What is the “strongest medical insurance department in history” that has just been established? What are the challenges?

On the last day of May, the National Health Insurance Agency, which has been pending, has finally lost its weight!

In addition to the new leadership team, the following departments under the National Medical Insurance Bureau have also been exposed. It is understood that the National Medical Insurance Bureau will have eight departments, including the Office, the Basic Medical Insurance Department, the Agreement and Regulation Department, and the Internal Control and Supervision Department. Information Center, Clearing Center, Management Center, and Medical Insurance Research Office.

From the perspective of functions, the Basic Medical Insurance Department will be responsible for policy formulation and supervision after the integration of the three guarantees. The bidding for pharmaceutical equipment will be handled by the Agreement and Regulation Department. It will also work with the Internal Control and Supervision Department to formulate the value of medical insurance payment. matter.

With the beginning of the rectification of the local medical insurance chaos, the medical insurance situation as a regulatory department will surely play a greater role. What will this newly formed “the most powerful medical insurance department in history” do next?

According to the opinions of the division of labor of the key work departments of the "Government Work Report" issued by the State Council in April, the key tasks of the National Medical Insurance Bureau are as follows:

(19) Promote social system reform. Deepen the comprehensive reform of public hospitals, coordinate and promote the reform of medical prices, personnel remuneration, drug circulation, medical insurance payment, improve the quality of medical and health services, and make great efforts to solve the problem of medical treatment for the masses.

(22) Increase the precision of poverty alleviation. This year, we will reduce the number of rural poor people by more than 10 million, and complete the resettlement of 2.8 million people. We will further promote poverty alleviation in industry, education, health, ecology and culture, fill in shortcomings in infrastructure and public services, strengthen poverty alleviation cooperation and counterpart support in the east and west, focus on poverty alleviation, support and support, and stimulate endogenous motivation for poverty alleviation. We will carry out special governance on corruption and work styles in the field of poverty alleviation and improve the methods of assessment and supervision.

(30) Enhance the basic role of consumption in economic development. Promote consumption upgrades and develop new modes of consumption new business. Support social forces to increase the supply of services such as medical care, old-age care, education, culture, and sports.

(37) Steadily increase the income level of residents. Continue to increase the basic pension for retirees and the basic pension for urban and rural residents. Increase the special expenses deduction for children's education, major medical care, etc., and reduce the burden reasonably.

(39) Implementing a healthy China strategy. Improve the level of basic medical insurance and major illness insurance, the per capita financial subsidy standard for residents' basic medical insurance will increase by 40 yuan, and half of it will be used for major illness insurance, so that more people can enjoy the rescue of major illness insurance and expand the disease insurance for major illnesses. We will expand the scope of direct settlement of medical treatment across provinces, and include grassroots hospitals, migrant workers, and foreign employment entrepreneurs.

Intensify the training of medical staff, strengthen the construction of general practitioners and pediatricians, and promote the grading diagnosis and treatment of family doctors. Through the development of "Internet + medical", medical associations, etc., the quality of medical resources will sink. Continue to raise the per capita financial subsidy standard for basic public health services. Adhere to prevention and strengthen prevention and control of major diseases. Improve maternal and child health services. Support the inheritance and innovation of Chinese medicine. Encourage the integration of Chinese and Western medicine. For the drugs that have been listed for sale overseas, the research will simplify the examination and approval procedures for import use and better protect the access of the people.

(41) Strengthening the protection of the people's livelihood. We will steadily raise standards such as urban and rural subsistence allowances, social assistance, and preferential treatment. Actively respond to the aging of the population, develop home, community and mutual support for the elderly, promote the combination of medical care and improve the quality of nursing home services. Caring for helping left-behind children in rural areas. Strengthen the protection of children in urban and rural difficulties. Do a good job in the care of the disabled soldiers and the military. Strengthen rehabilitation services for disabled people. Improve the social assistance system and support the development of charity.

In addition to the advancement of the above-mentioned key tasks, according to the report of China's medical and medical insurance, at the forum on “Development and Governance of Medical Security under the New Situation” held recently, some experts said that the newly established medical insurance bureau will face several new challenges:

First, under the new economic normal, there is limited room for growth in medical insurance financing. The pressure on medical resources management to improve efficiency against limited resources requires a sharpening of management to tap potential and balance supply and demand. Therefore, the future not only needs to pay attention to the balance of funds, but also needs to pay attention to the balance between the infinity of medical needs and the limited resources, and use its own advantages and mechanisms to promote the overall improvement of the quality and efficiency of medical services.

Second, after the integration of the new rural cooperative medical insurance and the urban residents' medical insurance, the new urban and rural residents' medical insurance and the urban workers' medical insurance are stable and divided in parallel or gradually unified and how to unify will be a new challenge.

Third, with the integration of medical assistance and basic medical insurance, the multi-level medical security system will be transformed into a basic medical insurance plus supplementary insurance structure. The insured will propose some new appeals and some new challenges will emerge.

Fourth, long-term care and protection is an important part of the complete medical security system. In the current economic situation and the lack of development of the service market, how to establish an effective care and protection system needs attention.

Fifth, special attention needs to be paid to the management of industrial injury insurance. Before the reform of the organization, the medical service management of industrial injury insurance was carried on the medical insurance. The current work injury insurance continued to be managed in the human society department. How to manage it effectively in the future and how to connect with the medical insurance service management requires observation and research.

Of course, the above experts also stressed that not all problems and challenges can be resolved in the short term. It is necessary to distinguish between short-term and long-term goals. In the near term, some urgently need to solve the institutional structure and mechanism construction problems that need to be solved. Study carefully, plan ahead, plan, design and promote from now on.

In addition, since the new medical insurance bureau has collected some functions of many original departments, how to coordinate? Some experts have emphasized that the integrated medical insurance function of the new medical insurance bureau is not only a weapon of reform, but also a gathering of risks. Concentration of power, if there is no effective incentive and restraint mechanism, may lead to institutional bureaucracy and reduce operational efficiency. The new medical security bureau can be described as a concentration of power, and its management effect is related to the development of medical institutions, the survival of medical consumables enterprises, the health and sustainability of medical insurance funds, the level of medical security for the people, and the quality of medical services.

Therefore, most experts recommend establishing a binding mechanism for the effective exercise of power. Some experts suggest that the mechanism be used to downplay power, the sun to supervise power, the third-party service to decentralize power, internal control to control power, to replace power with expert teams, scientific decision-making, to restrict power by technical means, and to prevent abuse of power by accountability system. And not doing it. Specifically, it is recommended to clarify the conditions and procedures for medical insurance, standardize behavioral management and non-compliance; medical, consumable price and payment standard management to give full play to the role of the market and negotiated methods; clarify the rules for dynamic drug adjustment and reduce stakeholder interference The medical insurance costs are implemented in the sunshine; the information system is used to carry out service supervision; the medical insurance purchase economic evaluation and negotiation and negotiation mechanism are established. Some experts also suggested that the Medical Insurance Bureau gradually disperse its power with the reform and gradually reduce its power.

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