Strengthening the Safety Bottom Line of Medical Insurance Fund

2023-06-06

Recently, the General Office of the State Council issued the "Implementation Opinions on Strengthening the Normalization Supervision of the Use of Medical Security Funds" (hereinafter referred to as the "Opinions"), emphasizing the compaction of the responsibilities of all parties involved in the use and supervision of medical insurance funds, the comprehensive optimization of various regulatory methods, the acceleration of the construction of a normalized regulatory system for the use of medical insurance funds, and the continuous improvement of long-term regulatory mechanisms, in order to improve the efficiency of fund use and regulate medical service behavior, We will effectively establish a bottom line for the safety of medical insurance funds and weave a dense network of basic medical security. The medical security fund is the "medical treatment money" and "life-saving money" of the people. Since the 18th National Congress of the Communist Party of China, China's medical insurance industry has achieved a historic leap, establishing the world's largest basic medical security system, and forming a multi-level medical security system framework. By promoting a series of reform measures such as direct settlement of medical treatment across provinces and regions, centralized procurement of drug consumables, and adjustment of medical insurance catalogs, we can better meet the needs of the public for medical reimbursement. According to relevant data, from 2018 to 2022, China's population participation rate remained stable at around 95%, while the participation rate of rural low-income and poverty alleviation populations remained stable at over 99%. The financial subsidy standard increased from 490 yuan to 610 yuan, and medical insurance helped nearly 10 million impoverished residents successfully lift themselves out of poverty. However, with the changes in the overall social situation, the reform of medical insurance payment methods, and the continuous expansion of medical insurance coverage and fund size, the supervision of medical insurance funds is facing a situation where there are many stakeholders, hidden insurance fraud methods, and a wide range of coverage, and the risk points of "leakage" are also increasing. From relevant data, from 2018 to 2022, the cumulative recovery of medical insurance funds nationwide reached 77.13 billion yuan; Since 2019, the National Medical Insurance Administration has discovered a total of 4.35 billion yuan in suspected illegal and irregular use of related funds; In 2022 alone, 2682 cases were solved and 1.07 billion yuan of medical insurance funds were recovered, demonstrating the importance of safety supervision of medical insurance funds. From the issuance of documents such as the "Notice on Carrying out Special Rectification Work to Combat Fraud and Deception in the Medical Insurance Field" and the "Interim Measures for the Management of Medical Security Fund Flight Inspection", the adoption of this "Opinion" has always been on the way to crack down on fraudulent behavior in the medical insurance field. The supervision of medical insurance funds and the improvement of the fund supervision system must also be constantly emphasized, always adhering to problem orientation and precise efforts, in order to constantly consolidate the high-pressure situation of "not daring to deceive", build a supervision and defense line of "not being deceived", and never let medical insurance funds become "Tang Seng meat". To truly protect the "medical money" and "life-saving money" of the people is a systematic project that requires multiple efforts and measures. One is to improve the level of legal construction. Strengthening the supervision of medical insurance funds requires legal compliance as a prerequisite. Starting from the implementation of the first medical insurance administrative regulation "Regulations on the Supervision and Management of the Use of Medical Security Funds" in 2021, based on clarifying the subject, form, measures, and types of violations of the supervision of the use of medical insurance funds, it is necessary to continuously clarify law enforcement norms, clarify law enforcement authorities, and constrain law enforcement

Edit:qihang    Responsible editor:xinglan

Source:GMW.cn

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