In 20 19, the per capita financial subsidy standard for medical insurance for urban and rural residents was increased in 30 yuan, reaching not less than that of 520 yuan per person per year, and half of the new financial subsidy was used to improve the ability of major illness insurance (per capita financing standard was increased in 20 18/5 yuan); Individual contributions will increase simultaneously in 30 yuan, reaching 250 yuan per person per year. According to the Notice of the General Office of the State Council on Printing and Distributing the Reform Plan of the Division of Fiscal Powers and Expenditure Responsibilities between the Central and Local Governments in the Medical and Health Field (Guo Ban Fa [2018] No.67), the central government will grant subsidies to all provinces, autonomous regions, municipalities directly under the Central Government and cities with separate plans. Provincial finance should increase its inclination to deep poverty areas and improve the way of financial sharing below the provincial level. Local governments at all levels should arrange financial subsidies in full according to regulations and allocate them in time according to regulations. According to the notice of the State Council on implementing some financial policies to support the citizenization of agricultural transfer population (Guo Fa [2065438+06] No.44), individuals who hold residence permits to participate in the insurance shall pay according to the same standards of local residents, and financial departments at all levels shall give subsidies according to the same standards of local residents. Medical security departments at all levels should orderly promote the convergence of work before and after the transfer of medical insurance fee collection and management responsibilities for urban and rural residents, and ensure that the annual financing quantitative indicators are put in place.
The second is to steadily improve the level of treatment and protection.
All localities should make good use of the annual medical insurance for urban and rural residents to ensure that the basic medical insurance benefits are in place. Consolidate and improve the reimbursement ratio of hospitalization expenses within the scope of the policy, establish and improve the overall planning and payment mechanism of medical insurance outpatient expenses for urban and rural residents, and focus on ensuring frequently-occurring diseases and chronic diseases with heavy burdens on the masses. Outpatient drugs such as hypertension and diabetes are included in medical insurance reimbursement, and the specific plan shall be formulated separately. Cancel the implementation of individual (family) accounts before the end of 2020 and make a smooth transition to outpatient service; If an individual (family) account has been cancelled, it shall not be restored or set in disguise.
Improve the guarantee function of serious illness insurance. Reduce and unify the deductible line of serious illness insurance, in principle, according to 50% of the per capita disposable income of residents in the previous year. Below this ratio, no adjustment can be made; The reimbursement rate within the policy scope is increased from 50% to 60%; We will increase the payment of serious illness insurance to the poor, reduce the deductible for the poor by 50%, increase the payment ratio by 5 percentage points, and completely cancel the capping line of serious illness insurance for the poor, further reducing the medical burden of seriously ill patients and people in need.
Third, comprehensively establish a unified medical insurance system for urban and rural residents.
In areas where the basic medical insurance for urban residents and the new rural cooperative medical system have not been fully integrated and unified, it is necessary to realize the transition from the two systems in parallel to a unified medical insurance system for urban and rural residents before the end of 20 19 in accordance with the deployment requirements of the CPC Central Committee and the State Council. In the process of system unification, it is necessary to consolidate the coverage of medical insurance for urban and rural residents, ensure that the participation rate is not lower than the existing level, and the participation rate continues to be stable to ensure full coverage; Improve the registration and payment methods for newborns, children, students and migrant workers to avoid repeated participation; There are other medical security system arrangements, which are not included in the coverage of medical insurance for urban and rural residents; Properly handle special problems and policies, do a good job of policy convergence before and after the system unification, stabilize the expectation of treatment, and prevent the tendency of pan-welfare.
All localities should focus on the uncoordinated development of medical insurance for urban and rural residents, combine with the integration of medical insurance-related functions, and unify services and information systems on the basis of ensuring the "six unifications" of coverage, financing policy, guaranteed treatment, medical insurance catalogue, fixed-point management and fund management, further improve the quality and efficiency of operation, ensure the comprehensive establishment of a unified medical insurance system for urban and rural residents, and achieve a more perfect system, fairer protection, more sustainable funds, more standardized management and more services.
Four, improve and standardize the policy and management of serious illness insurance.
All provinces, autonomous regions and municipalities directly under the Central Government should combine the comprehensive establishment of a unified medical insurance system for urban and rural residents, unify and standardize the financing and treatment guarantee policies for serious illness insurance, and promote the convergence and balance of treatment guarantee standards and payment levels among regions. According to the "Government Work Report" and the task of adjusting the financing and treatment policy of serious illness insurance proposed in this notice, the entrustment contract of serious illness insurance will be adjusted through consultation before the end of August 20 19, and the disbursement will be completed according to the latest financing standard before the end of 20 19 to ensure that the policies, funds and services are in place.
It is necessary to optimize the management service of serious illness insurance. In principle, serious illness insurance is entrusted to commercial insurance institutions, and medical security departments at all levels should improve the assessment mechanism of commercial insurance institutions, establish and improve the assessment system centered on the level of security and the satisfaction of the insured, urge commercial insurance institutions to improve the efficiency of service management, and play their due role in standardizing medical treatment behavior, controlling medical expenses, and guiding reasonable medical treatment. Improve the risk sharing mechanism through equal consultation. If the losses of commercial insurance institutions are caused by the adjustment of medical insurance policies, the medical insurance fund and commercial insurance institutions shall share them reasonably, and the specific proportion shall be agreed in the contract. Strengthen the information sharing between medical insurance agencies and commercial insurance institutions, clarify the data use authority, standardize the operation data statistics, and commercial insurance institutions regularly submit the data of serious illness insurance to the medical security department to cooperate with the operation monitoring and analysis.