The direct settlement of inter provincial medical treatment shows an "acceleration" -- an exclusive interview with long Xuewen, head of the medical insurance management center of the National Medical Insurance Bureau
2022-03-08
The government work report proposes to improve the direct settlement method for cross provincial and non local medical treatment, so as to realize the basic unification of the scope of medical insurance drugs throughout the country. The direct settlement of cross provincial medical treatment is related to every insured people. How is the current progress of direct settlement of remote medical treatment? How to improve the remote reimbursement service of medical insurance? Xinhua News Agency reporter interviewed long Xuewen, head of the medical insurance management center of the National Medical Insurance Bureau. Accelerate the direct settlement of inter provincial medical treatment and reduce "errand advance" "Promoting the direct settlement of medical expenses of basic medical insurance in different provinces is an important measure to improve the medical insurance system and solve the outstanding concerns of the people." Long Xuewen said that the National Medical Insurance Bureau set up a special working group to "grasp both" the inter provincial medical settlement of hospitalization expenses and outpatient expenses, so as to reduce the medical burden for insured personnel. At present, the direct settlement of hospitalization expenses across provinces has covered all provinces, all overall planning areas, all kinds of insured personnel and major expatriates. On this basis, the national medical insurance administration continued to expand the scope of networked designated medical institutions and promote cross regional collaborative business. In terms of outpatient expenses, after adding 15 pilot provinces for direct inter provincial settlement of outpatient expenses in early 2021, the coverage will be steadily expanded. By the end of the year, all overall planning areas can provide direct inter provincial settlement of general outpatient expenses, covering 128300 designated medical institutions. Up to now, the cumulative settlement of outpatient expenses has exceeded 10 million. In order to reduce the people's "running errands to advance funds", the National Medical Insurance Bureau has repeatedly simplified the filing materials, standardized the filing process, optimized the filing channels, successively launched personal commitment system, handling on behalf of relatives and other services, and encouraged insured places to explore and carry out self-service filing services of "no certification materials, no handling review, immediate opening and immediate enjoyment", so as to realize the "inter provincial general handling" of online filing of remote medical treatment. By the end of 2021, all coordinated regions have opened national unified online filing services, of which 90 coordinated regions in 17 provinces have opened "instant handling and instant enjoyment" self-service filing services. People's demand for medical treatment in other places is high, and the "hard bone" is accelerated The original intention of direct settlement of cross provincial medical treatment in other places is to enable the masses to "see a doctor" and "be optimistic about the disease" in other places. The National Medical Insurance Bureau has carried out many explorations for this purpose. However, with the continuous development of social economy and the higher level of medical needs of the people, the demands of the insured for medical treatment in other places are increasing. However, in view of the differences in medical insurance reimbursement policies, coverage and level across the country, the direct settlement of inpatients and outpatients across the country cannot be "achieved overnight". There are still "difficulties" such as unclear registration procedures and poor settlement materials. Among them, the "hard bone" of outpatient chronic and special disease cost settlement in different places is particularly "difficult to bite". Long Xuewen introduced that the direct settlement of outpatient chronic diseases across provinces has high frequency of medical treatment, strong timeliness and relatively high reimbursement proportion. At the same time, there are still great differences in the number of diseases, identification standards and treatment standards of outpatient chronic diseases. "No matter how difficult it is, you can't take a detour." Long Xuewen said that the national medical insurance bureau started with outpatient chronic and special diseases involving a large number of people and widely carried out in local areas, unified disease name, disease code and settlement rules, and promoted regional pilot to national pilot. By the end of 2021, 31 provinces and the Xinjiang production and Construction Corps had launched a pilot project in the area of co-ordination. As a place of insurance and medical treatment, two-way outpatient treatment of hypertension, diabetes, cancer out-patient chemoradiotherapy, uremia dialysis, and anti rejection therapy after organ transplantation were performed in 5 out-patient slow related treatment costs. "This is only the first step." Long Xuewen said that next, we should guide all pilot areas to speed up the transformation of information systems and expand the pilot scope of cross provincial direct settlement of outpatient treatment costs related to chronic diseases. Focus on solving the "remote" problem to facilitate people's medical treatment "A direct settlement needs to go through national, provincial, municipal and other multi-level medical insurance agencies and medical institutions. Any problem in any link will affect the direct settlement." Long Xuewen said that in order to further facilitate people's medical treatment, the National Medical Insurance Bureau will continue to improve the settlement policy of remote medical treatment, and make accurate efforts in terms of system and management standards: —— Classify and promote the settlement of inpatient and outpatient expenses as "inter provincial general office". "For the time being, the outpatient expenses of some insured persons cannot be settled in different places. We are exploring online channels to transfer relevant bills and information from the place of medical treatment to the place of insurance, so as to make more data run and less people run errands." Long Xuewen said that at the same time, it will also strengthen data sharing among departments and explore the online processing of manual reimbursement of medical expenses for cross provincial and remote medical treatment. —— Improve the direct settlement system for cross provincial and remote medical treatment. According to long Xuewen, the National Medical Insurance Bureau will continue to improve the outpatient mutual aid guarantee mechanism of basic medical insurance for employees and improve the outpatient guarantee policy of basic medical insurance for urban and rural residents; Implement the medical security treatment list system; Reform the filing management system for medical treatment in other places. —— Promote the standardization and standardization of medical security system management. "In view of the problems of decentralized inter provincial settlement policies and large regional differences in management services, we will introduce measures for the management of direct settlement of cross provincial and non local medical treatment of basic medical insurance." Long Xuewen said that we will further unify the rules and procedures for the direct settlement of inpatient and outpatient expenses across provinces, and basically realize the unification of the scope of medical insurance drugs nationwide by the end of 2022. In addition, the National Medical Insurance Bureau will continue to improve the construction of the national medical insurance information platform, strengthen the training of staff of designated medical institutions and agencies, and increase the publicity of remote medical treatment settlement policies. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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