China to further expand the pilot scope of direct settlement of outpatient expenses in all provinces

Summary

[China ampliará aún más el alcance del proyecto piloto para la liquidación directa de gastos ambulatorios en todas las provincias]The National Medical Security Administration and the Ministry of Finance recently issued the “Notice on the Promotion of Pilot Work for the Direct Settlement of Outpatient Expenses in the Provinces.” The “Management System” further expands the scope of the pilot program for the direct settlement of outpatient expenses in the provinces and explores the national unified system, the operating mechanism and the implementation route for the direct settlement of outpatient expenses in the provinces. . (Xinhua News Agency)

National Medical Security Administration,financialThe Ministry of Health recently issued the “Regarding the Promotion of the Direct Settlement ofjobsofnotice“He proposed that before the end of 2020, based onadministrationThe “system” further expands the scope of the pilot program for direct settlement of outpatient expenses in all provinces and explores the system and operation of a nationwide unified interprovincial direct settlement system for outpatient expenditures.mechanismAnd way of realization.

China plans to initially establish a unified national health insurance information platform by the end of 2021, which includesPublic service, 14 business subsystems, such as interprovincial and remote medical treatment management, among them the interprovincial remote medical treatment management subsystem is also calledManagement system“, was officially launched in early May 2020.

The notice requires 12 pilot provinces, autonomous regions and municipalities, including Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, Sichuan, Guizhou, Yunnan and Tibet, to be connected to the national remote medical management system to further expand plus pilot areas and pilots. Medical institutions and direct settlement scope. Insist on first intraprovincial and then interprovincial, first general outpatient and chronic disease outpatient, combined with the current situation of the construction of information platforms in various regions and the requirements of construction of unified information platforms at the national level, give priority to the connection areas with concentrated medical treatment and a high willingness to participate, mature and include one. Steadily advance the pilot work for direct settlement of outpatient expenses in all provinces.

At the same time, other provinces with conditions and will, for example, have basically achieved direct settlement of outpatient expenses in the province, which can be high over time.qualityTo complete the transformation of the interface, etc., you can submit a pilot request to the National Health Insurance Office before October 10, complete the transformation of the system by the end of November, and test the operation after the National Insurance Office Doctors accept it at the end of December.

The notice requires that the outpatient direct settlement judgment in all provinces adhere to the hierarchical diagnosis and treatment system to guide insured persons to seek medical treatment in an orderly manner Adhere to basic medical careinsuranceMedical treatment policy in different places,Process、Settlement methodBasically stable and unified medical treatment in different locations of the medical treatment agency and designated medical institutions.negotiationNegotiation, full control, intelligent monitoring, medical insurance doctor management,medical serviceQuality supervisionAnd other managementServicerank.

According to the requirements of the notice, outpatient expenses settled directly by medical personnel in different places in the provinces should, in principle, implement the scope of payment and regulationsinsuranceScope of payment for medicines, medical service items and medical consumables) Basic medicalinsurancebackgroundMinimum payment standard, payment ratio, maximum payment limit, scope of chronic ambulatory disease, etc.RefundThe policy implements the regulations of the insured place.

(Source: Xinhua News Agency)

(Responsible editor: DF118)