On July 25th, the 11th meeting of the Standing Committee of the 16th Municipal People's Congress was held, and the meeting listened to the report of the Municipal Government on the supervision and management of the use of medical security funds, as well as the opinions and suggestions of the Social Committee of the Municipal People's Congress. In recent years, the scale of income and expenditure of the medical insurance fund in this city has continued to expand, and the overall stability of the urban and rural residents' medical insurance fund has been maintained. The overall fund balance has been achieved, and by the end of 2023, the basic medical insurance coverage in this city will reach 20.588 million people. This city is deepening the supervision of medical insurance funds, strengthening the high-pressure situation of fund supervision, and safeguarding the "life-saving money" of the people. In 2023, 246 million yuan of unreasonable expenditures by designated medical institutions were refused or recovered, and 111 designated medical institutions and 1444 insured persons were investigated for illegal and irregular behavior, with a fine of 1.8585 million yuan imposed. At the meeting, Ma Jiye, Director of the Municipal Medical Insurance Bureau, presented a report on the supervision and management of the use of medical security funds, as the new version of the medical insurance catalog has increased to 3088 types of drugs commissioned by the Municipal People's Government. The report points out that currently, the city has established a multi-level medical security system with urban employee medical insurance and urban and rural resident medical insurance as the main body, major illness insurance as the supplement, medical assistance as the bottom line, supplemented by enterprise supplementary medical and commercial insurance, covering the whole population. Among them, basic medical insurance plays a major role. The basic medical insurance reimbursement for outpatient staff is 70%, for retirees it is 85%, and for community health institutions it is increased to 90%; More than 85% of hospitalized employees and over 90% of retirees, with the highest reaching 99.1%. More than 50% of urban and rural residents' basic medical insurance outpatient visits, more than 75% of hospitalizations, and up to 80%. By the end of 2023, basic medical insurance will cover 20.588 million people. The city will continue to study medical insurance maternity support measures, implement the participation of unemployment insurance recipients in maternity insurance and enjoy maternity insurance benefits, and include 16 therapeutic assisted reproductive technology projects in the basic medical insurance reimbursement scope in 2023. Strengthening the dynamic adjustment of the medical insurance catalog, the total number of new drugs has increased to 3088. This year, the city will reimburse 1252 Class B drugs as Class A drugs in designated community medical institutions, effectively reducing the burden on insured persons. At present, the level of medical insurance benefits in this city ranks among the top in the country. It is worth mentioning that in 2023, the major illness medical insurance in this city will benefit 60000 people, with a fund payment of 790 million yuan and medical assistance for 100000 people, reducing the burden on social assistance recipients by 430 million yuan. The efforts to investigate and punish the illegal and irregular behaviors of 111 designated pharmaceutical institutions in the supervision of medical insurance funds are continuously increasing. In 2023, 1140 cases of illegal and irregular activities were exposed in this city, and warning education was strengthened to guide all sectors of society to abide by the law and create a safe atmosphere for safeguarding fund security. The regulatory mechanism is constantly improving, institutional safeguards are strengthened, administrative measures for handling illegal and irregular behaviors in the medical insurance field are introduced, the system of administrative penalty discretion is improved, the "minor exemption from punishment and cautious punishment for first violation" system is pioneered in the medical insurance field, a social supervisor system is established, and the reward standard for reporting is increased to 200000 yuan. The crackdown on fraud and insurance fraud is also more effective. The report points out that the city comprehensively utilizes various forms such as daily supervision, self-examination and self correction, spot checks and re examinations, special rectification, and flight inspections to strengthen the high-pressure situation of fund supervision and safeguard the "life-saving money" of the people. Improve the management of designated medical institution agreements. There are currently 5744 designated medical institutions in this city, and we adhere to the full coverage of annual supervision and inspection of designated medical institutions throughout the city. We focus on key drugs with high medical insurance expense rankings, key areas such as orthopedics, blood purification, inspection and testing, rehabilitation therapy, etc., and carry out special rectification actions for key illegal and irregular behaviors. In 2023, 246 million yuan of unreasonable expenditures by designated medical institutions were refused or recovered, and 111 designated medical institutions and 1444 insured persons were investigated for illegal and irregular behavior, with a fine of 1.8585 million yuan imposed. Efforts have been made to carry out centralized rectification of corruption in the pharmaceutical industry, and all 14 clues related to the problems of the municipal cooperation mechanism special team have been completed. With the continuous upgrading of services, medical insurance services have become more convenient and beneficial to the people, increasing the sense of gain for the masses. The report points out that the city has expanded the channels for insured patients to purchase drugs and launched a pilot project for the "dual channel" management of national negotiated drugs. Insured individuals can purchase negotiated drugs at contracted pharmacies with external prescriptions issued by doctors, achieving full integration of prescription circulation, drug purchase, and medical insurance settlement. 483 types of negotiated drugs are available and accessible. Improving the quality and efficiency of medical insurance handling services, allowing more data to travel and reducing the need for the public to run errands. Simplify the process of filing for medical treatment in other places, and online self-service filing will take effect immediately. Medical treatment in other places within the Beijing Tianjin Hebei region will be considered as filing. The work of remote direct settlement has achieved positive results, with full coverage of inpatient and general outpatient remote settlement. More than 900 designated hospitals have opened remote direct settlement for outpatient chronic and special diseases, and more than 1400 designated pharmacies have opened remote direct settlement. As of now, 50.6174 million people have settled medical expenses in Beijing directly from other places, with a total medical cost of 209.696 billion yuan; 14.3935 million insured individuals in this city settled medical expenses directly outside of Beijing, with a total of 9.763 billion yuan. "Internet plus" promotes better access to health services. 151 hospitals in this city have implemented online payment for the entire process of medical insurance fees, including appointment registration and outpatient payment. Starting from July 1st, 447 designated pharmacies in this city will launch a pilot program for online payment of over-the-counter drugs. Insured individuals can purchase drugs online through platforms such as JD.com and Meituan, and their personal account funds can be paid online, making drug purchases more convenient and beneficial to the people. Focusing on key areas such as critical care medicine, the report points out that the city will continue to maintain a high-pressure situation in the supervision of medical insurance funds regarding the next steps of work. Strengthen the three-dimensional regulatory framework, deepen comprehensive supervision while implementing daily supervision, focus on key areas such as critical care medicine, anesthesia, and lung tumors, carry out aerial inspections in the city, and achieve full coverage in all districts. This city will also continuously innovate fund supervision methods, strengthen intelligent auditing, continuously improve the knowledge base and intelligent supervision rules base of medical insurance fund intelligent auditing, and create a full chain supervision before, during, and after the event. In the future, the level of informationization in medical insurance will continue to improve. Among them, the city will accelerate the expansion of medical insurance mobile payment, promote the expansion of medical insurance mobile payment through the "Jingtong" mini program and hospital owned applications, pilot medical insurance mobile payment in different regions of Beijing Tianjin Hebei, pilot medical insurance mobile payment in community service centers, and online purchase of over-the-counter drugs through personal accounts. Explore the pilot implementation and trial operation of large-scale model applications in the medical insurance field, and enhance the level of artificial intelligence application in the medical insurance field. Strengthen the application of drug traceability codes and promote breakthroughs in medical insurance big data supervision. Implement the transformation of the "multi card integration" medical insurance card environment for livelihood cards, and cooperate with the Municipal Human Resources and Social Security Bureau to carry out comprehensive replacement work. Medical insurance services will also be more refined. For example, this city will promote the launch and management of electronic medical billing receipts, reducing the time for manual windows and self-service machines to queue up and print paper receipts. Promote the efficient implementation of medical insurance in the field of "one thing", and do a good job in the process of newborns being born and enjoying maternity allowances without application. Expand the scope of cross provincial direct settlement of diseases and the coverage of cross provincial networked designated medical institutions. Study the reform ideas of payment methods for medical expenses in different regions. Deepen the functionality of personal accounts, realize online use of personal account settlement in the discharge process, and carry out pilot projects for "instant payment" of personal accounts in the Beijing Tianjin Hebei region and nationwide cross coordination cooperation. In the future, the reform of medical insurance will continue to deepen as the pilot program of outpatient pay per head for chronic disease patients is launched. The report points out that the city will promote the expansion of disease diagnosis related group payment reform (DRG), and include eligible secondary and above medical institutions in the actual payment scope. Select some close medical associations to carry out the pilot of outpatient service for chronic diseases such as diabetes and hypertension. In promoting the standardized management of the medical insurance catalog, we will continue to improve the management of the national medical insurance negotiation drug "dual channel". Next, our city will deepen the centralized and quantity based procurement of pharmaceuticals. Regularly carry out the implementation and expiration continuation of the results of the expansion of drug procurement, smoothly implement the selection results of the tenth batch of national organized drug procurement with quantity, complete the provincial drug procurement task, and achieve the goal of accumulating more than 500 drugs for centralized procurement. Orderly promote the bulk procurement of artificial lenses and sports medicine consumables organized by the state, as well as the renewal of artificial joints and oral implants. Actively participate in inter provincial alliance medical consumables procurement, carry out centralized procurement of selected products from six categories of medical consumables such as pacemakers and orthopedic trauma in the Beijing Tianjin Hebei "3+N" alliance, and further expand the scope of medical consumables procurement. Thirdly, in accordance with the requirement of "playing a game of chess for the whole country", we will continue to carry out the governance of online drug prices. It is suggested to improve the "Internet plus" medical service and medical insurance payment policy. The medical insurance fund is related to the vital interests of the masses of the people and the healthy and sustainable development of the medical security system. The Social Construction Committee of the Municipal People's Congress believes that in recent years, the city has continuously promoted the deepening of medical insurance reform, and a multi-level medical security system has been basically formed. The overall operation of the medical insurance fund is stable and safe, and the people's sense of obtaining medical insurance services continues to increase. However, currently the city is facing some new situations and problems in terms of medical security. Compared with the growing health needs of the people, there are still weak links, including the need to improve the performance of the use of medical insurance funds, the need to continue deepening medical insurance reform measures, the gap in convenient and beneficial medical insurance services, and the need to strengthen the supervision of medical insurance funds. In response to the above issues, the Social Construction Committee of the Municipal People's Congress has provided relevant suggestions. Regarding the performance of the medical insurance fund, the Social Construction Committee of the Municipal People's Congress pointed out that the current performance evaluation indicators of the fund are relatively single, mainly focusing on the surplus of income and expenditure and the progress of budget execution. The fund has not fully considered the guarantee of high-quality, efficient, and affordable medical services for the public. Unequal allocation of funds results in a dominant expenditure on tertiary medical institutions, while the proportion of primary medical institutions is relatively low. With the continuous aging of the population in this city, the expenditure of the "one elderly and one small" medical insurance fund for urban and rural residents is constantly increasing, and there is a great pressure on the balance of income and expenditure of the medical insurance fund for urban and rural residents. The reform measures of medical insurance also need to be further deepened. In terms of implementing the policy of centralized quantity based procurement, there are problems such as delayed supply of drugs and consumables in some centralized quantity based procurement. In addition, the incentive mechanism for treating difficult and severe cases through medical insurance payment methods needs to be further improved, and measures to support innovative pharmaceutical development through medical insurance policies need to be strengthened. The Social Construction Committee of the Municipal People's Congress suggests that we should continue to focus on people's health and deeply promote the linkage of the "three medical systems". Strengthen the refined management of the implementation process of centralized procurement, improve the supply guarantee mechanism, do a good job in supply and distribution, timely meet the needs of medical institutions, and improve the mechanism for soliciting opinions from medical institutions and selected enterprises. Further promote the reform of medical insurance payment methods, optimize disease grouping and score weighting, improve the "special disease single discussion" policy, encourage medical institutions to actively control unreasonable costs, provide scientific diagnosis and treatment, and improve the efficiency of fund utilization. Support the development of innovative medicine, encourage the research and development of new drugs and technologies, strengthen the supervision and evaluation of the quality and efficacy of generic drugs, and improve the evaluation mechanism guided by actual diagnosis and treatment effects. Intensify the support of medical insurance for pharmaceutical enterprises' research and development innovation, optimize the admission process for new projects and technologies, accelerate the promotion of innovative pharmaceutical product services for clinical use, and improve the multi-party payment system such as basic medical insurance and commercial insurance. Focusing on the needs of the masses, we need to continuously improve the level of convenient medical insurance services. The Social Construction Committee of the Municipal People's Congress suggests that we should give full play to the function of medical insurance in promoting hierarchical diagnosis and treatment, increase medical insurance policy support for grassroots medical institutions, accelerate the expansion and sinking of high-quality medical resources and regional balanced layout, support home doctor services, and promote medical insurance