In order to promote the reform of medical insurance payment methods, the supporting policies proposed in the Opinions are as follows:
Strengthen the management of capital budget.
According to the principle of fixed income and expenditure, balance of payments and slight surplus, the budget of medical insurance fund is scientifically compiled and strictly implemented.
Strictly regulate the responsibility boundary of basic medical insurance.
The basic medical insurance focuses on the expenses related to drugs, medical services and basic service facilities that meet the principle of "clinical necessity, safety and effectiveness, and reasonable price". Public health expenses, physical fitness or health care consumption that are not directly related to disease treatment shall not be included in the scope of medical insurance payment. All localities should fully consider the medical insurance fund, the overall social affordability and the personal burden of the insured, adhere to the principle of basic security and shared responsibility, and adjust the treatment policy in accordance with the prescribed procedures. For drugs and medical services in the medical insurance catalogue, scientifically and reasonably determine the medical insurance payment standard.
Jointly promote the reform of the medical and health system.
Establish a macro-control mechanism for the total amount of medical and health resources and medical expenses in the region to adapt to the level of economic development and the support capacity of medical insurance funds, and effectively control the excessive growth of expenses. Improve the transparency of diagnosis and treatment. Promote mutual recognition of physical examination results of medical institutions at the same level and reduce repeated inspections. Establish an information disclosure mechanism for the efficiency and expenses of medical institutions, regularly disclose indicators such as expenses and patient burden levels, accept social supervision, and provide reference for the insured to choose medical treatment. Improve the internal performance appraisal and income distribution mechanism of public medical institutions. Standardize and promote multi-point practice of medical staff.
The "Opinions" require that the budget management of medical insurance funds should be further strengthened from 20 17, and the multiple compound medical insurance payment methods based on disease payment should be fully implemented. By 2020, the reform of medical insurance payment methods will cover all medical institutions and medical services, and the proportion of payment by project will drop significantly.