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Original title: National Health Insurance Administration: The mobile balance of the health insurance fund exceeds 3 trillion yuan, which is enough to cover the cost of the new crown vaccine. Source: Beijing Youth Daily
Yesterday, at the State Council’s regular policy briefing held by the State Council Information Office, Shi Zihai, deputy director of the National Health Insurance Administration, made it clear that in response to the question of whether the fund of medical insurance is enough to cover the cost of the new corona vaccine, the balance accumulated over the years has exceeded 3 trillion yuan. There is no problem with vaccination and vaccination costs.
Stable functioning of the health insurance fund and broad overall balance
Shi Zihai said that the current round of new coronavirus vaccines and vaccination cost policies have been clarified. First, the cost of vaccinations and vaccination will be borne by the health insurance fund, and the government will provide the corresponding subsidies to the health insurance fund and residents will receive free vaccination. Second, the health insurance fund is mainly met using the balance of the past years, which does not affect the income and expenses of the fund in the current period and will not affect the current medical treatment of people.
Currently, the National Health Insurance Administration has worked with relevant departments to study and formulate detailed vaccine operational plans and vaccination cost guarantees after conditional marketing of vaccines. The next step will guide localities to organize and implement them.
Regarding the current fund balance problem, Shi Zihai presented that according to the statistics bulletin, the fund’s total income last year was 2.4 trillion yuan and the expenditure was about 2.1 trillion yuan. The balance of that year was 270 billion yuan, the accumulated balance over the years exceeded 3 billion yuan. The operation is stable and the balance is relatively large. Use of the balance will not affect people’s current health insurance benefits.
“In general, there is no problem with the health insurance fund covering the cost of vaccinations and vaccination this time,” he said.
Shi Zihai also pointed out that although the current reinvestment balance of the health insurance fund is relatively large, a third is in personal accounts, and the total fund balance is about 2 trillion yuan. Furthermore, the regional distribution of fund balances is very uneven, concentrated mainly in some provinces where the population flows and the degree of concentration continues to increase.
According to Shi Zihai, according to statistics, in the six eastern provinces and cities with high population flows, the cumulative balance of the general fund for employee health insurance accounted for 44.7% of the country in 2010, and has increased to 56 , 6% in the last year. anus. In particular, as economic growth moves from high to medium and high speed, the aging of the population continues to increase, the spectrum of diseases changes, advances in medical technology, etc., medical expenses continue to increase. and the growth rate of funds income is lower than the growth rate of spending will become the new normal Medical security There is some pressure on the fund’s medium and long-term balance.
“In the next step, we will carefully analyze the operation of the health insurance fund and actively work with the relevant departments to strengthen the supervision and management of the use of the health insurance fund to ensure the sustainable and balanced operation of the fund in the medium and long term. deadline, “Shi Zihai said.
Dealing with more than 400,000 illegal medical institutions last year
In addition to balancing the pressure, many entities have long used health insurance funds, long chains, many risk points, and difficult oversight. The problem of fraudulent insurance continues to be frequent and the supervisory situation is relatively serious.
According to Shi Zihai, in 2019, the national medical security department inspected a total of 815,000 designated medical institutions and managed 264,000 medical institutions that violated laws, regulations, and contracts through interviews, ordering corrections, recoveries, and fines, accounting for 32 %. Of the institutions inspected, the health insurance fund recovered 11.56 billion yuan that year; In 2020, the National Office of Health Insurance and the health department inspected more than 600,000 designated medical institutions, plus the self-examination of designated medical institutions, a total of the more than 400,000 medical institutions that violated laws and regulations were managed and recovered 22.31 billion yuan of health insurance funds.
Additionally, in recent years, health insurance fraud has also occurred frequently. Some designated medical institutions defraud insurance on a large scale, and a group of criminals sells drugs to cheat insurance for profit. According to Qin Yunbiao, political commissioner of the Criminal Investigation Office of the Ministry of Public Security, in 2020, public security organs across the country will investigate 1,396 such cases, arrest 1,082 suspected criminals and recover more than 400 million yuan in health insurance funds. .
Health Insurance Fund Supervision Regulations Increase Penalties for Illegal Acts
On May 1 of this year, the “Regulation for the Supervision and Administration of the Use of the Medical Security Fund” will be formally implemented. Shi Zihai pointed out that tightly weaving the cage of the medical security fund supervision system is the core content to prevent people’s “life-saving money” from being turned into “tang monk meat.” Specifically, it includes six aspects, clarifying the responsibilities of the relevant entities in the use of funds; stipulating the establishment of a supervision system that combines administrative supervision, social supervision and self-discipline of the industry; establishing medical insurance, health, traditional Chinese medicine, market supervision, finance, auditing and public security Arrangements have been made for cooperation mechanism in supervision of other departments; Requirements have been raised to strengthen the management of health insurance contracts; the form of supervision has been standardized; supervision and inspection measures and procedures have been stipulated.
Furthermore, the “Regulations” have also increased penalties for illegal acts and increased the deterrence of the law. The “Regulation” establishes legal responsibilities for different illegal entities and different illegal acts.
The first is to order corrections, returns, fines and sanctions to medical security agencies that violate the law.
The second is to order the designated medical institutions to make corrections, interview the responsible, return, fine, and order the designated medical institutions to suspend the medical services of the responsible departments for a specified period of time for general violations. from designated medical institutions; for designated medical institutions that violate the management system, they are ordered to make corrections and hire. Talk about the person responsible and the fine; If the designated medical institution misleads the insurance, it will be ordered to return, fined, and the designated medical institution will be ordered to suspend the medical service of the corresponding responsible department for a certain period of time, terminate the service contract and revoke the qualification of the practice; cause significant losses to the medical security fund or other serious ones. In case of adverse social impact, the legal representative or main responsible party will be restricted from exercising employment and sanctions.
Third, if an individual violates the law, he or she will be ordered to make corrections, will be ordered to return, or will be suspended for a certain period of online settlement of medical expenses and will be fined.
Fourth, those who embezzle or misappropriate the medical security fund will be ordered to recover, confiscate, and impose penalties on illegal income.
Fifth, the personnel of the medical security departments and other administrative departments will be sanctioned if they abuse their power, neglect their duties or practice favoritism.
(Text / Reporter coordinator Dong Xin / Liu Xiaoxue)
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