Starting from July 1, taiyuan employees’ personal medical insurance accounts will be used by families in mutual aid

2022-07-20 0 By

February 9, the city’s medical security work and party conduct and clean government construction conference was held.This year, the city will adhere to the “building taiyuan medical insurance that people are satisfied with” as the center, with the construction of smart medical insurance as the lead, continue to optimize the fine management mode of medical insurance, promote convenient services with high standards, realize the strategic purchase of funds, and constantly enhance the sense of gain of the insured people.This year, the city will establish a mutual aid security mechanism for employee medical insurance outpatient service.In accordance with the unified deployment of the province, the municipal “Measures for The Implementation of Mutual aid Security in Outpatient clinics for Employees” was issued to reform personal accounts, and family mutual aid in individual accounts for employee medical insurance was implemented from July 1 to reduce the medical burden of outpatient clinics.Since April 1, the province has implemented the unified range of chronic diseases and access (withdrawal) standards for employees’ medical insurance outpatient clinics, adjusted the policies for chronic diseases of employees’ outpatient clinics, reasonably determined the treatment standards, and improved the quality and efficiency of handling services.This year, Zhuhai will improve the direct settlement of cross-provincial out-of-place medical treatment.We promoted direct settlement of insurance for general outpatient services, chronic diseases, and serious diseases across provincial borders, and over 70% of hospitalization expenses were settled directly across provincial borders.At the same time, the registration process for medical treatment in other places has been simplified, the provincial government has introduced the self-service service of direct settlement for medical treatment in other places, making it more convenient for insured people to seek medical treatment in other places.Highlight 3: Reduce the outpatient drug burden of patients with “two diseases” “two diseases” refer to hypertension and diabetes.Last year, Zhuhai was listed as a national demonstration city in the special action of drug use guarantee for outpatient clinics with “two diseases”. The minimum payment standard for drug use guarantee mechanism for outpatient clinics with “two diseases” was reduced from 60 yuan to 30 yuan per year, realizing direct settlement of expenses for “two diseases”.The “package” payment model of drug cost for “two diseases” and total budget of medical group launched by the joint health department was promoted in the whole province.This year, Zhuhai will carry out the construction of a national demonstration city for outpatient drug use of “two diseases”.Construction of demonstration cities will be carried out to ensure full coverage of the population, meet drug demand, and strengthen health management. The burden of outpatient drug use for patients with “two diseases” will be reduced by strengthening measures such as “three inclusion” and “three guarantee”.This year, Zhuhai will further promote the reform of DRG payment mode.So-called DRG payment method, based on case mix as the fundamental basis, research methods, through the big data considering the individual characteristics of the cases, such as age, hospitalization days, operation, the severity of disease, complications and complications, and outcome factors, such as the clinical process, cost, consumption of similar cases similar to the same group (DRG) in the management system,And the group as a unit to establish the standard of medical expenses for payment.The city and the provincial direct medical insurance will realize the unified grouping and weight of DRG payment, and the actual payment will be fully launched in the city’s qualified designated medical institutions of Grade II or above, with coverage of no less than 70% and fund coverage of no less than 40%.At the same time, we will work together to advance the reform of various payment methods.Continue to promote county-level medical groups to “pay by capitation” and general outpatient clinics to “pay by capitation”, strengthen total management and performance appraisal;The medical insurance system will cancel the limitation on the hospitalization date of TCM rehabilitation treatment, and further expand the trial of TCM day ward and the scope of diseases;We will expand the coverage of day surgeries for patients who benefit from fee-based management, and implement the policy of medical insurance payment for pre-hospitalization expenses.Highlight 5: Making it more convenient for people to access medical care through the “one-code” medical insurance scheme and implementing the multi-point service model within the city.We strengthened the development of the three-level medical insurance administration service system at county, township and village levels. The six urban districts sped up their ability to handle medical insurance government services for employees, and encouraged county-level medical insurance departments to delegate their high-frequency business authority to township and village government service centers, so that medical insurance services could be handled locally.Counties and districts where conditions permit will be encouraged to set up a mechanism for assisting them in providing services on their behalf.Strive to bring the whole city of Taiyuan into the management of provincial bureau for medical treatment, and jointly promote the realization of taixin and Taiyu off-site medical settlement in the whole field without filing;Relying on electronic medical insurance vouchers, we will promote one-code access to medical insurance, and improve the convenience of medical treatment for local insured people.Source: Taiyuan Daily