The 14th Five-Year Plan for the Development of Medical Security in Suzhou is a key special plan of Suzhou Municipal Government. It was compiled by Suzhou Municipal Medical Security Bureau, deliberated and adopted at the149th executive meeting of the municipal government, and promulgated and implemented on September 30th, 20021year. The planning period is 20021-2025, which mainly expounds the overall thinking, development goals, main tasks and main policies and measures of medical security in our city during the tenth five-year plan period.

First, the planning ideas

The "Fourteenth Five-Year Plan" period is the first five years since the establishment of the Medical Insurance Department, and it is a crucial period for the transformation and upgrading, reform and development, and maturity of the medical insurance industry.

The goal of the plan is to conform to the spirit of national reform, the reality of Suzhou's development, and the good expectations of the masses, so as to make a good start for the development of medical security in Suzhou.

The main idea of the planning is: on the basis of the initial construction of a multi-level medical security system in the Thirteenth Five-Year Plan, seize the opportunity period of medical security development, actively respond to the challenges such as increasing fund income pressure and rising expenditure expectations, identify the development orientation, clarify the development goals, main tasks and major policy measures, and provide strong guidance for the development of medical security in our city during the Tenth Five-Year Plan period.

Second, the main contents of the plan

The content of the plan consists of four chapters, with 15 section and about 20,000 words.

The first part: development foundation and present situation.

This paper summarizes the achievements of medical insurance in Suzhou during the 13th Five-Year Plan period and the development foundation during the 14th Five-Year Plan period from the aspects of medical insurance system, multi-level medical insurance system, municipal overall planning, medical insurance payment mode reform, medical service price reform, medical consumables supply management, medical insurance fund supervision, medical insurance informatization level, medical insurance public service and medical insurance institution reform. This paper also analyzes the external environment and internal situation of Suzhou medical insurance development from five aspects: the increasing uncertainty of economic growth, the deep development of aging population, the continuous increase of medical expenses, the deepening of medical insurance reform and the lack of system reform, and points out the main problems and situations faced by the development of medical insurance.

The second part: guiding ideology, basic principles and development goals.

The guiding ideology for the development of medical insurance during the Tenth Five-Year Plan period is: around the implementation of the Opinions of the State Council on Deepening the Reform of Medical Insurance System and the Implementation Opinions of the Provincial Party Committee and Government, with meticulous management as the starting point, supported by standardized, standardized and digital construction, fully implement the requirements for the high-quality development of medical insurance, and further improve the multi-level medical insurance with universal coverage, clear rights and responsibilities, moderate protection and sustainability. At the same time, the plan identified four basic principles and 16 main development indicators.

The four basic principles defined in the plan are: adhering to the overall leadership of the Party, taking people's health as the center, doing our best, acting within our capabilities, adhering to municipal overall planning and regional integration.

Main indicators and expected targets

Part III: Main development tasks

In order to implement the main development goals of the "Tenth Five-Year Plan", the specific work measures and tasks of medical insurance in Suzhou during the "Tenth Five-Year Plan" period were defined. * * * Nine key development tasks and 13 key projects have been formulated.

Key development tasks

Improve the treatment guarantee mechanism. The plan is clear. By the end of 2022, the basic medical insurance will be coordinated at the municipal level, and the medical security benefits will continue to be standardized, unified, fair and moderate. We will implement the * * * economic security mechanism for employees' basic medical insurance outpatient service, enhance the economic security function of outpatient service, improve the medical security and assistance system for serious and serious diseases, and steadily promote the pilot work of long-term care insurance.

Improve the insurance financing mechanism. The plan proposes to establish a financing mechanism that is compatible with the city's social and economic development level, the affordability of all parties and the basic health needs according to the relevant national reform ideas, and appropriately reduce the proportion of unit contributions. While steadily raising the standard of government subsidies, residents' medical insurance moderately increases the weight of individual contributions, and the ratio of financial subsidies to individual contributions reaches about 2: 1.

Continue to promote the reform of medical services. The plan proposes to implement more efficient medical insurance payment methods, improve the total budget law of medical insurance funds, and focus on promoting the reform of grouping payment according to disease diagnosis (DRG). By the end of the Tenth Five-Year Plan, the proportion of hospitalization expenses paid by DRG to the total expenses of hospitalization funds will reach 70%, which will improve the efficiency of the use of medical insurance funds.

Improve the supervision mechanism of medical security fund. The plan is clear. During the Tenth Five-Year Plan period, the long-term fund supervision system will be further improved and standardized, and supervision means such as on-site inspection, remote monitoring, intelligent audit, expert review, big data screening, and disciplinary means such as agreement, administration and justice will be comprehensively used to crack down on fraud and insurance fraud. Improve the credit evaluation mechanism of medical security.

Fully promote the digital transformation of medical insurance. Promote the construction and online operation of the national medical insurance information platform, strengthen the support of information technology for the reform of key areas of medical insurance, and improve the digital and intelligent level of medical insurance.

Cooperate to promote the reform of medical service supply side. Clear planning, full implementation of the sunshine procurement policy, to promote public medical institutions in the province's unified sunshine procurement platform for online procurement and public trading of drugs (medical consumables). Carry out the pilot reform of medical service price and optimize the price structure of medical service.

Explore the establishment of medical security classification evaluation system. The plan puts forward that it is necessary to explore the establishment of an evaluation system for medical security departments during the Tenth Five-Year Plan period, classify and evaluate policies and measures, handling services and medical services, promote the rational application of evaluation results, and promote the continuous improvement of policies and measures, handling services and reasonable standardization of medical services.

Continuously optimize the public management service of medical security. Vigorously promote the "four modernizations" of medical insurance services with standardization, informationization and integration as the core, continuously optimize the direct settlement of medical treatment in different places, promote the construction of "15 minute medical insurance service circle", and enhance people's experience and satisfaction with medical insurance services.

Support the development of Suzhou biomedical industry. Make full use of the advantages of regional medical resources, continuously optimize the business environment, promote the popularization and application of innovative products, guide the empowerment of commercial insurance industry, help the high-quality development of biomedical industry, and create a new landmark of biomedical industry with Suzhou characteristics.

Major project

Part IV: Safeguard measures

From five aspects: organization and leadership, legal guarantee, team building, funding guarantee and publicity and guidance, the guarantee measures for planning and implementation are clarified.