Ministry of human resources and social development to realize the direct settlement of medical expen-dxperience

Ministry of human resources and social development: to realize the direct settlement of medical expenses in different places by the end of next year (reporter Jie Li) yesterday, the Ministry of human resources and Social Affairs issued the notice on further study and implementation of the spirit of the National Conference on health and health. The notice clearly identified a number of policy points, including the beginning of next year to basically achieve inter provincial offsite resettlement retirees hospitalization expenses direct settlement, to the end of next year, basically meet the referral requirements of off-site medical expenses directly settled. Next year, the unified notification of urban and rural residents medical insurance pointed out that we should accelerate the integration of basic medical insurance in urban and rural areas. To be fair and benefit the masses as the goal, to accelerate the integration of basic medical insurance management institutions, efforts to maintain social fairness and justice, improve the medical service utilization level of urban and rural residents and the level of protection, improve the masses and gain a sense of well-being; enhance the health insurance fund mutual aid ability, promote the health of medical service external incentive effect, provide a solid foundation for the three health reform. Efforts should be made to integrate all provinces (autonomous regions and municipalities) before the end of this year, and unified medical insurance system for urban and rural residents will be established in 2017. According to the disease payment, there will be no less than 100 kinds of notice, the emphasis should be placed on the payment reform in a more prominent position, combined with the medical insurance fund budget management, the full implementation of the total medical insurance payment control. To establish adapt to different people, different diseases or service features of multiple type of insurance payment, accelerate the capitation, DRGs, per diem payment, encourage the development of related disease diagnosis group (DRGs) according to the payment, explore the characteristics of traditional Chinese medicine service payment. In order to promote orderly competition between medical institutions and rational allocation of resources, the method of point number can be combined with budget management and disease payment according to the conditions. At the same time, this year the comprehensive reform pilot provinces and all public hospitals comprehensive reform pilot cities are required to implement DRGs reform, covering no less than 100 diseases. Serious illness insurance to the poor groups to improve the appropriate tilt illness insurance system, explore the specific measures appropriate to tilt to the poverty groups, focusing participatory urban and rural poor population, the implementation of preferential payment policy, to reduce the threshold and increase the proportion of reimbursement and other measures to improve the accuracy of security underpinning the sickness insurance system, efforts to solve the problems of population, poverty due to illness and other issues. At the same time, do a good job in the basic medical insurance, serious illness insurance, medical assistance system cohesion, to achieve seamless docking between the various systems, the use of medical insurance settlement network and social security card to establish a one-stop settlement mechanism, to provide more convenient and efficient service for the masses. Relocation of retirees in provinces next year direct settlement notice that the basic medical insurance to achieve national network and remote medical immediate settlement, according to the three steps taken, strengthen municipal co-ordination, improve the province networking settlement, accelerate the establishment of a national networked remote medical billing system, to achieve national networked remote medical billing system and provincial networked remote medical billing the docking system, ensure that next year the basic realization of inter provincial relocation of retirees hospitalization cost of direct settlement, by the end of 2017, the basic realization of remote medical referral in accordance with provisions of the hospitalization expenses settlement. During the year to start long-term care insurance system, around the country will explore the establishment of long-term care insurance system. The reform pilot area should explore inquiry

人社部:明年底实现异地就医住院费用直接结算本报讯(记者解丽)昨日,人社部印发《关于深入学习贯彻全国卫生与健康大会精神的通知》。通知明确了多项政策的时间点,其中就包括明年开始基本实现跨省异地安置退休人员住院费用直接结算,到明年底,基本实现符合转诊规定的异地就医住院费用直接结算。明年城乡居民医保实现统一通知指出,要加快推动城乡基本医保整合。要以公平可及和群众受益为目标,加快整合基本医保管理机构,着力维护社会公平公正,提升城乡居民医疗服务利用水平和保障水平,提高群众的获得感和幸福感;着力增强医保基金的互助共济能力,促进医保对医疗服务的外部激励约束作用,为三医联动改革提供坚实基础。各地要努力实现年底前所有省(区、市)出台整合方案,2017年开始建立统一的城乡居民医保制度。按病种付费将不少于100种通知强调要把支付方式改革放在更加突出的位置,要结合医保基金预算管理,全面推行医保付费总额控制。要普遍建立适应不同人群、不同疾病或服务特点的多元复合式医保支付方式,加快推进按人头、按病种、按床日付费,鼓励开展按疾病诊断相关分组(DRGs)付费,探索符合中医药服务特点的支付方式。有条件的地区可将点数法与预算管理、按病种付费等相结合,促进医疗机构之间有序竞争和资源合理配置。同时,今年综合医改试点省和所有公立医院综合改革试点城市都要实施按病种付费改革,覆盖病种不少于100个。大病保险向贫困群体适当倾斜要完善大病保险制度,探索向贫困群体适当倾斜的具体办法,聚焦建档立卡城乡贫困人口,实行倾斜性支付政策,采取降低起付线、提高报销比例等措施,提高大病保险制度托底保障的精确性,着力解决困难群体因病致贫、因病返贫等问题。同时,做好基本医疗保险、大病保险、医疗救助制度衔接,实现各项制度间的无缝对接,利用医保结算网络和社会保障卡建立“一站式”结算机制,为群众提供更加方便快捷的服务。跨省异地安置退休人员住院明年可直接结算通知指出,实现基本医保全国联网和异地就医直接结算,要按照三步走的思路,巩固市级统筹,完善省内联网结算,加快建立国家异地就医联网结算系统,实现国家异地就医联网结算系统与省级异地就医联网结算系统对接,确保明年开始基本实现跨省异地安置退休人员住院费用直接结算,2017年底,基本实现符合转诊规定的异地就医住院费用直接结算。年内启动长期护理保险制度各地还将探索建立长期护理保险制度。改革试点地区要探索长期护理保险的保障范围、参保缴费、待遇支付等政策体系,护理需求认定和等级评定等标准体系和管理办法,护理服务机构和护理人员服务质量评价、协议管理和费用结算等办法,长期护理保险管理服务规范和运行机制等。各试点地区将制定具体实施办法,力争10月底前上报试点方案,确保年内启动实施。(北京青年报)免费咨询相关的主题文章: