Direct settlement of outpatient expenses for remote medical treatment, pilot extension of long-term care insurance, joint centralized procurement of regional drugs, and credit medical treatment ...... in the Yangtze River DeltaIn the past five years, the integrated development of the Yangtze River Delta has become a national strategy, and the medical insurance departments of the three provinces and one municipality have promoted the integrated development of medical insurance through projects, continuously improved the convenience of medical treatment for the insured people in the Yangtze River Delta, promoted the convenient sharing of basic medical insurance public services in the Yangtze River Delta, and provided replicable and popularized experience for national reform.
Off-site medical treatment accelerates
Draw out the happiness line of people's lives
The difficulty of seeking medical treatment in other places has been a concern of patients for many years. In the past, the problem of reimbursement for medical treatment across provinces and places troubled many people. Individuals advance funds, return to the place of insurance to handle, and prepare various materials not only consume a lot of time and energy, but also bring a lot of financial pressure to the patient's family. Now, thanks to the accelerating integration process, the vision of "traveling" the Yangtze River Delta with a medical insurance card is gradually being realized. Uncle Yin in Zhenjiang suffers from macular hole in his eye, and he is likely to lose his sight without surgery. His wife, Aunt Zou, accompanied him to Shanghai ENT Hospital, and two-thirds of the cost of the operation was settled directly through the medical insurance, and he only paid more than 6,000 yuan in the end. "In the past, every time I came to Shanghai to see a doctor, I had to pay all the expenses in advance, and then take a stack of thick invoices back to Zhenjiang for reimbursement, which was very troublesome. Now this way, we can save a few trips!Aunt Zou said happily.
In the process of integration, what is more difficult to solve than the problem of remote medical treatment and hospitalization is the outpatient link known as "difficult to gnaw bones". Direct settlement of outpatient services is more difficult than that of hospitalization, because the settlement volume of outpatient clinics is much larger than that of hospitals, and the catalogue and reimbursement scope of outpatient diseases are different in different places, so the medical insurance policies are very different. Since 2018, the Yangtze River Delta region has taken the lead in the country to carry out the pilot of outpatient cross-provincial direct settlement, and the medical insurance departments of the three provinces and one city have worked together to closely follow the key words of "integration", do a good job in policy combing, joint debugging and testing, operation and maintenance guarantees, etc., and timely solve the difficult and blocking problems of remote medical treatment, realize the direct settlement of outpatient expenses in all regions, solve the problem of "advance" and "errands" for the masses to seek medical treatment in other places, and also play a leading and exemplary role in the development of outpatient direct settlement in other parts of the country. At present, the Yangtze River Delta region has achieved cross-provincial direct settlement of outpatient and inpatient outpatient and inpatient cross-provincial direct settlement, as well as five types of chronic and special diseases such as hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors, dialysis for chronic renal failure, and organ transplantation anti-rejection**, and the people in the region can enjoy the "same city service" for medical treatment in other places.
In addition, in the Yangtze River Delta Integrated Development Demonstration Zone, there are also new changes in the policy of purchasing drugs in different places. Since the beginning of this year, the medical insurance departments of Jiangsu, Zhejiang and Shanghai have made concerted efforts to organize the medical insurance departments of the three places in the demonstration zone to carry out the pilot project of direct settlement of drug purchases in designated retail pharmacies, breaking through the policy barriers that cross-provincial retail pharmacies cannot be included in the payment scope of basic medical insurance. In October this year, 872 designated retail pharmacies in the demonstration area realized direct settlement of medical insurance for off-site drug purchases, benefiting nearly 3,000 people in the demonstration zone. At present, this practice is being actively promoted in the Yangtze River Delta.
The reporter learned from the Provincial Medical Insurance Bureau that from January to October this year, Jiangsu opened 11,277 designated medical institutions and 29,650 designated retail pharmacies in the Yangtze River Delta region, and 961 cross-provincial two-way direct settlements for remote medical treatment in the Yangtze River Delta region of the province950,000 person-times, involving expenses of 2257.7 billion yuan, the Yangtze River Delta region insured people in the Yangtze River Delta region to seek medical treatment in different places, direct settlement of drug purchases is more efficient and convenient. At present, the work of remote medical treatment in the Yangtze River Delta region has entered a stage of optimized development of accelerated operation and efficient services, and will continue to improve the accessibility and satisfaction of the insured people in remote medical treatment.
The filing work continues to be optimized
Public services are more convenient to share
Only by weaving a dense medical security service network can the people have "medical" support. In the Yangtze River Delta, many citizens need to go to other places for medical treatment because they have lived in other places for a long time, work or live with their children, and they need to go through the filing procedures in other places in a timely manner. Since the beginning of this year, Jiangsu has fully implemented the long-term residents of other places to commit to the record, multi-place filing, two-way settlement and other convenient measures, after the personal commitment system does not need to supplement the materials, the place of insurance and the place of medical treatment can enjoy two-way treatment, truly realize the process of simplification, convenience and benefit;The multi-place filing allows the filing place to change from "single selection" to "multiple selection", breaking the medical problems of the insured people such as the elderly with many children and mobile work in multiple places, and realizing "one filing, multiple guarantees". At present, 100,000 people have been registered under the commitment system, and 110,000 people have been filed in many places. Since the beginning of this year, Jiangsu has also carried out the "trial-free second handling" for the self-filing of temporary out-of-town medical personnel, and after the temporary out-of-school medical personnel apply for the record independently, they do not need to upload materials, and the system automatically reviews and passes, creating an efficient service model of "opening the record and completing the application".
Not only that, the Yangtze River Delta also continues to explore record-free services and ensure that residents do not enjoy reduced treatment. In order to further reduce the burden on patients, Wujiang in Suzhou, Qingpu in Shanghai and Jiashan in Zhejiang Province in the Yangtze River Delta Integration Demonstration Zone have expanded the scope of exemption from filing to hospitalization, Internet + remote medical treatment settlement, etc., on the basis of exemption from filing for outpatient medical treatment in other places, so as to realize the exemption of filing in all fields of remote medical treatment settlement, and the treatment is consistent with that of the insured place. Insured persons do not need to file in advance for outpatient emergency treatment in all medical insurance designated medical institutions in the demonstration area, and only need to show the medical treatment voucher to directly swipe the card for medical treatment, and enjoy the dividends of urbanization and integration in the demonstration area. Among them, Wujiang District has expanded the record-free direct settlement of the demonstration zone to the whole of Shanghai, providing record-free direct settlement services for 1.23 million insured people in all remote medical network medical institutions in Shanghai, eliminating the rush and trouble of personal advance reimbursement.
The reporter learned that at present, many places in Jiangsu Province are also continuing to explore record-free services for remote medical treatment, among which Nanjing and Xuzhou, Lianyungang and Wuxi have achieved record-free direct settlement, and the treatment is not reduced.
Carry out the joint construction of medical projects
The famous doctor in the Yangtze River Delta walked to the door
The patient's pure ground-glass nodule shadow of the right lung has increased compared with the film in September last year, and it is safer to take surgery**" "I think this may be a lung infection, although the area has increased, but the solid component has not increased, and it can be observed again" ......A few days ago, experts from the Department of Respiratory and Critical Care Medicine, the Department of Medical Imaging, and the Department of Thoracic Surgery, Medical Imaging, and Interventional Medicine of Lai'an County People's Hospital of Chuzhou City, Anhui Province gathered together to jointly carry out a multidisciplinary expert outpatient clinic for pulmonary nodules, and conducted "three sessions" of incurable diseases sorted out by the hospital every week. "I didn't expect my video to be shown to experts in Nanjing. After the diagnosis, if necessary, Nanjing specialists can also come to Ann to perform surgery on me. Mr. Wu, a patient hospitalized in Lai'an County People's Hospital, said.
By strengthening precise docking, establishing a long-term cooperation mechanism, and carrying out the joint construction of medical projects, the masses have benefited more and more, and the people can also go to their doorsteps when they see a doctor in first-tier cities. In order to let the masses see the famous doctors in the Yangtze River Delta at their doorstep, the hospital relies on the all-round support of the top expert team in Shanghai, Nanjing, Hefei and other places to achieve the coordinated and progressive development of multidisciplinary in the hospital, and in the first half of 2023 alone, more than 300 external experts have been invited to the hospital, 55 times of teaching and more than 400 difficult surgeries have been carried out, and more than 3,000 patients have been served.
The integration process is getting deeper and deeper, and more medical insurance cooperation is taking shape. Recently, the Medical Insurance Bureau of Yixing City and Liyang City in Jiangsu, the Medical Insurance Bureau of Changxing County and Anji County in Zhejiang, and the Medical Insurance Bureau of Langxi County and Guangde City in Xuancheng City, Anhui Province jointly signed the Agreement on the Medical Insurance Cooperation Alliance of the Yangtze River Delta "One Place and Six Counties" Cooperation Zone. The "One Place and Six Counties" Cooperation Zone Medical Insurance Cooperation Alliance will fully connect the medical insurance integration channels of the "One Place and Six Counties" Cooperation Zone, and form a new development pattern of medical insurance organization co-construction, resource optimization, and interconnection and interaction in the "One Place and Six Counties" Cooperation Zone through the establishment of mechanisms such as direct settlement and interconnection of medical treatment in different places, medical insurance supervision cooperation, and medical insurance handling services.
Whether it is the cross-provincial settlement of medical insurance, the mutual recognition and exchange of examination results, the application of telemedicine consulting services, or the landing of branches of one top hospital after another, and the establishment of medical alliances and specialty alliances one after another, the medical "circle of friends" in the Yangtze River Delta region is growing, and the sharing of high-quality medical resources is accelerating, benefiting more patients in need.
*: Jiangsu Economic News.