Promote direct calculation of inter provincial medical expenses
2021-12-22
Recently, the relevant person in charge of the National Medical Security Bureau said that at present, the direct settlement of cross provincial and non local medical and hospitalization expenses has covered all provinces, all overall planning regions, all kinds of insured personnel and main expatriates in China. Since this year, the promotion of inter provincial direct settlement of general outpatient expenses has also been significantly accelerated. At present, it has covered 97.6% of the overall planning areas in China, basically realizing full coverage. The realization of full coverage of direct settlement of medical expenses across provinces is an important achievement in deepening the reform of "release, management and service" in the field of medical insurance in China, which has significantly improved the medical accessibility of the cross provincial floating population across the country, and created conditions for the comprehensive establishment of the outpatient social security mechanism of basic medical insurance within three years. The equalization of basic medical and health public services in urban and rural areas is an important factor affecting population mobility and population urbanization. The full realization of direct settlement of medical expenses across provinces and places will help to promote the equalization of basic medical and health public services and is of great significance to further promote urbanization. On the basis of realizing full coverage of direct settlement of cross provincial and non local medical treatment, in order to make non local personnel enjoy the convenience of direct settlement of cross provincial and non local medical treatment, it is also necessary to further improve the direct settlement rate of cross provincial and non local medical treatment. At present, the inter provincial direct settlement of inpatient expenses has achieved the full coverage of the overall planning area, and basically covers all designated hospitals from level I to level III. however, the direct settlement rate is now only 60%. The number of designated medical institutions carrying out inter provincial direct settlement of outpatient expenses is still limited, and there is still a certain gap from the full distribution and effectiveness of the policy. We need to take multiple measures to further promote the direct settlement of medical expenses in different provinces. First, while continuing to expand the coverage of direct inter provincial settlement of outpatient expenses, we should increase the number of designated medical institutions. At present, the full coverage of direct settlement of cross provincial and remote medical treatment is the full coverage in the sense of overall planning area. In the overall planning area covered by the policy, some designated medical institutions have not provided direct settlement services. Outpatient visits have higher requirements on the proximity of medical institutions. In order to make remote personnel effectively enjoy the convenience of inter provincial direct settlement of outpatient expenses, it is also necessary to promote more medical institutions to provide inter provincial direct settlement services for insured persons. Second, we should simplify the process and optimize services to promote reform with both speed and temperature. Over the past two years, relevant departments have done a lot of fruitful work in simplifying policy processes and improving service convenience. They have developed and launched the national medical insurance service app and remote medical treatment filing applet, and comprehensively promoted medical insurance electronic vouchers, so that remote medical treatment filing and settlement can be transferred from offline to online, which greatly facilitates the insured people. Considering that many elderly people are not familiar with the use of smart phones and the Internet, relevant departments also provide face brushing, relatives agency and other medical insurance services based on biometric recognition, family account and other modules, and have carried out aging transformation of app. For the objective situation that direct settlement cannot be achieved for remote medical treatment in various places, the relevant person in charge of the National Medical Insurance Bureau said that it is exploring and studying the transmission of relevant bills and information through online channels to improve the convenience of service. Third, we should do a good job in the policy publicity of direct settlement of cross provincial and remote medical treatment. Many people in different places, especially the elderly care population in different places and the accompanying elderly, usually have limited access to information and do not fully understand many policies to benefit the people, so it is difficult to enjoy the convenience provided by the policy in time. We should pay attention to and strengthen the policy publicity at the community level, so that the insured people can understand that as long as the registration is made online through the national medical insurance service app or the remote medical treatment filing applet, whether it is long-term residence and work in a different place, or referral to a different place for hospitalization due to disease treatment, You can use your social security card or medical insurance electronic voucher to get medical treatment in a designated medical institution in a different place and enjoy direct settlement for medical treatment in a different place. With the increasing coverage and depth of direct settlement of medical expenses across provinces, higher requirements are put forward for the settlement and supervision of medical insurance funds. In this regard, relevant departments should make full use of big data, strengthen online expense settlement and supervision, and constantly realize the legalization, specialization, standardization and normalization of remote medical treatment settlement fund supervision. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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