Principles for the use of medical insurance funds

The medical insurance fund is the "medical money" of ordinary people. Making good use of medical insurance fund is related to people's health and people's livelihood. Dongzhi county Medical Insurance Bureau has strengthened the construction of service mechanism and internal control system to safeguard the safety of medical insurance funds, safeguard the rights and interests of the people and promote the standardized use of medical insurance funds.

Strengthen people's health as the center. Integrate "people's health as the center" into the whole process of medical insurance management and development, running through all aspects of the use of medical insurance funds. To further clarify the principle of fund use, we should follow the principle of legal, safe, open, convenient and sustainable use of medical insurance funds; Further increase the construction of handling management system to provide standardized and standardized handling services for the masses; Further standardize the medical behavior of medical institutions, ensure that they provide medical services according to regulations, rationally use medical insurance funds, and earnestly safeguard people's health rights and interests.

Strengthen the main responsibility of using medical insurance funds. Further clarify the main responsibilities of all parties, implement the medical insurance system, study and publish the payment scope of medical insurance funds, improve the business, financial and medical insurance management systems, increase agreement management, strengthen payment supervision, investigate and deal with illegal use of funds according to law, resolutely crack down on any form of fraudulent insurance, and accept social supervision; Medical institutions do a good job in internal management, save the reimbursement data of insured patients, transmit the data in real time, actively investigate and report the risk of hospital fund use, and accept social supervision; The insured person manages the personal medical insurance certificate and enjoys the medical insurance benefits according to the regulations.

Strengthen the construction of supervision system and mechanism. Further implement the social supervisor system, guide industry self-discipline and personal trustworthiness with social supervision, and build a new pattern of supervision; According to the medical insurance service agreement mode of the whole province, combined with the management characteristics of our county, the service agreement content is refined and the DRG payment supervision practice content is increased; Strengthen the study of laws and regulations related to medical insurance, introduce information technology and third-party forces, and improve the ability of administration according to law.

Strengthen accountability for violations. Intensify the propaganda and interpretation of the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, combine the typical cases exposed by superiors, do a good job in case interpretation, clarify the behavioral responsibilities and legal consequences of relevant subjects in the use of medical insurance funds, and resolutely investigate cases, mistakes and questions, so as to provide a strong guarantee for the standardized use of medical insurance funds.