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The Ministry of Human Resources and Social Security, the Ministry of Finance, and the National Health and Family Planning Commission recently jointly issued the "Guiding Opinions on Further Improving the Settlement of Medical Expenses for Medical Treatment in Other Places under Basic Medical Insurance", proposing that basic medical insurance will realize direct settlement of out-of-town hospitalization expenses within the province in 2015, and in 2016

Direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces will be achieved by the year.

The three ministries and commissions require that each province should establish and improve a provincial-level off-site medical settlement platform to support the exchange of information on medical personnel, medical service data, and cost settlement data between coordinating regions within the province, and carry out direct settlement of off-site medical treatment within the province through the platform.

The person in charge of the Medical Insurance Department of the Ministry of Human Resources and Social Security said that the guidance puts forward the idea of ????promoting the settlement of medical expenses in other places for medical insurance in a hierarchical manner, requiring the goal of fully realizing the direct settlement of medical expenses within the city, and ensuring that fund budgets, financing treatment policies, and medical treatment are all achieved.

The unification of management and the integration of information systems strive to achieve "no difference in the same city".

This document also proposed corresponding work goals. In 2014, it will be basically realized that the municipal level will coordinate the direct settlement of medical treatment in the district, and standardize and establish a provincial level settlement platform for out-of-town medical treatment; in 2015, it will basically realize the municipal level's coordination of the direct settlement of medical treatment in the district and within the province.

Direct settlement of expenses, establish and improve the national and provincial level settlement platform for off-site medical treatment; in 2016, direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces will be fully realized.

The document proposes that the key group for direct settlement of medical expenses across provinces is relocation of retirees, which refers to long-term retirees who have obtained household registration in their place of residence in accordance with the household registration policy, mainly the elderly who live with their children after retirement.

They are generally older, have heavy medical burdens, and have not returned to the insured place for a long time. The "errands" and "advance payments" when reimbursing for medical treatment in other places have the greatest impact on them. Therefore, the need for direct settlement of medical expenses in other places is the most urgent.

At the same time, the boundaries of this group of people are relatively clear, which is also conducive to a safe start in cross-provincial and remote medical treatment work.

In the next step, combined with the advancement of the household registration and residence permit system reforms, places with conditions can explore the inclusion of other people living in different places across provinces into the scope of direct settlement of hospitalization medical expenses based on summarizing experience.

The following is the full text of the Q&A published on the website of the Ministry of Human Resources and Social Security: Please briefly introduce the background of the promulgation of the "Guiding Opinions on Further Improving the Settlement of Medical Expenses for Medical Treatment in Other Places under Basic Medical Insurance".

In recent years, my country's basic medical insurance system has made great progress. Universal medical insurance has been basically realized, the level of security has gradually improved, and service capabilities have been significantly improved.

At present, all localities have generally realized the direct settlement of medical expenses for basic medical insurance in the coordinating region, solving the problem of insured persons first paying funds for medical treatment and then being reimbursed by the medical insurance agency.

In order to solve the problem of medical expense settlement for insured persons when they seek medical treatment in other places, the Ministry of Human Resources and Social Security issued the "Opinions on the Settlement Service of Basic Medical Insurance for Medical Treatment in Other Places" (Ministry of Human Resources and Social Security [2014] No. 190) in 2009.

Various localities have actively explored in accordance with the spirit of the document, achieved certain results, and accumulated a lot of experience.

At present, 27 provinces have established intra-provincial settlement platforms for medical treatment in other places, and 22 of them have basically realized direct settlement of medical treatment in other places within the province; some places have carried out inter-provincial settlement of medical treatment in different places through point-to-point online settlement, entrusted collaboration and other methods.

explore.

However, from a national perspective, there are still many problems in the advancement of settlement work for medical treatment in other places: First, some places have not yet achieved municipal-level coordination, and direct settlement has not been achieved within the municipal scope; settlement of medical treatment in other places within the province is not yet standardized;

Provincial out-of-town medical settlement lacks top-level design and coordination.

Second, the settlement of hospitalization expenses for retirees resettled in other places has problems such as complicated procedures and high pressure for advance payment.

Third, there is a lack of supervision over off-site medical practices, and fraud and defrauding medical insurance funds by forging medical bills and medical materials often occur.

In this regard, in accordance with the requirements of the Party Central Committee and the State Council and the relevant arrangements for medical reform, and on the basis of summarizing local experience, the Ministry of Human Resources and Social Security, together with the Ministry of Finance and the Health and Family Planning Commission, jointly studied and drafted the "On Further Improving Basic Medical Insurance"

"Guiding Opinions on the Settlement of Medical Expenses for Medical Treatment in Other Places", and solicited opinions from relevant departments of the State Council and provincial (autonomous and municipal) human resources and social security departments.

What is the idea of ??solving the problem of medical treatment in other places in a hierarchical manner in this document on medical treatment in other places?

What are the specific goals?

The "Guiding Opinions on Further Improving the Settlement of Medical Expenses for Medical Insurance in Other Places for Basic Medical Insurance" puts forward the idea of ??promoting the settlement of medical expenses for medical insurance in other places in different levels: First, improve municipal coordination.

It is required to achieve the goal of fully realizing the direct settlement of medical expenses within the city, to achieve the unification of fund budgets, financing treatment policies, medical treatment management and the integrated connection of information systems, and strive to achieve "the same city, no different place".

The second is to standardize medical treatment in other places within the province.

Each province should establish and improve a provincial-level off-site medical treatment platform, carry out direct settlement of off-site medical treatment within the province through the platform, establish a unified medical insurance technical standard library, and standardize the settlement methods and handling procedures for off-site medical treatment.

The third is inter-provincial medical expense settlement management.

Explore the establishment of a national-level off-site medical settlement platform, gradually realize the direct settlement of hospitalization medical expenses for retirees resettled in other places across provinces, and do a good job in the medical management of out-of-place referrals and out-of-place emergency patients.