Medical Insurance Situation Report

Medical Insurance Situation Report

The medical insurance work in our county is guided by the important thought of "Three Represents", fully implements the spirit of superior documents on medical insurance, and adapts to the economic situation and To meet the requirements of diversified employment methods, we must keep pace with the times, pioneer and innovate, and establish a multi-level medical security system, focusing on improving the system, strengthening management, optimizing services, and expanding the scope, in order to effectively protect the basic medical care of cadres and workers and maintain social stability. , Promote the healthy and rapid development of the county's economy, and have achieved certain results. The relevant work is now briefly reported as follows:

1. Overview

The County Medical Insurance Bureau is in 6th year x The Menstruation County Party Committee Standing Committee meeting approved its establishment. It is a fully funded public institution at the deputy section level and is under the management of the County Personnel, Labor and Social Security Bureau. In February 2002, it was equipped with bureau leaders and was officially listed in March. In July of the same year, the county's Basic medical insurance for urban employees; our bureau currently has a fully funded enterprise with 7 employees, including a secretarial unit, a fund management unit, and an insurance management unit. It is mainly responsible for organizing and implementing the reform plan for the county's medical insurance and separately managing the medical expenses of retired cadres. Work, undertake and manage the medical insurance business for nearly 8,000 insured persons in the county, and be responsible for group supplementary medical insurance and other types of supplementary medical insurance and other business work.

2. Main work situation

1. Increase publicity and expand medical insurance coverage

To increase the total amount of funds and enhance the ability to resist risks, only To expand the coverage of medical insurance, our bureau has made great efforts to increase publicity and create a good atmosphere for the whole society to pay attention to and participate in medical insurance; mainly through distributing leaflets, slogans, visiting insured units for door-to-door publicity, and Vigorous publicity will be carried out through telephone contact, on-site visits, and symposiums. Starting from 20, we will make full use of the monthly "Healthy Road" publication to discuss the relevant policies of medical insurance, the benefits enjoyed, and how middle-aged and elderly insured persons Carry out extensive publicity on health care. Up to now, 22 issues have been published and more than 10,000 copies of the "Road to Health" publication have been distributed. At the same time, during the Double Ninth Festival every year, it also co-organizes some activities with the Senior Citizens' Sports Association that are beneficial to the physical and mental health of the elderly. Healthy activities are well received by middle-aged and elderly people and have achieved good social effects.

2. Adhere to the "people-oriented" scientific concept of development, and have basically established a multi-level medical security system

Our county has adhered to the "people-oriented" scientific development concept, intensified work efforts, and has initially built many A multi-level medical security system: First, the basic medical insurance for administrative institutions in our county has been launched since July 2006 (Chongfu Zi [2006] No. 50), and the medical benefits of employees in administrative institutions throughout the county have been significantly improved. Second, the "Measures for the Administration of Hospitalization Medical Insurance for Urban Employees in Chongyi County" has been promulgated, which fundamentally solves the problem of medical insurance for employees of enterprises in need, employees of restructured enterprises, landless farmers, and people with flexible employment; The third is to completely solve the problem of medical insurance Regarding the medical insurance issues for key preferential treatment recipients with rural household registration, the city has innovatively promulgated the "Implementation Measures for Medical Insurance for Key Preferential Care Objects in Chongyi County" (Trial). The department pays 520 yuan to handle the procedures for new rural cooperative medical insurance, hospitalization medical insurance, and group supplementary medical insurance; unified personal accounts are set up for preferential treatment recipients, and 150 yuan is transferred to the personal account at one time every year; unified handling of hospitalization insurance and chronic disease for preferential treatment recipients The insurance is coordinated and used by the county medical insurance bureau to pay subsidies for hospitalization medical expenses and chronic disease medical expenses for key preferential treatment recipients; for key preferential treatment recipients with urban household registration, it shall be handled in accordance with the relevant provisions of basic medical insurance. As of September 2006, the number of insured persons in the county has reached 7,347, completing 102 of the tasks assigned by the municipal government at the beginning of the year, and collecting funds of 2.913 million yuan.

3. Improve the system, improve policies, and increase the supervision and management of the "two fixed points"

The current total amount of basic medical insurance funds in our county is small, and the number of insured people is small. , only by adhering to the "people-oriented" scientific development concept and working hard to improve the system, strengthen management, and optimize services can the safe operation of the fund be ensured. First, last year, the city took the lead in introducing a medical insurance prescription rights system for designated medical institutions. It implemented a file management and violation registration system for more than 90 doctors who have obtained prescription rights qualification certificates. Doctors who violated the regulations three or more times were listed in the "Road to Health" Relevant violations are reported in publications. If the circumstances are serious, the County Personnel and Labor Bureau will issue a written notice and criticize, and their promotion, salary, professional titles, etc. will be affected. Secondly, the management of hospitalization registration and referral to another hospital has been strengthened, and various operating procedures have been further standardized; thirdly, It is to strengthen the reimbursement management of medical expenses. After recovering from illness, hospitalized patients must present the settlement receipt and hospitalization fee list issued by the designated hospital. The medical supervisors will review the various expenses and submit their opinions to the person in charge of the bureau for approval before they can handle the reimbursement procedures; fourth, it has increased the In terms of medical supervision, we have adhered to weekly medical supervision and inspections, established an effective pre- and in-process supervision mechanism, and effectively controlled some unreasonable expenses; fifthly, we have strengthened the management of hospitalization for chronic diseases. In the name of the Bureau of Personnel, Labor and Social Security, the "Several Provisions on Strengthening the Management of Hospitalization of Chronic Diseases for Medical Insurance Patients (Trial)" was issued, tentatively defining 10 diseases such as diabetes as chronic diseases, and the procedures for the hospitalization of patients with chronic diseases. , reimbursement procedures, cost burdens, etc. have been stipulated accordingly; Sixthly, the "Code for Medical Staff of Designated Medical Institutions in Chongyi County" has been formulated. The "Code" regulates the service behavior of medical staff from ten aspects, prompting them to improve Service quality ensures that the majority of medical insurance personnel are satisfied with medical treatment; seventh, the supervision and management of the "two designated institutions" have been strengthened, a credit rating evaluation system for designated institutions has been established, and the interim measures for the credit rating management of designated medical insurance institutions in our county have been introduced to objectively and fairly Implement credit rating management for designated institutions, establish an access and exit mechanism, and guide them to abide by integrity and standardize operations.

4. The medical benefits of retired cadres, deputy county level and above and enterprise cadres transferred from the military are guaranteed

In accordance with the requirements of establishing two mechanisms for medical expenses of retired cadres, the county has The medical expenses of 78 retired cadres and more than 30 people with deputy county or above benefits were separately coordinated, separately accounted, managed in separate accounts, and registered in accounts; according to the unified requirements of superiors, medical insurance was provided for the county's enterprise military demobilized cadres procedures to ensure their medical treatment; at the same time, we actively provide high-quality services to retired cadres. In early May this year, we organized retired cadres across the county to undergo free physical examinations, and established a "Chongyi County Retired Cadres Health File" to promptly Feedback to them on the results of the physical examination was unanimously praised by retired cadres.

5. Continuously strengthen self-construction and improve the level of medical insurance management

The first is to improve the learning system. Adhere to the regular organization of cadres and employees every Friday to study political theory, labor security policies and regulations, and medical insurance business knowledge, and require study notes to be inspected from time to time; secondly, various work systems have been established and improved to fully implement target management work responsibilities The third is to standardize the various operating procedures of medical insurance and formulate corresponding reward and punishment measures, and strive to provide warm, thoughtful, convenient and fast services to insured persons, satisfy the masses, and establish a good image of medical insurance agencies Fourth, the construction of the medical insurance computer network has been improved and the level of scientific and standardized management has been improved. Since January last year, in order to facilitate the majority of insured employees and improve the competitive awareness of diagnosis, treatment and services among designated medical institutions, our county’s medical insurance computer network management system has been online and operated with 7 designated institutions, and all insured employees’ personal accounts have been implemented IC card consumption; starting from May 1 this year, all insured persons in the county can use their medical insurance IC cards to swipe their cards for medical treatment and purchase of medicines at designated service institutions across the city, referred to as "medical insurance card"

Three , Existing problems and suggestions

1. The publicity of medical insurance policies is not strong enough, the form is single and not novel enough, the coverage is small, and the ability to resist risks is not strong.

2. The normal overspending of the medical expense co-ordination fund for retired cadres and people with benefits above the deputy county level lacks a strong protection mechanism.

3. Further strengthen information exchange with designated institutions and insured units, ensure timely communication and exchange of information between medical insurance agencies, designated institutions and insured units, so as to better serve insured objects Serve.