The General Office of the State Council issued the Implementation Opinions on Strengthening the Normalization Supervision of the Use of Medical Security Funds
2023-05-31
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"). The Opinion points out that the medical insurance fund is the "medical money" and "life-saving money" of the people. Strengthening the normalized supervision of the use of medical insurance funds is of great significance for ensuring the safe operation of medical insurance funds, improving the efficiency of fund utilization, regulating medical service behavior, and reducing the burden of medical treatment on the public. We must fully implement the spirit of the 20th National Congress of the Communist Party of China, accelerate the construction of a standardized regulatory system for the use of medical insurance funds with clear rights and responsibilities, strict and effective, safe and standardized, and efficient rule of law, and firmly uphold the safety bottom line of medical insurance funds. The Opinion proposes three policy measures, including: firstly, clarifying the responsibilities of all parties. Strengthen the regulatory responsibility of the medical insurance administrative department, and strengthen the supervision of the signing and performance of medical insurance agreements by medical insurance agencies. Strengthen supervision over the medical service behavior, medical expenses, and the use of medical insurance funds by designated medical institutions that are included in the payment scope of medical insurance funds. Strengthen the audit and inspection responsibilities of medical insurance agencies, establish and improve business, financial, safety, and risk management systems, and do a good job in service agreement management, cost monitoring, fund allocation, treatment review, and payment. Strengthen the main responsibility of self management of designated medical institutions, establish and improve internal management systems related to the use of medical insurance funds, and use medical insurance funds in a reasonable and standardized manner. Strengthen the responsibilities of industry department supervisors, and each department should implement relevant regulatory responsibilities according to their respective responsibilities. Strengthen the regulatory responsibility of local governments, and local people's governments at all levels are responsible for leading the normalized supervision of the use of medical insurance funds within their respective administrative regions. They should coordinate the resources of various departments within the region, form a joint regulatory force, and provide strong guarantees for the normalized supervision of the use of medical insurance funds. The second is to implement normalized regulation. Clearly, it is necessary to make good use of regulatory measures such as flight inspections, special rectification, and daily supervision to systematically promote fund supervision work. Innovate regulatory methods, strengthen the application of intelligent monitoring and big data regulation, and build a technical defense line for the entire process of pre notification, in process review, and post supervision. Improve social supervision, improve the reporting and complaint mechanism of medical insurance funds, implement the reporting and reward system, continue to expose typical cases, strengthen warning and deterrence, and mobilize the enthusiasm of the whole society to participate in fund supervision. The third is to improve the institutional mechanisms. Clearly, we need to further improve the regulatory system and mechanism, strengthen the comprehensive application of agreements, administration, and justice, and solve various regulatory difficulties. Establish and improve a regulatory mechanism that emphasizes both incentives and constraints, and further stimulate the endogenous motivation of medical institutions to use medical insurance funds in a standardized manner. Promote information exchange and sharing, and strengthen the effective connection between administrative law enforcement and criminal justice before, during, and after the event. Promptly transfer clues to disciplinary inspection and supervision agencies regarding suspected violations of discipline, duty violations, and duty crimes. Establish a sound credit management system and clarify disciplinary measures for dishonest institutions and personnel. Establish a cross regional supervision mechanism for medical treatment in different locations, and implement the supervision responsibilities of the medical treatment and insured areas. Establish and improve a mechanism for handling major issues, and strengthen supervision and guidance to local authorities.
Edit：He Chuanning Responsible editor：Su Suiyue
Source：Xinhua
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