Guided by Theory of Three Represents, our county's medical insurance work has fully implemented the spirit of the higher-level documents on medical insurance, adapted to the requirements of diversified economic forms and employment methods, kept pace with the times, pioneered and innovated, established a multi-level medical security system, made great efforts to improve the system, strengthened management, optimized services and expanded the scope, and achieved certain results, effectively guaranteed the basic medical care of cadres and workers, maintained social stability and promoted the healthy and rapid development of our county's economy. The related work is briefly reported as follows.
I. Overview
The county medical insurance bureau was established in June X with the approval of the Standing Committee of the county party committee. As a fully funded deputy-level institution, it is managed by the county personnel, labor and social security bureau. In February 2002, it was equipped with the leadership of the bureau and officially listed in March. In July of the same year, the basic medical insurance for urban workers in our county was launched. Our bureau has seven fully funded enterprises, including a secretary unit, a fund management unit and an insurance management unit. Mainly responsible for organizing the implementation of the county-wide medical insurance reform plan and the independent overall management of medical expenses of retired cadres, undertaking and managing the medical insurance business of nearly 8,000 insured persons in the county, and being responsible for group supplementary medical insurance and other supplementary medical insurance.
Second, the main work situation
1. Intensify publicity and expand medical insurance coverage.
The only way to increase the total amount of funds and enhance the ability to resist risks is to expand the coverage of medical insurance. To this end, our bureau has made great efforts to increase publicity and create a good atmosphere for the whole society to pay attention to and participate in medical insurance. Mainly through the distribution of leaflets, slogans, door-to-door publicity to the insured units, telephone contact, field visits and symposiums. From 20th, make full use of the monthly magazine "Road to Health" to widely publicize the relevant policies of medical insurance, the benefits enjoyed and how the middle-aged and old-aged insured persons can carry out health care. Up to now, 22 issues have been published, and more than 65,438+00,000 copies of The Road to Health have been issued. At the same time, during the annual Double Ninth Festival, some activities beneficial to the physical and mental health of the elderly are jointly organized with the sports associations of the elderly, which are welcomed by the majority of middle-aged and elderly people and have achieved good social effects.
2, adhere to the "people-oriented", basically establish a multi-level medical security system.
Our county has adhered to the principle of "people-oriented" in Scientific Outlook on Development, intensified its work and initially established a multi-level medical security system. First, since July 2006, the basic medical insurance for administrative institutions in our county (Chongfuzi [2006] No.50) has been started, and the medical treatment of personnel in administrative institutions in the county has been significantly improved; Second, the "Administrative Measures for Hospitalization Medical Insurance for Urban Workers in Chongyi County" was promulgated, which fundamentally solved the medical insurance problems of employees in difficult enterprises, employees in restructured enterprises, landless farmers, flexible employees and other personnel; Third, in order to completely solve the problem of medical security for rural key household registration recipients, the "Implementation Measures for Medical Security for Rural Key Household Registration Recipients in Chongyi County" (for Trial Implementation) was innovatively issued in the whole city. The policy of "three unifications" is implemented for the key entitled groups in rural household registration, that is, the civil affairs department pays 520 yuan to handle the procedures of new rural cooperative medical insurance, hospitalization medical insurance and group supplementary medical insurance; Set up individual accounts for special care recipients, and transfer them to individual accounts once a year 150 yuan; Unified for entitled groups for hospitalization insurance and chronic disease insurance, the county medical insurance bureau to co-ordinate the use, for the payment of key entitled groups hospitalization medical expenses subsidies and chronic disease medical expenses subsidies; The key entitled groups of urban household registration shall be handled in accordance with the relevant provisions of the basic medical insurance. By September 2006, the number of insured people in the county had reached 7,347, accounting for 1.02% of the tasks assigned by the municipal government at the beginning of the year, and the collection fund was 29 1.3 million yuan.
3, improve the system, improve the policy, increase the supervision and management of the "two fixed points".
At present, the total amount of basic medical insurance funds in our county is small, and the number of participants is small. Only by adhering to the "people-oriented" principle, striving to improve the system, strengthening management and optimizing services can we ensure the safe operation of funds. First, last year, the city took the lead in introducing the prescription right system of designated medical institutions for medical insurance, and implemented the file management and illegal registration system for more than 90 doctors who have obtained the qualification certificate of prescription right. For doctors who have violated the rules for more than three times, the relevant violations were reported in the journal Health Road. If the circumstances are serious, informed criticism will be written by the county personnel and labor bureau, and his promotion salary and professional title will be affected. The second is to strengthen the management of hospitalization registration, referral and transfer, and further standardize various operational procedures. The third is to strengthen the management of medical expense reimbursement. After the inpatients recover from illness, they must go through the reimbursement procedures with the settlement receipt and hospitalization expenses list issued by the designated hospitals, and the expenses shall be audited by the medical supervisor, and the opinions shall be submitted to the person in charge of the bureau for approval; Fourth, medical supervision has been strengthened, weekly medical supervision and inspection have been adhered to, and an effective supervision mechanism has been established beforehand and during the process, effectively controlling some unreasonable expenses; The fifth is to strengthen the hospitalization management of chronic diseases. In the name of the Bureau of Personnel, Labor and Social Security, the "Several Provisions on Strengthening the Hospitalization Management of Chronic Diseases of Medical Insurance Patients (Trial)" was issued, which tentatively defined diabetes and other 10 diseases as chronic diseases, and made corresponding provisions on the hospitalization procedures, reimbursement procedures and cost burden of patients with chronic diseases; Sixth, the Code for Medical Staff in Designated Medical Institutions in Chongyi County was formulated, which standardized the service behavior of medical staff from ten aspects, urged them to improve the service quality, and ensured that the majority of medical insurance personnel were satisfied with medical treatment; Seventh, the supervision and management of "two fixed points" have been strengthened, the credit rating evaluation system of fixed-point institutions has been established, the Interim Measures for Credit Rating Management of Medical Insurance Fixed-point Institutions in Our County has been promulgated, the credit rating management of fixed-point institutions has been implemented objectively and fairly, and the access and exit mechanism has been established to guide them to abide by integrity and standardize their operation.
4, retired cadres, deputy county and above treatment and enterprise demobilized cadres medical treatment is guaranteed.
According to the requirements of establishing two mechanisms for medical expenses of retired cadres, the medical expenses of 78 retired cadres and more than 30 people at or above the deputy county level in the county were separately coordinated, accounted for in separate accounts, managed in special accounts and registered in ledgers; In accordance with the unified requirements of the superior, the medical insurance procedures were handled for the demobilized cadres of enterprises in the county to ensure their medical treatment; At the same time, actively provide quality services for retired cadres. At the beginning of May this year, we organized a free physical examination for retired cadres in the county, and established a health file for retired cadres in Chongyi County, and timely fed back the results of the physical examination, which was well received by retired cadres.
5, constantly strengthen their own construction, improve the management level of medical insurance.
The first is to improve the learning system. Adhere to organize cadres and workers to study political theory, labor security policies and regulations and medical insurance business knowledge regularly every Friday, and ask them to take study notes and conduct inspections irregularly; Second, establish and improve various work systems and fully implement the target management responsibility system; The third is to standardize the operating procedures of medical insurance, formulate corresponding reward and punishment measures, and strive to provide enthusiastic, thoughtful, convenient and fast services for the insured, so as to satisfy the masses and establish a good image of the medical insurance agency; Fourth, the computer network construction of medical insurance has been improved, and the scientific and standardized management level has been improved. Since last year 1 month, in order to facilitate the majority of insured employees and improve the awareness of diagnosis and service competition in designated medical institutions, the computer network management system of medical insurance in our county has been networked with seven designated institutions, and all personal accounts of insured employees are consumed by IC cards; From May 1 this year, all insured persons in the county can use the medical insurance IC card to swipe their cards at designated service institutions within the city to seek medical treatment and purchase medicines, which is referred to as "medical insurance card" for short.
Three. Existing problems and suggestions
1, the publicity of medical insurance policy is not strong enough, the form is single and not novel enough, the coverage is small, and the ability to resist risks is not strong.
2, retired cadres and deputy county-level treatment personnel medical expenses fund normal overruns, the lack of a strong guarantee mechanism.
3, to further strengthen the information exchange with designated institutions and insured units, to ensure timely communication between medical insurance agencies, designated institutions and insured units, exchange information, and better serve the insured.