the National Medical Security Administration, the promulgation of the "Regulations" has put forward new requirements for the medical insurance agency to further optimize the management and services of designated medical institutions. In the next step, the medical insurance department will focus on optimizing the management and services of the "two designated institutions" from three aspects. First, expand the designated coverage of medical insurance. The "Regulations" stipulate that the handling agency should negotiate and sign service agreements with qualified agencies according to the needs of handling work, so as to facilitate the public to enjoy medical insurance services. As of the end of August this year, the number of designated medical institutions nationwide reached 1.078 million, an increase of more than 100,000 over last year, an increase of 13.4%. Among them, there are 594,000 designated medical institutions and 484,000 designated retail pharmacies. In the next step, we will continue to expand the designated coverage of medical insurance, and expand the scope of designated medical insurance to grassroots medical institutions and designated retail pharmacies, so as to facilitate the people to see a doctor and buy medicines nearby. Second, strengthen the agreement management of designated medical institutions. Agreement management is an important management measure for medical insurance agencies to standardize the medical service behavior of "two designated institutions" and maintain the safety of medical insurance funds. In the first half of this year, the national medical insurance agencies have verified a total of 462,300 designated medical institutions, and a total of 145,900 have been dealt with by agreement, recovering the loss of 5.138 billion yuan in medical insurance funds. The "Regulations" stipulate that the management of medical insurance service agreements should be strengthened, and the whole process of agreement signing, performance, and breach of contract treatment should be further regulated. In the next step, we will further optimize the application conditions for the "Two Designated Institutions" and improve the evaluation process. At the same time, we will formulate a unified national medical insurance service agreement template, improve the access, exit and performance appraisal mechanisms of designated medical institutions, strengthen the handling of breaches of contract, and resolutely protect the health care system. The people's "medical money" and "life-saving money". Third, further optimize the audit and settlement services of designated medical institutions. The "Regulations" stipulate that the handling agency should improve fund payment and settlement services, and establish and improve the collective negotiation and negotiation mechanism with the "two designated agencies". With the comprehensive advancement of the reform of the medical insurance payment method, the next step will be to further improve the medical insurance fund payment method and settlement management mechanism, strengthen consultation and negotiation with designated medical institutions, introduce experts, improve the review mechanism, and improve the DRG and DIP-related A dynamic adjustment mechanism for weights and premium rates, strengthening fee review and inspection, doing a good job of prepayment at the beginning of the year, monthly settlement, annual liquidation, and medical insurance fund allocation, reducing the pressure on designated medical institutions to advance funds, and effectively improving the efficiency of medical insurance fund use. At the same time, the medical insurance agency will also accept the supervision of relevant departments and all aspects of the society, effectively strengthen its own standardized management, strictly prevent internal control risks, and better provide medical insurance agency services.
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