First, fully understand the significance of outpatient co-ordination. It is an important measure to improve the level of medical security to carry out the overall planning of residents' medical insurance outpatient service, which is conducive to broadening the security function and reducing the burden of medical expenses for the masses. It is an important part of improving the management mechanism of medical insurance, which is conducive to the overall adjustment of health resources and the improvement of security performance; It is an important starting point for implementing the requirements of "ensuring the basics, strengthening the grassroots and building mechanisms", which is conducive to supporting the construction of primary medical institutions, promoting the implementation of the basic drug system, and promoting the coordinated development of various reforms in the medical and health system. The following principles should be adhered to in carrying out outpatient co-ordination: adhere to the basic guarantee, focus on ensuring outpatient frequently-occurring diseases and chronic diseases with heavy burden on the masses, and avoid turning them into welfare compensation; Adhere to the social economy and realize the fair use and treatment of funds; Adhere to relying on primary medical and health resources, strictly control the cost of medical services, and improve the efficiency of fund use. All localities should unify their thinking, implement their responsibilities, strengthen organization and implementation, and ensure the completion of the overall task of outpatient service for all. In accordance with the requirements of "Guiding Opinions on Developing Outpatient Overall Planning of Basic Medical Insurance for Urban Residents", we should strengthen management, innovate mechanisms and strive to improve the performance of outpatient overall planning. Give full play to the important role of medical insurance in the reform of medical and health system, focus on adjusting the structure and building mechanisms, reduce the cost of medical services, and optimize the allocation of health resources. Second, reasonably determine the scope of protection and payment policy. The funds needed for outpatient co-ordination are solved by the residents' medical insurance fund. All localities should comprehensively consider the medical needs of residents, the level of expenses and the distribution of health resources. , careful planning, reasonable arrangements for outpatient and inpatient funds. 20 1 1 year's new financial subsidy funds are mainly used to carry out outpatient co-ordination on the basis of ensuring the improvement of hospitalization medical treatment. Outpatient co-ordination is based on ensuring the basic medical needs of the insured, mainly paying the outpatient medical expenses that meet the requirements in primary medical and health institutions, focusing on ensuring the frequently-occurring diseases and chronic diseases with heavy burden on the masses. Difficult areas can gradually expand the coverage of outpatient clinics from the beginning of bringing serious outpatient illnesses into the scope of overall fund payment. Reasonable determination of outpatient co-ordination payment ratio, minimum payment standard (amount) and maximum payment limit. In accordance with the provisions of the medical expenses incurred in primary medical and health institutions, the payment ratio is not less than 50% in principle; If the accumulated outpatient medical expenses are high, the proportion of payment may be appropriately increased. Outpatient medical expenses incurred by non-primary medical institutions shall not be paid in principle without referral from primary medical institutions. According to the characteristics of outpatient diagnosis and treatment and drug use, explore the establishment of diagnosis and treatment items and drug payment methods respectively. In view of the high frequency of outpatient service, the outpatient co-ordination deductible line can be determined by the way of paying for each visit. According to the fund's affordability, comprehensively consider the local average outpatient expenses, the number of visits by residents, the hospitalization rate and other factors, reasonably determine the maximum payment limit for outpatient co-ordination, and gradually increase with the enhancement of the fund's affordability. It is necessary to combine the improvement of medical treatment mechanism, make overall consideration of outpatient and inpatient payment policies, make a good connection between them, and improve the efficiency of fund use. Measures should be taken to encourage patients to go to the outpatient clinic for chemotherapy and radiotherapy for malignant tumors, uremia dialysis, anti-rejection treatment after organ transplantation, insulin treatment for diabetic patients, drug maintenance treatment for severe mental patients and some operations that are more economical and convenient than outpatient hospitalization. According to the characteristics of these special treatments and operations, all localities can independently determine designated medical institutions (not limited to primary medical institutions), and formulate corresponding management and payment methods with reference to hospitalization to reduce their medical expenses. Third, improve medical service management measures according to the needs of outpatient support, establish and improve the medical service management and assessment system suitable for outpatient characteristics, strengthen the assessment of outpatient rate, referral rate, average cost and cost structure, and standardize the medical service behavior of designated medical institutions at the grassroots level. Do a good job in connecting with the construction of primary medical service system, the basic drug system, the general practitioner system and other reforms to promote each other. Residents' medical insurance clinics should co-ordinate the implementation of the basic medical insurance drug list to ensure the use of Class A drugs (including basic drugs) in designated primary medical institutions. Put forward clear requirements for the preparation and use of Class A drugs in designated primary medical institutions, and incorporate them into the assessment system of designated primary medical institutions. For some outpatients who need Class B drugs for basic medical treatment, areas with conditions can study and explore ways to make payment and management of drugs purchased by doctors in primary medical institutions. Strictly implement the zero-difference sales policy of essential drugs in government-run primary medical institutions to reduce the cost of drugs. General medical expenses will all be included in the scope of medical insurance payment and paid according to the prescribed proportion. Establish and improve the norms and regulatory measures of outpatient co-ordination diagnosis and treatment services, strengthen the supervision of the service behavior of designated primary medical institutions, reasonably control the quantity and cost of diagnosis and treatment services, and avoid the occurrence of irregular diagnosis and treatment behaviors such as decomposition treatment and repeated charges. Fourth, innovate medical management and payment mechanism. Innovating outpatient medical management and payment mechanism, gradually shifting the management focus from cost control to cost control, reducing service costs and improving security performance. We should make full use of primary medical institutions, guide the masses to seek medical treatment at the primary level, and promote the formation of a graded medical system. Give full play to the regulatory role of medical insurance on health resources, rationally use outpatient and inpatient resources, reduce hospitalization rate, and control medical expenses as a whole. Actively explore the management mechanism of first consultation and two-way referral for medical treatment at the grassroots level. To determine the first-visit primary medical institutions, we should comprehensively consider the service capacity of medical institutions, the willingness of insured residents, whether to establish cooperative relations with higher-level hospitals and other factors. Generally, one year is fixed, and the insured can only choose one. Actively explore two-way referral, clarify the responsibilities of first-visit and referral medical institutions, and gradually establish risk control and cost sharing mechanisms. Standardize the transfer of patients in primary medical institutions, promote the transfer of patients in hospitals, and promote the formation of a reasonable division of labor for medical treatment. Give full play to the advantages of medical insurance group purchase, control the cost of medical services through negotiations, and reduce the burden of patients' expenses. All co-ordination areas should study and formulate outpatient co-ordination group purchase methods, and clarify rules, contents and processes. And explore group buying in head service, chronic disease management, commonly used drugs and routine diagnosis and treatment projects. On the basis of carrying out comprehensive budget management, we will explore ways of payment such as paying per head, establish a risk-taking mechanism, and promote medical institutions and doctors to actively control costs. According to the characteristics of different payment methods, clear regulatory focus, improve the quality of medical care, and protect the basic medical rights and interests of insured residents. Five, strengthen the handling management to strengthen the budget management of residents' medical insurance fund, make overall arrangements for outpatient and inpatient funds, and improve the efficiency of fund use. On the basis of unified budget management, outpatient and inpatient medical expenses are accounted and counted separately. Improve the monitoring index system of outpatient and inpatient expenses and establish a dynamic analysis system. Improve the management of outpatient co-ordination agreement. With the improvement of the outpatient co-ordination payment mechanism, the contents of the agreement will be enriched and refined, and the outpatient co-ordination policy requirements, management measures, service quality, assessment methods and reward and punishment mechanisms will be implemented in the fixed-point agreement, and the medical service supervision will be strengthened through the agreement. Regularly publish the medical service charges, quality and mass satisfaction of designated medical institutions, and give full play to the role of social supervision. Strengthen the assessment, and the assessment results are linked to the expense settlement, rewards and punishments. Strengthen the construction of information systems. All co-ordination areas should speed up the issuance of social security cards, extend the network to all designated primary medical institutions and street (township) and community (village) service outlets as soon as possible, and strengthen operation monitoring by means of information technology to facilitate immediate settlement. Improve the construction and deployment level of medical insurance information system, and the data should be concentrated at least at the municipal level. Put forward clear requirements for the connection between the information system of designated medical institutions and the medical insurance information system. Designated medical institutions transmit medical settlement information to medical insurance institutions, and gradually improve it from regular feedback to real-time feedback. The content should include the summary and detailed information of personal medical treatment basic information and various medical services (including self-funded items). Six, actively and steadily carry out outpatient co-ordination work of the provinces (autonomous regions and municipalities) human resources and social security departments (bureaus) should attach great importance to outpatient co-ordination work, study and formulate specific implementation measures and work plans, and strengthen work guidance and policy coordination in all co-ordination areas. In areas where residents' medical insurance outpatient co-ordination has not been carried out, relevant policies should be introduced and implemented as soon as possible; In areas where residents' medical insurance outpatient co-ordination has been carried out, policies should be further improved and management strengthened in accordance with the requirements of this notice. As a whole, outpatient key contact cities should explore key topics, solve key and difficult problems and realize system innovation. Conditional areas can adjust the use of employee medical insurance personal accounts and explore the overall way of employee outpatient security. Outpatient overall planning has a strong policy and involves a wide range. Human resources and social security departments at all levels should take the initiative to strengthen communication and coordination with development and reform, finance, health, civil affairs and other departments to promote the coordinated advancement of medical reform. All provinces (autonomous regions and municipalities) should give full play to the role of key cities, promote good experiences and practices in a timely manner, and form a joint force of up and down interaction. In the process of promoting the overall planning of residents' medical insurance outpatient service, please report in time in case of new situations and new problems.