Ji'nan takes 12 serious diseases into medical insurance and explores the establishment of a serious illness guarantee mechanism
source: Ji'nan times Susan Jiang Lin
2012, what are the major actions of Ji'nan medical reform? Reporters from the Ji'nan municipal government on 11 days have been informed that "Ji'nan city deepens the major work arrangements for the reform of the medical and health system in 2012", This year the new rural cooperative medical scheme and the urban residents' medical insurance subsidy standard have been raised to 240 yuan per person per year, the personal payment level has been raised correspondingly, and the per capita financing has reached 300 yuan. In addition to 8 categories of diseases, such as uremia and childhood leukemia, 12 categories of serious diseases such as lung cancer and esophageal cancer are included in the scope of protection and assistance.
this year will explore the establishment of a serious illness protection mechanism
many families are poor because of illness. The reporter learned that Ji'nan will study and formulate measures to guarantee major diseases, explore the use of basic medical insurance funds to buy commercial major diseases insurance or establish supplementary insurance, effectively improve the level of major diseases, and effectively solve the problem of serious diseases.
this year Ji'nan will fully promote uremia, childhood leukemia, children's congenital heart disease, breast cancer, cervical cancer, heavy mental disease, multi drug resistant tuberculosis, and AIDS opportunistic infection and 8 major diseases, including lung cancer, esophagus cancer, gastric cancer, colon cancer, colon cancer, chronic granulocytic leukemia, acute myelocytic leukemia, acute 12 major diseases, including myocardial infarction, cerebral infarction, hemophilia, type I diabetes, hyperthyroidism, cleft lip and palate, are included in the pilot area for safeguards and assistance.
promotion of "one card", medical insurance instant settlement
in medical insurance reimbursement, the reporter learned that this year, Ji'nan will promote medical insurance "one card" to facilitate medical staff to medical treatment. The basic realization of the insurance personnel to co-ordinate the immediate settlement of medical expenses in the region and in the province, and to promote the immediate settlement of the trans provincial medical costs in different places, focusing on the resettlement of retirees in different places. At the same time,
Ji'nan will steadily push forward the cross regional transfer of medical insurance system among workers and strengthen the convergence of all basic medical insurance systems.
at the level of basic medical security, the maximum payment limit of the overall fund in Ji'nan staff medical insurance, urban residents medical insurance and NCMS policy is increased to more than 6 times the annual average wage of the local workers, more than 6 times the disposable income of the local residents, and more than 8 times the annual per capita net income of the whole country. And it is not less than 60 thousand yuan.
the proportion of hospitalization expenses in the medical insurance and NCMS policy of urban residents reached over 70% and about 75% respectively, gradually narrowing the gap between the proportion of the actual cost of hospitalization and the proportion of overall payment in the outpatient department.
reduce the inspection Price of large equipment in public hospitals
in the reform of public hospitals, Ji'nan will reform the compensation mechanism, adopt comprehensive measures, such as adjusting medical prices, reforming medical insurance payment methods, implementing the government responsibility and other comprehensive measures and linkage policies, to break the "medicine supplement medicine" mechanism. We gradually change the three channels of public hospital compensation from service charges, drug plus income and financial subsidies to two channels: service charges and financial subsidies. The reasonable income or loss formed by the hospital should be compensated by adjusting the price of medical technology service and increasing government investment. The adjusted fees for medical technology services are included in the scope of medical insurance payment according to the regulations.
after the national and provincial policy of cancelling drug addition, Ji'nan will appropriately raise the price of medical and medical services, such as diagnosis and treatment fee, operation fee, nursing fee and so on, according to the higher level policy on medical service price, and reduce the inspection Price of large equipment. The government investment in public hospital large equipment is deducted from depreciation. The cost is made to check the price.
[related news]
medical insurance fixed-point drugstore must be equipped with full-time pharmacist
reporter from the Ji'nan city human resources and Social Security Bureau learned that "Ji'nan basic medical insurance retail pharmacies designated work temporary measures" has been implemented since June 1st, valid for 1 years. In accordance with the requirements, at least 1 professional pharmacists (licensed pharmacists) or qualified pharmacists are qualified at the designated retail drugstores, and they have signed labor contracts with them and paid social insurance continuously from the date of obtaining a designated qualification.
in accordance with the interim measures, the retail drugstores of the "Ji'nan basic medical insurance certificate" should be obtained, to ensure the variety and quality of the basic medical insurance, to control the cost of drug service reasonably, to make it convenient for the insured to buy medicine and to manage it easily. In the application and management, the designated retail pharmacies will be quantified.
among them, the allocation conditions are specifically approved by the "standard of drug management quality management" (GSP), qualified by the annual inspection of the drug supervision and management department (20 points), and the ability to supply the basic medical insurance in time and provide the service for 24 hours (20).
at the same time, there are at least 1 professional pharmacists (licensed pharmacists) or qualified pharmacists who have been qualified by the pharmacists and have signed labor contracts with them and paid social insurance continuously from the date of obtaining a designated qualification, of which 1 are 20, 2 or more 30, and 5 points with part-time qualified personnel. The drugstore and other employees all signed labor contracts and paid social insurance (20 points) according to the regulations. There were no items except drugs, and there was no outside rental counter (20 points) in the place. The above conditions should not be less than 80 points.