People's Daily Online Review: Keep Every 'Life Saving Money' Safe
2024-10-28
On October 22nd, the Blue Book on the Supervision and Management of China's Medical Insurance Fund (2023-2024) was released in Beijing. It is reported that from January to September this year, medical insurance departments at all levels across the country have recovered a total of 16.06 billion yuan in medical insurance funds. As of now, medical institutions have voluntarily refunded nearly 3.62 billion yuan through self-examination and self correction. As an important component of the social security system, the medical insurance fund is the "medical money" and "life-saving money" of the people. Resolutely cracking down on fraudulent insurance practices and purifying the operating environment of the medical insurance fund is an inevitable requirement for safeguarding the health rights and interests of the people, and is also a key measure for the sustainable development of the medical insurance system. In recent years, with the continuous improvement of China's medical insurance system and the expansion of the medical insurance fund, the regulatory situation remains severe. On the one hand, the concealment of insurance fraud methods has increased, making it more difficult to handle. On the other hand, problems such as irregular fees and excessive diagnosis and treatment occur frequently. In addition, with the deepening of medical insurance reform and the promotion of policies such as outpatient coordination and cross provincial medical treatment, fund supervision is facing numerous new challenges. To manage and make good use of the "life-saving money" of the people, we need to strengthen the crackdown and take proactive measures. To effectively curb insurance fraud, the National Healthcare Security Administration has taken a series of practical and feasible regulatory measures. Especially by continuously increasing the intensity of flight inspections, as of September this year, the national flight inspection has inspected 500 designated medical institutions and found suspected violations totaling 2.21 billion yuan. In addition, in response to the self inspection and self correction of medical institutions, big data technology is used to monitor the use of medical insurance funds in real time, detect abnormal situations in a timely manner, and achieve early detection and processing. To safeguard the "life-saving money" of the people, it is necessary to weave a solid institutional network. Establishing a medical insurance payment qualification management system and a "driver's license style scoring system" aimed at regulating the behavior of medical institution personnel, increasing the cost of violations, and promoting self-restraint; Strengthening the management of social supervisors of medical insurance funds can broaden regulatory channels, enhance regulatory transparency and efficiency, and promote the optimization of medical insurance policies; At the same time, strengthening the designated management of long-term care service institutions can standardize the service market, ensure service quality, and safeguard the rights and interests of patients. With the introduction of a series of rules and regulations, the "protection network" of the medical insurance fund has been tightly woven, and the supervision and crackdown on illegal activities have gradually escalated. The high-pressure situation of illegal and criminal activities related to the medical insurance fund will be further consolidated. Strengthening the supervision of medical insurance funds requires systematic collaboration. In April of this year, the National Healthcare Security Administration, together with the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, and the National Health Commission, issued the "2024 Special Rectification Work Plan for Illegal and Irregular Issues in the Healthcare Security Fund", which clarified the work requirements, rectification priorities, division of responsibilities, and supervision methods, pointing out the direction and providing fundamental guidance for strengthening the supervision of the healthcare security fund. With the joint efforts and cooperation of all parties, the special rectification work has shifted from individual efforts to a coordinated and linked pattern, upgraded from passive response to proactive action, expanded from local governance to global rectification, from case investigation to mechanism construction. The comprehensive governance situation has initially formed, and the ecological environment for the use of medical insurance funds has been greatly improved. Spending every penny of the medical insurance fund on treating diseases, saving lives, and improving people's well-being is both the right path and the great way. Cracking down on insurance fraud and strengthening supervision is a systematic project that requires early and strict supervision, as well as joint efforts from the government, medical institutions, insured persons, and all sectors of society. Only by comprehensively and fully preventing the leakage of medical insurance funds can we ensure the safety and reliability of medical insurance funds and benefit the people. (New Society)
Edit:CAI YITONG Responsible editor:MENGMENG
Source:people.com
Special statement: if the pictures and texts reproduced or quoted on this site infringe your legitimate rights and interests, please contact this site, and this site will correct and delete them in time. For copyright issues and website cooperation, please contact through outlook new era email:lwxsd@liaowanghn.com