The basic medical insurance for urban residents medical services management, including the scope of medical services management, medical services and medical cost management sentinel billing management.
To co-ordinate the establishment of serious illness mainly of the basic medical insurance for urban residents is to implement the people-centered scientific concept of development and building a socialist harmonious society important initiatives. Strengthen and improve the management of medical services, the protection of medical insurance and reasonable rights and interests of residents, standardize medical services, control medical costs, improve medical efficiency in the use of insurance funds to ensure the smooth operation of the system is of great significance. All relevant departments at all levels should closely cooperate in the basic medical insurance for urban residents in the experimental work, strengthen the basic medical insurance for urban residents medical services
Management, the effective protection of vast numbers of participants the basic medical needs of residents.
1, in the light of the basic medical insurance for urban workers, medical services management of the relevant provisions in light of the characteristics of urban residents, improve the basic medical insurance medical services management of the relevant policies. The basic medical insurance for urban residents and the new rural cooperative medical practice management integration, but also can refer to the new rural cooperative medical care of the medical management of the regulations. All localities should in accordance with relevant state regulations and the spirit of this advice, according to local conditions, and actively explore strengthening the basic medical insurance for urban residents medical services management of specific measures.
Second, all localities should improve the basic medical insurance administration, clinics and medical service facilities project management, to strengthen high-priced drugs, new clinics, large medical equipment checks and medical supplies high-value access to and use of management, control medical costs, Improve the basic medical insurance for urban residents efficiency in the use of funds, reduce the urban residents in the basic medical insurance fund and the cost burden on the participants.
Third, the basic medical insurance for urban residents designated medical institutions and the implementation of sentinel retail pharmacy management. Specific management measures in accordance with the basic medical insurance for urban workers designated medical institutions designated retail pharmacy management and the relevant regulations. According to the medical treatment of urban residents characteristics and needs further refinement and improvement of designated medical management services agreement, give full play to the basic medical insurance for medical services bound by the role. According to the medical security system coordinated development of the need to co-ordinate all types of medical protection groups identified medical services sentinel management methods and measures.
4, rationally determine the designated medical institutions and retail pharmacies the scope and number of specific departments from throughout the labor and social security to health, Chinese medicine Food and Drug Administration and regulatory authorities identified. Enrollment residents in the designated medical institutions and retail pharmacies filled by the medical treatment of the costs incurred by the medical insurance fund to be paid in accordance with the regulations. According to participants throughout the medical needs of residents, will meet the conditions of maternity hospitals, maternal and child health care centres, children's hospitals and community health service institutions into the fixed-point range.
5, to explore the participants to promote rational use of medical services residents resource management mechanism, and guide participants residents make full use of community health services, primary health care institutions to provide medical services and Chinese medicine services and explore ways of establishing two-way referral mechanisms. Into the fund to pay for out-patient medical costs of serious illness and co-ordinate the general out-patient medical services, to develop effective use of community and primary health care services for medical treatment and medical management approach to clearing costs. Residents of the participants in the designated community health service organizations and grass-roots medical institutions for medical treatment costs, to increase the proportion of the payment.
6, according to medical services and funding levels, and establish and perfect the basic medical insurance costs of clearing, settlement and reasonable medical expenses set standards and into the management agreement. To meet the medical expenses, according to the agreement in full and timely billing and payment, do not meet the medical expenses not paid.
7, and actively explore the medical insurance agencies designated medical institutions and medical consultation services to the billing method and standards. Actively explore the kinds of payment, such as the amount of prepaid billing method, the designated medical institutions to mobilize the initiative to participate in the management and reduce the cost of medical services initiative.
To co-ordinate the establishment of serious illness mainly of the basic medical insurance for urban residents is to implement the people-centered scientific concept of development and building a socialist harmonious society important initiatives. Strengthen and improve the management of medical services, the protection of medical insurance and reasonable rights and interests of residents, standardize medical services, control medical costs, improve medical efficiency in the use of insurance funds to ensure the smooth operation of the system is of great significance. All relevant departments at all levels should closely cooperate in the basic medical insurance for urban residents in the experimental work, strengthen the basic medical insurance for urban residents medical services
Management, the effective protection of vast numbers of participants the basic medical needs of residents.
1, in the light of the basic medical insurance for urban workers, medical services management of the relevant provisions in light of the characteristics of urban residents, improve the basic medical insurance medical services management of the relevant policies. The basic medical insurance for urban residents and the new rural cooperative medical practice management integration, but also can refer to the new rural cooperative medical care of the medical management of the regulations. All localities should in accordance with relevant state regulations and the spirit of this advice, according to local conditions, and actively explore strengthening the basic medical insurance for urban residents medical services management of specific measures.
Second, all localities should improve the basic medical insurance administration, clinics and medical service facilities project management, to strengthen high-priced drugs, new clinics, large medical equipment checks and medical supplies high-value access to and use of management, control medical costs, Improve the basic medical insurance for urban residents efficiency in the use of funds, reduce the urban residents in the basic medical insurance fund and the cost burden on the participants.
Third, the basic medical insurance for urban residents designated medical institutions and the implementation of sentinel retail pharmacy management. Specific management measures in accordance with the basic medical insurance for urban workers designated medical institutions designated retail pharmacy management and the relevant regulations. According to the medical treatment of urban residents characteristics and needs further refinement and improvement of designated medical management services agreement, give full play to the basic medical insurance for medical services bound by the role. According to the medical security system coordinated development of the need to co-ordinate all types of medical protection groups identified medical services sentinel management methods and measures.
4, rationally determine the designated medical institutions and retail pharmacies the scope and number of specific departments from throughout the labor and social security to health, Chinese medicine Food and Drug Administration and regulatory authorities identified. Enrollment residents in the designated medical institutions and retail pharmacies filled by the medical treatment of the costs incurred by the medical insurance fund to be paid in accordance with the regulations. According to participants throughout the medical needs of residents, will meet the conditions of maternity hospitals, maternal and child health care centres, children's hospitals and community health service institutions into the fixed-point range.
5, to explore the participants to promote rational use of medical services residents resource management mechanism, and guide participants residents make full use of community health services, primary health care institutions to provide medical services and Chinese medicine services and explore ways of establishing two-way referral mechanisms. Into the fund to pay for out-patient medical costs of serious illness and co-ordinate the general out-patient medical services, to develop effective use of community and primary health care services for medical treatment and medical management approach to clearing costs. Residents of the participants in the designated community health service organizations and grass-roots medical institutions for medical treatment costs, to increase the proportion of the payment.
6, according to medical services and funding levels, and establish and perfect the basic medical insurance costs of clearing, settlement and reasonable medical expenses set standards and into the management agreement. To meet the medical expenses, according to the agreement in full and timely billing and payment, do not meet the medical expenses not paid.
7, and actively explore the medical insurance agencies designated medical institutions and medical consultation services to the billing method and standards. Actively explore the kinds of payment, such as the amount of prepaid billing method, the designated medical institutions to mobilize the initiative to participate in the management and reduce the cost of medical services initiative.
No comments:
Post a Comment