Medical network - April 26 medical insurance directory "progress". 

 

Yesterday (25), the ministry of human resources and social security held a regular press conference in the first quarter of 2017, people club department spokesman ai-hong lu directory, health care medical field negotiate insurance fraud and other issues to resolve. 

 

▍ "health care +" in the first half 

 

This year released the 2017 edition of the basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue, on this basis, according to the central about exploring to establish orgnaization of agency of insurance of medical treatment and the requirement of medical institutions, drug supplier negotiation mechanism, people club department to seek to establish negotiating access mechanism is put forward. 

 

According to the mechanism, clinical curative effect is necessary, but the price is more expensive, according to the current market price included in the directory may bring some risk to the fund's exclusive patent medicine, medicine, take by expert judges determine the scope of the negotiations and drug, medicine, pharmacy, health economics, insurance management, and other experts in the field of negotiations, such mechanism is established. After the agreement, will be eligible drug on drug list again. 

 

Nearly half of tumor in 44 drugs targeted drugs, covers the common major diseases such as cancer and cardiovascular disease drugs. 

 

People club department, according to the confirmed that negotiations with production enterprises, is currently negotiating plan formulation, in the process of developing schemes, will listen to related learning (association), the enterprise and the opinions of the experts and scholars. Scheme is determined, we will organize experts to negotiate according to the program, for the completion of negotiations in the first half of the work, and adjust the schedule ready to join with the local b directory. 

 

▍ against insurance fraud will be a new mechanism 

 

News conference, the media asked, recently shenzhen some public 3 armour hospital doctors and outlaws collusion, by way of prescribing a compliance medicare card such as news was exposed. 

 

This people club department, said after the aware of relevant information, in guangdong province and shenzhen people club department has carried out investigation and verification, serious processing are jointly with relevant departments. Spokesman said, through the social security card to obtain medical insurance personal accounts belong to the fraud insurance fraud crime, serious damage to the interests of the masses of ginseng protect personnel, also harm to the sustainable development of the health care system. To prevent and combat the illegal behaviour of health care fraud insurance fraud is a long-term work. People club department will strengthen supervision measures to further improve the long-term mechanism: 

 

A, in order to strengthen the management of medical insurance fixed-point medical institutions, perfect the medical insurance service agreement, strengthening designated exit mechanism, to explore the health care doctor management, gradually achieve regulatory objects from medical institutions to the medical staff medical service behavior; 

 

Second, continue to promote health intelligent monitoring system. This kind of monitor and control system has been established in many cities, through the use of monitoring and control system, strengthen the drug for outpatient, hospital, shopping and other kinds of medical service behavior monitoring, in order to strengthen the management of orgnaization of audit audit, regulating the behavior of medical personnel, medical services and ginseng protect personnel to medical behavior; 

 

Third, research to improve the specific measures of individual account, from further plug up loopholes in the system; 

 

Four, health care fraud will be punished in accordance with the law violation behavior, strengthen social insurance fraud case investigation and transferred to the work, to promote health care regulation and the effective connection of criminal justice, insurance fraud behavior of fraud found together, investigate together. In addition, the club will actively cooperate with related departments, strengthen the management of public hospital and its medical staff supervision. 

 

The attached: 

 

2017 people club department focus 

 

A, perfecting the social security system. Set about to establish the basic endowment insurance treatment to determine urban and rural residents and the opinions of the fundamental annuities normal adjustment mechanism, to guide the integration of urban and rural residents basic medical insurance system, improve the urban residents health jointly with the finance department government subsidies standards, to guide local pilot to advance long-term care insurance, birth insurance and insurance of primary medical treatment to merge the implementation of the pilot. 

 

2, collects pay social insurance covering, promote the full implementation of universal coverage registration plan, completes the docking system and data warehousing. Now social insurance coverage continues to expand, as of the end of march, the national basic pension, basic medical, unemployment, work injury and maternity insurance, respectively 892 million, 1.012 billion people, 180 million people, 180 million people, 183 million people; The five fund income is 1.53 trillion yuan, up 26.9% from a year earlier, total 1.18 trillion yuan, up 21.7% from a year earlier. 

 

Third, strengthen the management of fund investment and supervision. By the end of march, Beijing, Shanghai, henan, hubei, guangxi, yunnan, shaanxi, 7 provinces (autonomous regions and municipalities) government and the social security fund council signed the entrusted investment contract. People club will use the information network + supervision ", to carry out the old-age insurance key indicators special verification work. Speed up and improve the social security fraud and transfer mechanism, strict fund supervision and law enforcement. Continue endowment insurance fund investment operations, strengthen the investment regulation. 

 

Four, strengthen social insurance management services. Accelerate the long-distance medical networking settlement work, by the end of march, 27 provinces access official national platform, 114 districts (including the province at the corresponding level, the xinjiang production and construction corps) has access, social security card card number to 989 million. Club will advance some provinces and cities to speed up the information system construction and transformation, with the national system of connected access, the orgnaization of social insurance more unity under provincial level, improve the orgnaization of social insurance management and service system.