1. Actively promote the centralized procurement of pharmaceutical and medical consumables. According to the work deployment of the Provincial Medical Insurance Bureau, continue to comprehensively promote the implementation of the centralized procurement and use of drugs organized by the state and the province, organize and guide the relevant medical institutions in our city to timely fill in the pre-purchased quantities of related drugs in the coming year, and actively carry out the centralized procurement of various batches of drugs. and use, conscientiously guide medical institutions to do a good job in the centralized procurement and use of various batches of drugs, actively do a good job in the centralized procurement and use of medical consumables by the provincial bureau, and actively promote the normalization of centralized procurement of drugs and medical consumables in our city to further reduce the cost of The purchase price of drugs and medical consumables in the city will be reduced to reduce the burden on the masses. As of December 30, 2021, our bureau has instructed relevant medical institutions to implement 12 batches of centralized procurement of drugs and medical consumables organized by the state and the province (including 5 batches of national centralized procurement of drugs, 1 batch of medical consumables, and 2 batches of provincial centralized procurement of drugs). Second, 4 batches of medical consumables) 222 medicines and 71 kinds of medical consumables have been centrally purchased, and have been fully implemented in our city.
2. Actively implement the policy of retaining medical insurance fund balances. To implement the relevant spirit of the national and provincial policies on the retention of TCM insurance funds in the organization of centralized drug procurement, our bureau has successively issued the “Yangjiang City Medical Security Bureau Yangjiang Finance Bureau on Yangjiang City’s Implementation of the Centralized Drug Purchasing Work of the State Organization of the TCM Insurance Fund Balance Retention Policy” Notice” and other five documents, and actively implement the policy of retaining the balance of traditional Chinese medicine insurance funds for the centralized procurement of drugs organized by the state. According to statistics, the first batch of state-organized centralized drug procurement (extension of the pilot program) has retained funds of about 2.73 million yuan, and the second batch of state-organized centralized drug purchases has retained funds of about 340,000 yuan.
3. Vigorously promote the use of medicines negotiated by the national medical insurance. According to the requirements of the national and provincial medical insurance bureaus and other relevant documents, supervise and supervise the medical insurance agencies to regularly monitor the landing and use of the new version of the national negotiated drugs every month. By the spirit of the province’s implementation opinion document on establishing and improving the “dual-channel” management mechanism for drugs negotiated by national medical insurance, the “Implementation Rules for Establishing and Improving the “Dual-channel” Management Mechanism for Drugs Negotiated by National Medical Insurance (Trial)” was issued to establish and improve the “Dual-channel” management mechanism for drugs negotiated by national medical insurance. The “dual-channel” drug supply guarantee mechanism further enhances the level of drug supply guarantee under state negotiations and forms a “dual-channel” for negotiating drug supply guarantee. The “dual-channel” medication guarantee mechanism of Guotan Medicine will be implemented in our city in 2022. At present, our city has selected 3 “dual-channel” designated retail pharmacies for national medical insurance negotiated drugs and identified Yangjiang People’s Hospital as a pilot hospital. At the same time, to ensure that the newly added 67 kinds of Guotan drugs are included in medical insurance reimbursement, a separate payment policy for some Guotan drugs has been formulated.
4. Actively promote the province’s unified classification and coding standards for medical insurance drugs and medical consumables. According to the latest unified catalogue of diagnosis and treatment items and catalogue of medical consumables of the Provincial Medical Insurance Bureau, the out-of-pocket ratio of medical consumables and diagnosis and treatment items is formulated according to the actual situation, and the handling agencies and medical institutions are urged to update and maintain relevant medical insurance drugs, medical consumables and other categories in a timely and dynamic manner according to the provincial requirements. With the code base, the city has fully implemented the province’s unified classification and coding standards for medical insurance drugs, and medical consumables since August 15, 2021.
(6) Further improve the management of medical service prices in our city
The first is to adjust the price of nucleic acid testing for the new coronavirus in our city promptly to further reduce the burden of testing costs for the masses; the second is to take the lead in organizing relevant public hospitals to re-match the prices according to the latest project catalog of the provincial bureau and formulate the “Basic Medical Services in Yangjiang City” in combination with the current government price guidance documents. Price List of Price Items (2021 Edition)” and implement it; the third is to carry out new medical service price items and revised item pricing, formulate new basic medical service price items (172 items), newly revised basic medical service price items for public medical institutions at all levels in our city The price of the medical service price items (41 items), and the rest of the related work is going through the procedure and will be printed and distributed after being reported to the municipal government for approval; fourth, the third party is entrusted with the data reported by the city’s 18 sample medical institutions in the past three years. Measure the cost of medical services in medical institutions, and carry out the price assessment and price adjustment of basic medical service projects in Yangjiang in 2021. At present, the price adjustment work plan has been submitted to the Provincial Medical Insurance Bureau for approval. After the approval, the price adjustment work will be carried out if the price adjustment start indicators are met.
(7) Implementing the supervision of medical insurance funds
1. Gradually improve the construction of the supervision system. In February 2021, an inter-departmental joint meeting system for the comprehensive supervision of the Yangjiang Medical Security Fund was established, consisting of medical insurance, public security, health care, auditing, market supervision, and other departments. In May 2021, our bureau adjusted the joint meeting system, including the judicial and financial departments into the constituent departments of the city’s joint meeting system, further enhancing the city’s joint efforts to combat fraud and defrauding medical security funds, and improving the collaborative supervision mechanism for medical insurance funds.
2. Carry out publicity campaigns against fraud and fraud to maintain fund safety. Taking “online publicity” and “handheld publicity” as the mainline, adopting a combination of online and offline, tradition and innovation, publicizing and interpreting medical security fund supervision laws, regulations and policies in a more intuitive and popular form, and guiding the public to correct Recognize and actively participate in fund supervision, and create a good atmosphere in which the whole society pays attention to and consciously maintains the safety of medical security funds.
3. Organize and carry out special work in our city to combat fraud and insurance fraud. The first is to hold a special work conference on the supervision of medical insurance funds in the city with the public security, justice, health, and other departments, to convey the spirit of the national and provincial medical insurance fund supervision work conferences, and to mobilize and deploy the special rectification work in 2021; “Work Plan for the Special Rectification Action on Insurance Fraud”, established a leading group for the special rectification action against fraud and insurance fraud, and coordinated the city’s special rectification action against fraud and insurance fraud. Carry out on-site inspections of designated medical institutions with third-party inspectors hired to conduct on-site inspections on the rationality of diagnosis and treatment behavior, medication, fees, finance, etc. The verified medical expenses in violation of regulations shall be recovered, and the relevant designated medical institutions shall be urged to carry out and reform. The medical insurance departments of all counties (cities, districts) carried out special inspections within their jurisdictions concerning the practice of the Municipal Bureau and achieved good results.
As of the end of December 2021, a total of 13 designated medical institutions have been negotiated in the city, 3 have been criticized, 5 have been rectified within a time limit, 10 have been suspended from medical insurance service agreements, 1 have been transferred to public security organs, and 7 cases have been exposed. It is planned to refuse to pay (recover) 36.7281 million yuan of medical insurance funds.
(8) Implement audit rectification work
Based on the questions and opinions of the “Yangjiang City 2020 Basic Medical Insurance Fund Audit Report”, according to the requirements and suggestions of the audit report, sort out the list of problems, establish a rectification ledger, and implement rectification measures. At present, of the 8 feedback items involving our bureau, 7 items have been rectified and 1 item is being rectified. In the next step, we will continue to complete the rectification work within the time limit by the requirements of the audit work.
(9) Fully implement strict governance of the party
1. Actively carry out party history learning and education activities. Focusing on the general requirements of “learning history to understand the truth, learn history to increase trust, learn history to respect morality, and learn history to practice”, the practical activities of “I do practical things for the masses” throughout the whole process of learning and education, focusing on learning in one hand, further improving ideological understanding, and grasping problems in the other hand, and practically To solve the pain points, difficulties and blocking problems for the masses, to “learn the party history, understand the ideas, do practical things, and start a new situation”, the four “I do practical things for the masses” key livelihood projects have been fully completed, and substantial results have been achieved. The results have been well received by the masses, and the overall evaluation of the steering group is “good”.
2. Do a good job in the rectification of inspection feedback. Conducted a special study on the 18 rectification opinions in three aspects that the third inspection team of the Municipal Party Committee reported, formulated practical and feasible rectification measures, and clarified the responsible leaders, responsible departments, and responsible persons. Good rectification of inspection feedback to ensure that the inspection and rectification work is effective. At present, 16 items have been rectified and 2 items are being rectified.
3. Strengthen the party-building work of the organs. One is to strengthen the study of political theory. Through party history learning and education, etc., organized 7 study seminars, hired experts and scholars to give lectures to cadres and workers in the overall situation 3 times, carried out 15 special studies of the theoretical study center group of the party group, and organized party members and cadres to follow up on Xi Jinping’s new era of Chinese characteristics society 19 times of ideology and 51 political elements. Further, enhance the “four awareness”, strengthen the “four self-confidence”, resolutely achieve the “two maintenance”, and consciously put political discipline and political rules in the front. The second is to strengthen branch construction. Adhere to the “three meetings and one lesson” system, organize 14 branch committees, 7 branch meetings, and organize party members and leading cadres to give party lessons 6 times. Give full play to the vanguard and exemplary role of party members, organize more than 90 batches of party members and cadres to go to the Gongwei Hanging Point Nanpai Village Committee and Baisha Community to carry out voluntary activities of cultural Gongwei, effectively solve problems for the grassroots contact points and the masses served, and further improve Party branch leadership, organization and execution. The third is to strengthen the construction of party style and clean government. Strengthen the education of clean government, organize 2 special counseling sessions, and organize 71 conversation reminders for 23 overall cadres and employees. Use negative teaching materials to strengthen the warning education for cadres and workers 4 times, and constantly rectify the “four winds”. Implement democratic centralism, hold 20 party group meetings, and strictly implement the “three important and one big” collective decision-making system. The fourth is to strengthen ideological construction. Implement the main responsibility of ideology, organize ideological deployment, and special research 7 times. Strengthen the management and control of online public opinion, organize and carry out a special campaign with the theme of cleaning up and purifying the “WeChat Moments”, carry out ideological training and education three times, strengthen the ideological education of cadres and workers, and strengthen the construction of ideological positions.
2. Current work
According to the work requirements of superiors and in light of the actual work of this bureau, the following tasks are urgently done:
(1) Start the bidding for the eighth period of Yangjiang’s supplementary medical insurance and critical illness insurance. Our bureau has announced the purchase intention, purchase plan, and purchase demand of the city’s supplementary medical insurance and the eighth period of critical illness insurance. After the announcement, expert demonstration and bidding work will be carried out.
(2) Completion of the bidding for the Yangjiang Medical Insurance Intelligent Monitoring and Auditing Service Project. Our bureau has entrusted a third-party bidding agency company to publicize the bidding opinions of the Yangjiang medical insurance intelligent monitoring and auditing service project on the Internet. After the publicity and bidding work, the third-party intelligent monitoring and auditing service team that won the bid for the project will officially enter our bureau to carry out the project. Medical insurance monitoring and audit work.
(3) Initiate the preparations for the tender for the operation and service projects of the National Medical Security Information Platform. Our bureau has reached a unified opinion with the Municipal Finance Bureau, the Municipal Social Security Bureau, and the cooperative banks on the operation service fee of the National Medical Security Information Platform in 2022-2024, and plans to launch the bidding for this project shortly.
(4) Printing and distributing our city’s basic medical insurance outpatient mutual aid measures. According to the “Notice on Printing and Distributing the Implementation Measures of Guangdong Provincial Employee Basic Medical Insurance Outpatient Mutual Benefit Guarantee” issued by the Guangdong Government Office, we will further improve the city’s basic medical insurance general outpatient policies and reform the medical insurance personal account policy.
(5) Innovatively carry out the reform of medical insurance payment methods for traditional Chinese medicine services. According to the provincial work deployment, an implementation plan for implementing the “Guiding Opinions on Carrying out Medical Insurance Payment Reform to Promote the Inheritance, Innovation, and Development of Traditional Chinese Medicine” will be issued before the end of March to promote the development of traditional Chinese medicine treatment.
(6) Continue to do a good job in the management of medical service price items. The prices of the newly added basic medical service price items and the newly revised basic medical service price items of public medical institutions at all levels in our city have been drawn up, and will be issued and implemented after being reported to the municipal government for approval; carry out the price assessment and price adjustment of basic medical service items in Yangjiang City in 2021 Work, the price adjustment work plan has been submitted to the Provincial Medical Insurance Bureau for approval, and after the approval, the price adjustment work will be carried out if the price adjustment starts indicators are met.
(7) Do a good job in preparing for the medical reform assessment in 2021. According to the requirements of the provincial and municipal medical reform offices, carefully prepare the statistical reports and corroborating materials related to the work indicators of our bureau in the medical reform assessment plan and submit them to the municipal medical reform office to meet the provincial medical reform assessment.
(8) Strengthen the supervision of medical insurance funds. Continue to maintain a high-pressure situation of cracking down on illegal and criminal fraud of medical insurance funds, and strengthen the promotion of cracking down on fraud and insurance fraud. Actively introduce third-party supervision forces, combine daily inspections with special inspections, continue to increase efforts to crack down on fraud and fraud, and jointly maintain the safety of medical insurance funds.
(9) Hold a special democratic life meeting and summary meeting on the study and education of the party history. Conscientiously implement the work arrangements of the Party History Study and Education Office of the Municipal Party Committee, strictly do a good job in the preparations for the Party History Study and Education Summary Conference and the Democratic Life Conference, and hold the Party History Study and Education Summary Conference and the Democratic Life Conference on time and according to quality.
3. There are main problems
(1) The policy on the payment period of medical insurance has not yet been perfected. According to the provincial overall planning, the province plans to unify the payment period of medical insurance. Our city has not yet issued relevant policies on the payment period of medical insurance, and the insured still needs to pay for the whole life to enjoy the medical insurance treatment.
(2) The reimbursement ratio of medical insurance for urban and rural residents is relatively low. According to the provincial overall planning, the reimbursement ratio of tertiary medical institutions of urban and rural residents medical insurance needs to reach more than 65%. At present, the reimbursement ratio of tertiary medical institutions of urban and rural residents medical insurance in our city is 60%, and the reimbursement ratio is relatively low.
(3) Lack of fund supervision power. Due to the limitation of the establishment, our bureau has not approved the law enforcement establishment and has not set up a special law enforcement team. The law enforcement force is weak. In the implementation of the fund supervision work, the staff lacks professional knowledge, and the fund supervision work cannot keep up with the new situation and new problems of fund management. Lack of regulatory power.
(4) The connection between the administrative agency and the handling agency is not smooth enough. The current medical insurance agency in our city is a subordinate department of the Municipal Human Resources and Social Security Bureau, and the medical insurance administrative department is separated from the medical insurance agency, resulting in a lack of smooth communication in handling work.
(5) The efforts of Party building still need to be further strengthened. Usually, there is more emphasis on business implementation, and relatively little thinking and research on party building work, resulting in a low level of party building work, and the efforts to promote business through party-building need to be strengthened.
4. 2022 work plan
In 2022, our bureau will further clarify work objectives, clarify work ideas, highlight work priorities, take effective measures, strive to forge ahead, work hard, and do a good job in medical insurance for the next year.
(1) Further improve the medical security policy. One is to further improve the city’s flexible employment personnel to participate in the basic medical insurance policy for employees. The second is to implement the measures for the implementation of basic medical insurance outpatient mutual aid guarantees for employees. The third is to adjust the basic medical insurance treatment in our city. The fourth is to improve the city’s employee medical insurance payment period policy. The fifth is to further improve the medical insurance policy for retired military personnel in our city. The sixth is to study and formulate new measures for the implementation of medical assistance in our city.
(2) Further optimize medical insurance handling services. The first is to further improve the city’s basic medical insurance relationship transfer and continuation method within the province. The second is to explore more new application scenarios based on “Guangdong Medical Insurance”, introduce more convenient and beneficial measures, and allow more businesses to be “handheld” and “online”.
(3) Continue to promote the reform of the medical insurance payment method system. Deeply promote the reform of medical insurance payment methods such as the Yangxi Medical Community; intensify the reform of traditional Chinese medicine medical insurance payment, and promote the inheritance, innovation, and development of traditional Chinese medicine; improve the management of medical insurance payment standards, and implement the national and provincial medical insurance drug payment standards.
(4) Actively promote the “dual-channel” management mechanism for drugs negotiated by the national medical insurance, to meet the guarantee of the supply of drugs negotiated by the state for the insured patients, and ensure the availability of the insured drugs.
(5) Solidly promote the work related to the centralized procurement of drugs and consumables in public medical institutions in our city. In 2022, our bureau will solidly promote the centralized procurement of drugs and consumables in public medical institutions in our city, and implement the centralized procurement of drugs and consumables for medical insurance payment.
(6) Continue to do a good job in the management of medical service price items. By the national and provincial medical service price policy requirements and work deployment, further, do a good job in the management of medical service price projects.
(7) Continue to supervise the implementation of the new version of the national negotiated drugs in 2022. Supervise the medical insurance agency to monitor the landing of the new version of the national negotiated drugs every month, and regularly collect statistics on the landing of the relevant negotiated drugs and report it to the province.
(8) Strengthen the supervision of medical insurance funds. The first is to increase the intensity of publicity and training and enhance the legal awareness of the two institutions. The second is to report the results of the special inspection of fraud and insurance fraud, increase the exposure of typical cases, and effectively deter the violations of laws and regulations by the two institutions. The third is to enrich the supervision force, increase the law enforcement establishment and increase law enforcement agencies, build a relatively fixed law enforcement team, and strengthen daily supervision and surprise inspections. The fourth is to strengthen the guidance of grass-roots fund supervision and further improve the medical insurance administrative law enforcement process and code of conduct.
(9) Efforts to promote the reform of medical insurance agencies. Fully implement the key reform work arrangements and inspection and rectification tasks of the Municipal Deepening Reform Commission, actively seek support from superiors, promote the smooth reform of the city’s agencies, and strive to solve problems such as poor communication and coordination between the medical insurance administrative agency and the medical insurance agency.
(10) Strengthen the sense of responsibility for managing the Party and governing the Party. Implement the main responsibilities of party building, consolidate the work responsibilities of party members and leading cadres, establish a responsibility system, strengthen daily supervision, strict accountability, and promote the implementation of responsibilities and see actual results. Regularly study party building work, and promote the implementation of various key party-building tasks.
2022-03-16
