Chaoyang District, Beijing, Binhai New Area of Tianjin Municipality and Langfang City, Hebei Province signed the "Framework Agreement on Promoting the Coordinated Development of Medical Insurance in the Beijing-Tianjin-Hebei Pilot Zone (City)" in Langfang on December 26.
According to Liao Zangyi, an associate professor at the School of Politics and Public Administration of China University of Political Science and Law, it is very necessary to expand the scope of direct settlement of outpatient chronic diseases in Beijing, Tianjin and Hebei. Due to the convenience of transportation, a large number of insured people with household registration in Tianjin and Hebei are insured locally, but they have been working and living in Beijing for a long time, and the medical insurance card can be settled in real time when they see a doctor in Beijing, Tianjin and Hebei, which means that the joint test and acceptance of the inter-provincial settlement system of the three places has been completed.
On November 22, at the outpatient settlement window of Laishui County Hospital of Traditional Chinese Medicine in Hebei Province, patients were paying by brushing their faces. Xinhua News Agency.
According to the agreement, we will further promote the coordinated development of medical insurance integration in Beijing, Tianjin and Hebei around the urgent and difficult problems in the process of medical reimbursement and the blockages and difficulties in the handling of medical insurance. Explore and solve the problem of manual reimbursement of medical expenses for the insured people in the three places, expand the scope of designated medical institutions for direct settlement of medical expenses in different places in the three places, explore the full upload of medical expense data in designated medical institutions, and gradually realize the sharing of information on remote medical treatment settlement.
Wang Shaoli, former vice president of Beijing Huilongguan Hospital, said, "Promoting the coordinated development of medical insurance, like the mutual recognition of inspection and test results that has been achieved in the early stage, is a specific measure to implement integrated and coordinated development, which is of great significance for the three places to share the results of integration." ”
The agreement pointed out that it is necessary to explore the dynamic centralized sharing of the basic medical insurance drug catalogue and diagnosis and treatment catalogue handled by the medical insurance in the three places, so as to improve the efficiency and quality of the review of manual reimbursement of expenses in different places, and shorten the waiting period for manual reimbursement and advance of the insured people. So if patients from Hebei and Tianjin come to Beijing, will Beijing's medical resources be strained?
Liao Zangyi mentioned that this phenomenon will not appear on a large scale, China's previously issued "Guiding Opinions of the General Office on Promoting the Construction of a Hierarchical Diagnosis and Treatment System" clearly put forward the 16-character policy of "primary diagnosis, two-way referral, acute and slow treatment, and linkage up and down" to ensure that there will be no large-scale run on medical resources.
It is expected to achieve direct settlement of medical treatment nationwide in the future, but it needs to improve the supporting measures of medical insurance policies. Liao Zangyi said that, first, the inter-provincial settlement system of the overall planning area should be unified with unified standards and specifications, and the deployment of the system should be done well, and the port should be reserved in advanceSecond, the perfect working capital operation system must keep up, and real-time settlement involves the advance of funds from the medical insurance department in the place of medical treatmentThird, the medical insurance supervision and review measures need to weave a sky net, and after the direct settlement of medical treatment in other places is passed nationwide, there will definitely be criminals who will take advantage of loopholes, which requires the medical insurance think tank to further improve the regulatory measures and weave a good network of supervision.