Guarding the 'life-saving money' of the people requires more steps forward
2024-10-25
To safeguard the "life-saving money" of the people, it is not only necessary to ensure that supervision runs through multiple lines such as medical insurance, healthcare, pharmaceuticals, finance, and information, but also to pay more attention to the role of big data and achieve "precise strikes" through the combination of on-site inspections and big data. Not only should we further improve the self-examination and self correction system of the national designated medical institutions based on the problem list, but we should also increase the public exposure of violations and strengthen the warning and deterrence effect. Not only should we explore the establishment of a qualification management method for medical insurance payment, warning medical personnel to actively restrain their "prescription pens", but we should also better mobilize all sectors of society to participate in fund supervision, so that lawbreakers who have bad ideas about medical insurance funds have nowhere to hide. On October 22nd, the relevant person in charge of the National Healthcare Security Administration revealed at the press conference of the "Development Report on Supervision and Management of China's Medical Security Fund (2023-2024)" that from January to September this year, medical insurance departments at all levels recovered 16.06 billion yuan of medical insurance funds, a year-on-year increase of 38.7%; Medical institutions voluntarily returned nearly 3.62 billion yuan from the medical insurance fund through self-examination and self correction. The National Healthcare Security Administration's flight inspections have covered all provinces in China. This year, 500 designated medical institutions have been inspected, exceeding the total number of the previous five years. As a core component of the social medical insurance system, the medical insurance fund bears the responsibility of ensuring the health of billions of people. Its safe and reasonable use is related to people's well-being and social stability. In 2018, the total revenue of China's basic medical insurance (including maternity insurance) fund for the whole year was 2.1 trillion yuan, with a total expenditure of 1.8 trillion yuan. In 2023, the revenue will rise to 3.4 trillion yuan, and the expenditure will increase to 2.8 trillion yuan. In recent years, the medical security system with Chinese characteristics has been continuously improved, management services have been improved in quality and efficiency, the overall operation of the medical insurance system has been stable, the treatment of the masses has been consolidated and improved, and the overall operation of the fund is safe and sustainable. The medical insurance fund is the "medical money" and "life-saving money" of the people, which is related to the vital interests of every insured person. At present, the regulatory situation of medical insurance funds is still severe and complex. From the fraud and insurance fraud cases investigated and dealt with by various levels of medical insurance departments over a period of time, it can be seen that some places have a high incidence of luring the masses to fake hospitalizations, unguarded hospitalizations, unqualified medical practice, forging medical documents, tampering with inspection and testing reports, fabricating diagnosis and treatment projects, and other blatant behaviors. Individual medical institutions not only collude to defraud insurance, but also attempt to maliciously counter inspections through collective collusion, tampering with cases, destroying accounting vouchers, deleting data, and other behaviors. These situations fully demonstrate that it is urgent to safeguard the "life-saving money" of the people, and we must declare war on all kinds of illegal and irregular use of medical insurance funds with the spirit of real action and the courage to overcome difficulties. With the joint efforts of all parties, the ecological environment for the use of China's medical insurance fund has been greatly improved. However, the illegal and irregular issues in the field of medical insurance have historical, widespread, and stubborn characteristics, and the current supervision of medical insurance funds is still in the stage of tackling them. On the one hand, the methods of insurance fraud are iteratively upgraded, highly covert, and difficult to handle. For example, some hospitals attract urban and rural residents to stay in the hospital with gimmicks such as "free transportation," "food and accommodation," and "medication and money upon discharge. Criminals have clear division of labor in areas such as false medication, fabricated medical records, fake testing, and false recording of consumables, and even set up dedicated personnel to be responsible for "responding to medical insurance inspections". The degree of organization and division of labor in illegal and irregular behavior is becoming increasingly high, and the characteristics of gang and professionalization are becoming more and more obvious. On the other hand, "leakage" still exists to a certain extent, with frequent violations of regulations on charging fees, swapping project fees, excessive diagnosis and treatment, and overcharging for package packaging. It is urgent to strictly regulate and control it in accordance with the law. At the same time, with the deepening of medical insurance reform, the continuous deepening of policies benefiting the people, the comprehensive promotion of outpatient coordination, the rapid popularization of cross provincial medical treatment, the deepening of medical insurance payment method reform, and the facing of many new situations and problems in fund supervision. Overall, the regulatory situation of medical insurance funds remains severe, and maintaining fund security is a long and arduous task. To safeguard the "life-saving money" of the people, it is not only necessary to make good use of the existing clear and public annual inspection and "four no's and two direct" (no notification, no greeting, no report, no accompanying reception, going straight to the grassroots, direct to the scene) special inspection, so that supervision runs through multiple lines such as medical insurance, healthcare, medicine, finance, and information, but also to pay more attention to the role of big data and achieve "precise strikes" under the combination of on-site inspection and big data. Not only should we further improve the self-examination and self correction system of the national designated medical institutions based on the problem list, promote medical institutions to more consciously regulate their medical service behavior, but we should also increase the exposure of violations and strengthen the warning and deterrence effect. Not only should we explore the establishment of a qualification management method for medical insurance payment, but we should also explore ways similar to "driver's license deduction" to score relevant responsible persons and warn medical personnel to actively restrain their "prescription pens". We should also better mobilize all sectors of society to participate in fund supervision, so that lawbreakers who have bad ideas about medical insurance funds have nowhere to hide. By actively responding to social concerns and making more efforts to safeguard the people's "life-saving money", China can weave the world's largest medical security network closer and closer. Faced with severe challenges, the deep intervention and strong supervision of the health department have injected a shot in the arm to maintain the safety of the medical insurance fund. To establish a long-term regulatory mechanism for the medical insurance fund, it is fundamentally necessary for the legislative body to further improve relevant laws and regulations, take a step forward in refining the identification standards and punishment measures for violations, and regulate the use of medical insurance funds with a "live" and "long tooth" legal high-voltage line, so that every medical insurance fund can be accurately dripped into the hands of those who truly need it. (New Society)
Edit：Chen Jie Responsible editor：Li Ling
Source：Beijing Youth Daily
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