In January this year, the top administrative leaders of each province made a work report for 2024 to the people's congress on behalf of the provincial people. According to the full text of the first work report of 31 provinces across the country, the author has briefly sorted out the relevant content of the review of the medical insurance work in 2023 and the medical insurance work arrangement in 2024, which can give a glimpse of the national medical security work for the reference of the industry.
In terms of the review of medical insurance work in 2023, many provinces focused on the work of "direct settlement of medical treatment in other places, procurement of drug consumables, basic medical insurance participation, financing, and treatment", and the core idea is to emphasize and solve the urgent and difficult livelihood problems such as "making it more convenient for the masses to seek medical reimbursement in other places and effectively reducing the economic burden of patients' medical treatment".
11 provinces mentioned direct billing for medical treatment in other places. Hebei has completely canceled the filing of Beijing-Tianjin-Hebei remote medical treatment; The direct settlement rate of inpatient treatment in Shanxi reached 87%, ranking fifth in the country; Jilin Province outpatient medical treatment in other places to achieve record-free direct settlement; Jiangxi realizes that medical treatment in other places in the province is exempt from filing and enjoys the same medical insurance treatment in the insured place; Shandong basically realizes direct settlement of medical treatment in other places; Hunan general outpatient settlement in different places; Guangdong took the lead in realizing the cross-city and non-local identification of specific diseases in the basic medical insurance outpatient clinic, and the remote medical expenses were fully covered by three types of settlementable items, networked medical institutions, and settlement groups; Guangxi has implemented the "five exemptions and five reductions" medical insurance reform such as "no filing" for medical treatment in other places in the region; Direct settlement for remote medical treatment in Sichuan covers all counties (cities and districts); Ningxia has fully launched the direct settlement of cross-provincial and non-local outpatient medical expenses for employees; Xinjiang continues to expand the scope of direct settlement for cross-provincial and non-local medical treatment.
Seven provinces mentioned the purchase of pharmaceutical consumables. Shanxi implements 786 kinds of centralized procurement drugs, ranking first in the country; Guangxi's centralized procurement of drugs and medical consumables has reduced the burden of medical treatment for the masses by more than 13 billion yuan; Chongqing's centralized procurement of drugs and medical consumables has reduced the burden on the masses by 6.5 billion yuan; Sichuan has landed 450 and 13 categories of drugs and medical consumables in the province respectively, with a decrease of more than %, gnawing the hard bones of oral implants "the most difficult to collect in history"; Qinghai centralized procurement of drug consumables** with an average decrease of 50%; Ningxia has made great efforts to solve the problem of high medical expenses for the masses, and the average reduction of more than 600 kinds of drugs has been more than 50%; Xinjiang has carried out centralized procurement of drug consumables on a regular basis, saving more than 15 billion yuan in medical expenses for patients, and effectively alleviating the problem of expensive medical treatment for the masses.
Six provinces mentioned basic medical insurance participation. The participation rate of basic medical insurance in Hebei is stable at more than 95%; Jiangsu's basic medical insurance participation rate is stable at 98more than 5%; Jiangxi's basic medical insurance participation rate is stable at 99more than 85%; The participation rate of basic medical insurance in Guangxi remains above 97%, and all residents within 0-20 kilometers of the border enjoy medical insurance treatment such as full insurance subsidies; The participation rate of Chongqing's basic medical insurance exceeds 97%, and the number of people insured by "Chongqing Kuaibao" exceeds 6.2 million; The participation rate of basic medical insurance in Yunnan has remained stable at more than 95%.
Six provinces mentioned financial subsidies for residents' medical insurance. The subsidy standard for basic medical insurance for urban and rural residents in Jilin has been increased to 640 yuan per person per year; The per capita financial subsidy standard for medical insurance for urban and rural residents in Fujian has been increased to no less than 640 yuan; The per capita financial subsidy standard for medical insurance in Henan has been steadily improved; Hubei's medical insurance and other security standards have been steadily improved; Hainan basic medical insurance subsidy completed the upgrade; The medical insurance subsidy for urban and rural residents in Ningxia was increased to 640 yuan.
Six provinces mentioned a steady increase in medical insurance benefits. Tianjin's medical insurance, maternity and other benefits continue to improve; Heilongjiang's basic medical insurance treatment level has been steadily improved; The reimbursement ratio of hospitalization in primary medical institutions in Shandong has increased to more than 85%; The level of people's livelihood security benefits such as medical insurance in Shanghai has been steadily improved; Guangdong fully implements the medical security treatment list system; Guangxi's critical illness insurance has been increased by 19 on the basis of basic medical insurance reimbursement5%。
In addition,Four provinces mentioned outpatient mutual aid for employee medical insurance. The reform of Shanxi Employee Medical Insurance Outpatient Mutual Aid Security has been steadily promoted; Liaoning implemented the reform of the outpatient mutual aid guarantee mechanism of employee medical insurance; The reform of outpatient mutual aid for employees in Shanghai has been fully completed; Guangdong completed the reform of outpatient mutual aid security for employees' medical insurance. Four provinces mentioned the scope of the medical insurance payment catalog. Shanghai's multiple payment mechanism for innovative drugs and devices continues to improve; Guangxi IVF-related medical services are included in medical insurance reimbursement; Shaanxi has included 51 chronic diseases and endemic diseases in the scope of medical insurance; Qinghai is the first in the country to formulate and issue a medical insurance catalogue for Tibetan and Mongolian medical preparations. Two provinces mentioned smart medical insurance information work. 110 hospitals in Beijing have realized mobile payment for medical insurance; Sichuan has fully implemented the full-process application of medical insurance code and mobile payment of medical insurance, and the masses have "paid on the code" for medical treatment and drug purchase, and 80% of medical insurance matters have been "handled online". 2 provinces mentioned the effectiveness of pharmaceutical governance. Inner Mongolia dynamically adjusted 236 medical services**, and the out-of-pocket expenses of the masses for medical treatment were reduced by 19% on average; Guangdong's provincial drug ** index fell by 1755%。
In terms of problem analysis, almost all provinces mentioned that there are shortcomings and weaknesses in the field of people's livelihood such as medical care, which puts forward higher requirements for the medical security work in the new stage.
In terms of medical insurance work arrangements in 2024, many provinces plan to focus on promoting "provincial overall planning of basic medical insurance, expansion and quality improvement of volume procurement, promotion of coordinated development and governance of the three medical services, precise expansion of national insurance, and establishment and improvement of long-term care insurance system". The core idea of the medical insurance work in each province in 2024 is to "further improve the ability of basic medical insurance to resist risks, further effectively reduce the economic burden of patients seeking medical treatment, and further drive the high-quality development of the medical industry and the pharmaceutical industry to go deeper and more practical".
14 provinces plan to promote provincial-level co-ordination. 10 provinces, including Liaoning, Jilin, Anhui, Henan, Hubei, Hunan, Guangdong, Shaanxi, Qinghai and Xinjiang, have promoted provincial-level overall planning of basic medical insurance; Shanxi promotes the provincial overall planning of medical insurance for urban and rural residents; Shandong implements provincial-level overall planning of employee medical insurance; Jiangxi implements provincial adjustment of basic medical insurance; Sichuan implements the adjustment fund model and the provincial overall planning of basic medical insurance.
9 provinces expanded the scope and improved the quality of procurement with volume. Tianjin expands the centralized procurement of drugs and medical consumables; Liaoning expands the procurement category of pharmaceutical consumables; Shanghai deepens the reform of the procurement mechanism for pharmaceutical consumables; Fujian has improved the mechanism of centralized procurement of drug consumables; Guangxi added 100 kinds of drugs and 15 types of medical consumables for centralized procurement; Chongqing has increased the centralized procurement of drugs and medical consumables; Sichuan expands the coverage of centralized procurement of drugs and high-value medical consumables; Qinghai expands the area and improves the quality of drug consumables with centralized procurement; Ningxia promotes the centralized procurement and unified and standardized use of pharmaceutical consumables to further reduce the burden of medical treatment for the masses.
Eight provinces plan to promote the coordinated development of the three medicines. Tianjin, Anhui, Fujian, Hubei, Hunan, Guizhou, and Yunnan promote the coordinated development and governance of medical insurance, medical care, and medicine; Chongqing has deepened the reform of the medical and health system and promoted the coordinated development and governance of medical insurance, medical treatment and medicine.
Seven provinces plan to increase the intensity of universal participation. Jilin plans to accelerate the promotion of the national insurance plan; Heilongjiang plans to further promote the expansion of basic medical insurance; Anhui plans to subsidize low-income people to participate in basic medical insurance; Jiangxi plans to carry out a special action to accurately expand the coverage of national insurance; Sichuan plans to consolidate the achievements of medical insurance, rural low-income population and poverty alleviation population; Guizhou has implemented a national insurance plan, and the medical insurance participation rate has stabilized at more than 95%; Yunnan plans to deepen the expansion of basic medical insurance.
Seven provinces have established and improved long-term care insurance systems. Tianjin promotes the pilot of long-term care insurance system; Jilin and Hainan promote the establishment of long-term care insurance systems; Jiangsu expands the population covered by long-term care insurance; Zhejiang will fully implement the long-term care insurance system, with more than 20 million new insured people in 2024; Shandong has steadily promoted the quality and expansion of long-term care insurance for residents; Chongqing has extended long-term care insurance coverage to people with moderate disabilities and continuously expanded the scope of inclusive insurance.
In addition,Five provinces mentioned deepening the reform of payment methodsShanghai, Chongqing, and Sichuan plan to deepen the reform of payment methods; Jiangxi plans to complete the three-year action plan for the reform of medical insurance payment methods; Guangdong plans to deepen the reform of payment according to the value of disease groups and disease types. Four provinces mentioned adjusting the financial subsidy standards for residents' medical insuranceThe per capita financial subsidy for basic medical insurance for urban and rural residents in Shanxi increased by 30 yuan; Jilin plans to increase the subsidy standard for medical insurance for urban and rural residents; Sichuan plans to adjust the financing and financial subsidy standards for urban and rural residents' medical insurance in a timely manner; **It is proposed to raise the standard of basic medical insurance subsidies for urban and rural residents. Four provinces mentioned the overall improvement of the level of medical insurance treatmentTianjin plans to improve the level of medical insurance treatment as a whole; Shanghai plans to coordinate the adjustment of medical insurance and other people's livelihood security treatment standards; Fujian plans to improve the level of medical insurance benefits; Gansu plans to improve the financing and treatment adjustment mechanism of basic medical insurance. 4 provinces mentioned the dynamic adjustment of medical services**Fujian plans to improve the dynamic adjustment mechanism of medical services; Guangdong plans to establish a sensitive and moderate dynamic adjustment mechanism for medical services and improve the formation mechanism of medicine; Sichuan plans to deepen the reform of medical services; Guizhou plans to adjust the medical service ** project in a reasonable and orderly manner. 3 provinces mentioned strengthening the supervision of medical insurance**: Heilongjiang plans to strengthen the normalized supervision of the use of medical insurance, and strictly investigate and punish fraud and other violations of laws and regulations; Guangdong plans to strengthen the supervision of the use of medical insurance; Chongqing plans to strengthen the normalized supervision of medical insurance.
By combing the relevant content of the 2023 work review and the 2024 work arrangement in the work report of the first place in various places, combined with the relevant spirit of the 2023 annual work summary meeting of the National Health Insurance Administration and the 2024 national medical security work conference, we can deeply feel the direction and work ideas of the first in the field of people's livelihood such as medical security. At the same time, improving the level of medical security and reducing the burden of medical treatment for patients are also key and necessary measures to create a new pattern of "being able to consume, dare to consume, and be willing to consume". Local medical insurance departments and medical insurance workers can learn from each other, further identify the direction of work, clarify the focus of work, and use good methods and paths to contribute to the construction of a strong country in the new era.
Attachment: 2024** work report of all provinces across the country related to medical security
Author |Jiang Changsong is the assistant to the president of the Medical Insurance Research Institute.
* |China Medical Insurance.
Edit |Yang Zixuan, Zhang Wenqing.
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