Sanming City, Fujian Province, has always adhered to the people's health as the center, continued to deepen the reform of "decentralization, decentralization and service" in the field of medical insurance, built a four-level grassroots medical insurance management service network, extended medical insurance management services to the "service end", and created an efficient and convenient medical insurance grassroots management system.
First, the basic situation
** The general secretary pointed out: "I will read the worries of the people; I will do what the people desire." Sanming City adheres to the pragmatic spirit of responding to the people's calls, thinking about the people's thoughts, solving the people's difficulties, and promising the people's needs, thoroughly implementing the spirit of the National Health Insurance Bureau and the Fujian Provincial Medical Insurance Bureau to optimize the convenient service measures in the field of medical insurance, focusing on the construction of the service system, the sinking of service matters, and the improvement of service skillsThe four-level medical insurance service system of the village opens up the "last mile" of the medical insurance handling and service masses.
Second, the main practices
(1) High-level advancement to achieve a systematic layout. Sanming City continues to play a leading role in the reform of medicine, medical insurance and medical care, and takes the optimization of convenient service measures in the field of medical insurance as an important part of the medical insurance reform, which is promoted by the first overall plan. In the process of formulating the document, in accordance with the general requirements of "medical insurance handling services should also be taken ahead to demonstrate", fully considering the actual situation of medical insurance handling, and after more than 50 drafts of revisions and improvements, in September 2022, in the name of the Sanming Municipal People's Office, the "Notice on Further Optimizing Convenient Service Measures in the Field of Medical Insurance" (Ming Zheng Ban Gui 2022 No. 8) was issued, proposing to cover the improvement of grassroots service institutions, decentralization of medical insurance handling business, Promote 24 measures in 12 aspects such as the standardization and standardization of medical insurance services, and according to the division of functions, the county (city, district) people's ** and the Municipal Finance Bureau, the Municipal Health Commission, ** Review and Reform Office) and other 19 municipal and provincial units in Ming as the main responsible units, clarify the promotion responsibilities, leading departments and completion time limits, and strengthen the transmission of responsibility. There are 7 counties (cities and districts) in 10 counties (cities and districts) in the jurisdiction of the people's **synchronous **city** documents or local implementation documents, and the whole city has formed a city-level **leading, county-level ** main grasp, various departments to promote, and the whole field to coordinate the promotion mechanism. The city's 141 township (street) social affairs comprehensive service centers and 1,942 organized village (community) neighborhood committees have completed the establishment of medical insurance service posts (convenience points) before the time node as required, so as to achieve full coverage of the distribution of grassroots medical insurance service outlets horizontally to the edge and vertically.
(2) High-standard positioning to achieve standardized construction. Combined with the spirit of the city's first document, the city's medical insurance system took the initiative to act based on its main responsibilities and main business, and quickly issued the "Notice on Matters Related to Convenient Services in the Field of Primary Medical Insurance" (Ming Yibao 2022 No. 54), which further clarified the three aspects of primary medical insurance service network settings, staffing standards, and decentralized service matters, and promoted the outlets to achieve "five unifications". First, the site selection is unified. It is clarified that township and neighborhood medical insurance service posts should be set up in the comprehensive social affairs service center, and the medical insurance service points in villages and communities should be set up within the office area of the village (resident) committee in principle, so as to facilitate the provision of "one-door" and "one-stop" services for the masses. At present, the city's 141 township (street) medical insurance service posts and 1,942 organized villages of medical insurance service convenience points are set up in the township (street) social affairs comprehensive service center or village (neighborhood) committee as required. Second, the outlets are unified. Based on the official logo of "China Medical Security", 7 medical insurance service work logos, 14 job responsibilities and 1 service guide are designed for the township (street) and village (community) "medical security convenience service points", medical insurance service window logos, personnel post work cards, service list and other medical insurance service logos, 14 job responsibilities and 1 service guide, which are hung by grassroots outlets, so as to facilitate the masses to "enter a door" and "recognize a window" and enjoy accurate and fast medical insurance services. Third, the equipment standard is unified. In accordance with the standard of 2 computers, 1 printer, 1 scanner, 2 PIN pads and 2 card readers in each township and street, the office equipment is clearly defined as a unified service platform for the grassroots medical insurance management, and the four-level information sharing and business collaboration of cities, counties and villages are realized. Fourth, unified staffing. It is clear that each township and street social affairs comprehensive service center is equipped with 1-2 full-time and part-time staff, and each village and community arranges 1 person in the village two committees or (community) staff to serve as a medical insurance assistant, and the city's 141 townships (streets) are equipped with a total of 2,256 full-time and part-time medical insurance service personnel, including 283 townships and streets, and 1,973 villages (communities) to ensure that the decentralized medical insurance handling matters are handled. Fifth, the list of services is unified. 5 service items such as "urban and rural residents' insurance registration" will be delegated to villages (communities), and 19 service items such as "employee insurance information change registration" will be delegated to towns (streets), and the number of items that can be done in towns (streets) accounts for 67 items in the list of government services86%, to complete the requirements of more than 30% of the province.
(3) Efficient improvement and standardized services. Whether the construction of the medical insurance service system is good or not depends on the quality and efficiency of the service. In order to forge a grassroots medical insurance management team that has done a good job and can be accepted, we should pay close attention to the key point of "training and guidance", and combine "please come up" and "sink down", and grasp it with both hands and be hard with both hands. The first is to carry out training and practice skills. In order to forge a "good job" and "catch" of the grassroots medical insurance management team, around the decentralization of handling matters, the city's primary medical insurance full-time and part-time personnel for work mobilization, all-round policy publicity and business system operation training, since the establishment of primary medical insurance service outlets, has been "invited up" preaching and training 36 times, covering 1081 people. The second is to improve the quality and efficiency of sinking guidance. In accordance with the requirements of high standing, small incision and concretization, a special work class has been set up at the municipal level, and a work promotion team has been set up by the medical insurance dispatched agencies in each county (city and district) to carry out front-line research in 12 township (street) medical insurance service outlets and 10 counties (cities and districts) under the jurisdiction of Sanyuan District at the municipal level, to inspect the office space on the spot, understand the staffing and equipment configuration, immerse themselves in the service level, and guide the difficulties in policy interpretation and handling operations. Up to now, the city has carried out 183 sessions of "sinking" guidance, covering 2,218 person-times, and alleviating the problems of grassroots management in a timely manner. The third is to regularly track Ming's progress. Compile the "Monthly Report on the Implementation of Convenient Service Measures in the Field of Grassroots Medical Insurance in XX County (City, District) of Sanming City", and track the software and hardware strength of the grassroots level in performing their duties from 15 details in 4 aspects, such as software and hardware allocation, actual business handling, and training and guidance of the management department, highlight the problem orientation, pay attention to problem relief, and ensure that the promotion is orderly and effective. Fourth, the construction of demonstration trees. The construction of grass-roots service outlets and the construction of civilized units, comprehensive management (safety) units, "May Day" pioneers and other activities to strive for excellence combined, in each county (city, district) respectively selected 1 township (street) service point and village (community) service point for key construction, with high standards, strict requirements to build the city's grassroots medical insurance service demonstration site, give full play to the demonstration point to drive the radiation role, to point to the area, the formation of the city's role in looking at the example and learning from the example to be a strong atmosphere. At present, there is a service network in one township as a demonstration site, and the establishment of outlets is included in the "four key points" of the annual political supervision of the municipal discipline inspection department.
3. Work Highlights
Mingxi County has implemented a post subsidy of 100 yuan per person per month for 97 village and community medical insurance assistants in 9 townships and towns in the county, which has greatly improved the enthusiasm of grassroots medical insurance service personnel and the stability of the team. Jianning County coordinated with the county human resources and social security and financial departments to jointly issue a document to develop one public welfare post for each of the 9 townships and towns in the jurisdiction, implement one person and one post, full-time and full-time post, and give public welfare post subsidies and social security subsidies, so as to realize the recruitment conditions of medical insurance assistants in the county.
First, the treatment is unified, which ensures the overall quality and stability of the township medical security personnel.
Fourth, effectiveness
The first is the "expansion" of service items. Clarify the scope and handling process of medical insurance business in township (street) and village (community) service outlets, and delegate 14 medical insurance handling service items, such as employee insurance registration (flexible employment personnel) and the filing of retirees resettled in other places, to the township (street) social affairs comprehensive service center; The five medical insurance handling service items, such as the registration of urban and rural residents and the registration of changes in employees' insurance information, will be delegated to villages (communities). Since the implementation of the policy, a total of 77,969 cases of subsidence business such as the registration of urban and rural residents have been handled, and 96,053 people have been served.
The second is to "accelerate" the handling of affairs by the masses. By unifying the service process, handling materials, handling links and service standards of sinking matters, limiting the completion time, so that the decentralized matters handling process is all within 3 links, the immediate completion of township and street service matters reaches 12 items, and all village and community service matters can be completed immediately, and the service outlets provide special personnel to help handle the agency service, which effectively shortens the time for the masses to handle affairs and improves the efficiency of medical insurance handling services.
The third is the "improvement" of service experience. By expanding the layout of outlets, extending service tentacles and personnel training, and moving medical insurance services to the "doorstep" of the masses, the insured people can enjoy more convenient and efficient medical insurance services that are consistent with the standards of the city and county agencies in the villages and townships, and the service experience has been greatly improved. At the same time, fully considering the situation that the elderly are mostly in rural areas, the staff of the outlets are required to be both good "propagandists" and "agents" and "waiters", responsible for preaching medical insurance policies for the elderly in the village, helping to handle the handheld medical insurance business such as residents' medical insurance payment, medical insurance electronic voucher activation and application, providing warm medical insurance services, and setting up a "heart-to-heart bridge" to serve the masses.
Original title: High-point planning, full connection to the construction of the grassroots management system.
Author |Sanming Medical Security ** Center.
* |China Medical Insurance.
Edit |Yang Zixuan: What to do.
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