Direct settlement of cross -provincial medical treatment presents "acceleration" -Ti -person in charge of the State Medical Insurance Bureau Medical Insurance Management Center

  The government work report proposes to improve the direct settlement method of cross -province medical treatment and realize the basis of national medical insurance drugs. Direct settlement of cross -provincial medical treatment is related to each crowd. What is the progress of direct settlement for medical treatment at different places? How to improve medical insurance reimbursement services? A reporter from Xinhua News Agency interviewed Long Xuewen, head of the Medical Insurance Management Center of the State Medical Insurance Bureau.

  Accelerate the direct settlement of cross -provincial medical treatment to reduce the direct settlement of "running legs" and "promoting basic medical insurance cross -provincial medical expenses, which is an important measure to improve the medical insurance system and solve the public’s outstanding concerns." Working group, "two hands" for hospitalization and outpatient expenses across provinces, reducing the burden of medical treatment for participants. At present, the direct settlement of hospitalization costs across provinces has covered all provinces, all regions, all kinds of insured personnel, and major out -of -person personnel. On this basis, the National Medical Insurance Bureau continues to expand the scope of fixed -point medical institutions to promote cross -regional collaborative business. In terms of outpatient expenses, after the increase in 15 outpatient expenses in early 2021, the province of direct settlement pilot provinces has been steadily expanded. At the end of the year, all overall regions can provide ordinary outpatient expenses directly settlement, covering Wanjia’s designated pharmaceutical institution. As of now, the cumulative settlement of outpatient costs has exceeded 10 million.

  In order to reduce the masses’ "running legs", the State Medical Insurance Bureau has repeatedly simplified the filing materials, standardized the filing process, and optimized the filing channels, and successively launched services such as personal commitment systems and relatives on behalf of relatives. Self -service filing services that have been approved for review, instant opening, and instant enjoyment "to achieve" cross -provincial generalization "for medical online registration.

  As of the end of 2021, all the national unified online filing services have been opened, of which 90 coordinated areas of 17 provinces have opened "real -time processing and instant enjoyment" self -service filing services.

  The demand for medical treatment in different places has accelerated the "hard bone" to allow the masses to "see a doctor" and "optimistic about disease" in other places in other places. However, with the continuous development of socio -economic and higher -level medical needs of the people, the demands for medical treatment in different places have continued to improve. However, in view of the differences in the medical insurance reimbursement policies, the scope and level of protection in various places, the direct settlement of hospitalization and outpatient clinics across the country cannot be "done overnight."

The filing process is not clear, the material application procedures are complicated, the settlement has "poor treatment", and the difficulties and blocking points of the standard identification still need to be resolved.

  Among them, the "hard bone" of the outpatient clinic is particularly "difficult". According to Long Xuewen, the outpatient clinic has a high frequency, strong timeliness, and relatively high proportion of reimbursement in the outpatient disease. At the same time, there are still large differences in the number of diseased diseases, identification standards, and treatment standards in various outpatient diseases in various places. Essence

  "No matter how difficult it is, you can’t detour.

"Long Xuewen said that the National Medical Insurance Bureau started with a slow special disease involved in the outpatient clinic involving many crowds and localities, and the name, the coding and settlement rules of the diseased disease, and promoted the regional pilot to the nation’s pilot. As of the end of 2021, there were 31 nationwide in the country. Both the province and the Xinjiang Production and Construction Corps have launched a pilot area for overall planning regions. As an insured and medical place, two -way opening high blood pressure, diabetes, malignant tumor outpatient chemotherapy, uremia dialysis, organ transplantation of anti -discharge treatment 5 outpatient clinics have 5 outpatient slow special special specialties Direct settlement services for disease -related treatment.

  "This is just the first step.

"Long Xuewen said that next, we must guide the pilot areas to speed up the transformation of information systems and expand the scope of direct settlement piloting piloting pilot -related treatment costs in the clinic.

  Efforts to solve the problem of "different places" facilitate the masses to seek medical treatment. "A direct settlement needs to pass through multi -level medical insurance agencies and medical institutions of the country, provincial, and municipalities, and problems in any link will affect direct settlement." It is convenient for the masses to seek medical treatment, and the National Medical Insurance Bureau will continue to improve the medical settlement policy for different places, and accurately exert its efforts in institutional systems and management standards: —— Category to promote the "cross -provincial generalization" of hospitalization and outpatient cost settlement. "Some insurers’ outpatient costs have not yet achieved medical settlement for different places. We are exploring online channels to spread relevant bills and information from the medical place back to the insurance place, so that the data runs more and the masses run less.

"Long Xuewen said, at the same time, it will also strengthen data sharing between departments, and explore the online handling of medical expenses on cross -province medical expenses. —— Improve the direct settlement system of cross -provincial medical treatment. Improve the basic medical insurance clinic for the protection mechanism of the basic medical insurance clinic, improve the policies of the basic medical insurance clinic guarantee policy of urban and rural residents; implement the system of medical security treatment list; reform the management system for medical security for medical security. The provincial settlement policy is decentralized and the regional differences in management and services are issues. We will introduce direct settlement management measures for basic medical insurance cross -provincial medical treatment. "Long Xuewen said that further unified hospitalization and outpatient costs cross -provincial direct settlement rules and processes, and basically realized the unity of national medical insurance drugs 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 the staff of designated medical institutions and agency institutions, and increase the propaganda medical settlement policy.

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