[Editor's note].
Investigation and study is our party's housekeeping skill. Promoting high-quality development through solid investigation and research is the proper meaning of being responsible to the people and standing firmly on the people's position.
Medical insurance is a matter of people's livelihood that involves every person. With the continuous improvement of the medical security system, the importance of medical assistance has become increasingly prominent. However, the previous medical assistance work in Qingpu District had problems such as outdated information systems and cumbersome handling procedures, which not only increased the difficulty of the masses in handling medical assistance, but also affected the efficiency of medical assistance work.
How to improve the intelligent, precise and convenient level of medical assistance, reduce the burden of medical assistance for the masses, and improve the sense of gain and satisfaction of the masses? Let's take a look at the research notes of Zhu Jianzhong, Secretary of the Party Group and Director of the Qingpu District Medical Insurance Bureau.
In 2022, Shanghai will comprehensively carry out special governance actions on issues related to medical assistance. In the process of promoting the work, I gradually understood the current situation and existing problems of the medical assistance work in Qingpu District, and continued to optimize the medical assistance work in the district through investigation and research, communication and exchanges, special meetings, etc., and tried to find a new way to solve the problem of "enjoying without application".
There is an urgent need to establish a medical assistance information system.
After research, I realized that the deeper I sank, the more I listened, and the more detailed the questions, the more real and accurate the situation became.
This article** Shanghai survey
Since the launch of the special action to deal with issues related to medical assistance, I have successively visited Baihe, Zhujiajiao, Xujing, Huaxin, Jinze, Xiayang and other towns to walk into communities, rural areas, and front-line service windows, and have discussions and exchanges with the public and handling personnel to gain an in-depth understanding of the situation.
Through research, I realized that after the newly established District Medical Insurance Bureau took over the medical assistance function, it did not establish a medical assistance information system for many reasons, but only used the "green paper system" of the original civil affairs department, but the system has stopped maintenance and updating, the system is outdated and has a high error rate, and the citizens and handling personnel have many complaints.
Zhu Xuefang, who lives in Xiayang Street, said that in order to obtain medical assistance, she had to run to the window with the invoice, write the application, and deliver the materials after seeing a doctor. "In the prevention of poverty due to illness, due to illness back to poverty, etc., medical assistance plays an important role, but there are many inconveniences in the process of handling applications and receiving medical assistance, taking our village as an example, in recent years, with the increase in the intensity of the old reform, there are 13 households in the jurisdiction of the rescue object of the separation of households, many residents have moved out, every time they apply for medical assistance have to run a long way, the medical expenses invoice is sent over, some residents for convenience, the invoice is accumulated to a certain number and then come, hundreds of invoices need to be counted manually, really laborious. Xu Cuiyan, a rescue cadre in Wangxian Village, said.
Huaxin Town Community Affairs Reception Service Center window service staff Yu Hongqing reflected, because of the shortage of manpower and heavy workload, so now the town center requires all villages to assist in collecting the masses' medical assistance declaration invoices, generally summarized once a quarter, one by one, and accumulated again and again, because the system is not easy to use, a lot of work is manual operation, not to mention the increase in workload, but also prone to errors.
In order to promote the standardized and orderly development of medical assistance work and safeguard the vital interests of the people in difficulty, after the district medical insurance bureau and the civil affairs department complete the handover of medical assistance functions, a special person is responsible for medical assistance work, and each street and town is required to arrange a special person to be responsible for docking and contact, and verify and confirm one by one on the basis of the system report every month.
Ni Liping, a cadre of the medical insurance center, said that since October 2019, she has been in contact with the special managers of each street and town, and the number of samples in each street and town is not less than 10% of the number of transactions completed in the last month in the street and town, of which each rescue business with a single rescue amount of more than 5,000 yuan must be reviewed. But every day in front of the computer, staring at the invoices the size of tofu blocks uploaded by the town, checking them one by one, it is difficult to improve the efficiency of work.
Take multiple measures to build up "enjoy without application" medical assistance.
After fully grasping the situation in all aspects and clarifying the bottlenecks of the problem, after collective research and discussion, I made every effort to promote the construction of the "free application" system for medical assistance, so that the people in need can enjoy the medical assistance policy without leaving home, and effectively reduce the burden of medical expenses on the recipients of assistance.
The specific work is implemented in the following steps: First, relying on data empowerment, build a rescue system. At the beginning of 2023, with the support of the Municipal Medical Insurance Bureau, the District Party Committee and the District **, our bureau will establish a project to carry out the construction of the medical assistance "enjoy without application" system, and through docking with the database of the Municipal Medical Insurance Bureau, the data of medical insurance settlement, comprehensive burden reduction, serious illness of residence insurance, and mutual assistance for employees will be imported into the district medical assistance "enjoy without application" system, and the system can automatically call the identity information of medical assistance personnel and automatically obtain the invoice data of the applicant's assistance, which has laid a solid data foundation for smart handling.
The second is to promote process optimization and realize "enjoy without application". In order to further enhance the sense of gain and satisfaction of the masses, so that the masses can enjoy the relief treatment without applying, our bureau has adjusted the cumbersome process of "application, approval, and allocation" to the "no application, no disturbance" service model of active system authentication, background data comparison, and accurate verification and allocation, and truly realized the transformation of medical assistance from "people looking for policies" to "policies looking for people". Through the determination of the aid targets, the establishment of the basic database of the aid targets, the serious illness database of urban and rural residents, the comprehensive burden reduction database, the employee mutual aid and security database, etc., to achieve the effective convergence of the classification management of the aid objects and the rescue rules, adhere to the principle of "insurance first, then assistance", set up system early warning, review and proofreading and other links, effectively avoid duplicate reimbursement and reimbursement beyond the regulations.
The third is to strengthen personnel training and consolidate the foundation of the grassroots level. In order to effectively improve the ability to serve the grassroots and serve the masses, so that the grassroots cadres can be proficient in the operation and use of the relevant policies of medical assistance and the "enjoy without application" system, the district medical insurance department will continue to cultivate "experts" in medical assistance work for the grassroots through business training, job rotation practice, on-the-job teaching and other forms. Effectively improve the people's sense of gain and satisfaction.
In the next work, I will continue to normalize the investigation and research work as an important way to practice the mass line, often pounce on the grassroots and sink to the front line, not only "into" the grassroots, but also "heart" to the masses, ask the masses, ask the plan in practice, and strive to make the work more grounded, more popular, more in line with the people's will, and contribute wisdom and strength to the high-quality development of medical security.
The Paper, for more original information, please **"The Paper" app).