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Original Title: Five Key Points from the Health Insurance Fund Regulatory Announcement
Recently, the “Regulation on the supervision and administration of the use of medical security funds” has been deliberated and approved by the executive meeting of the State Council, and was announced a few days ago. The medical security fund is the “health care money” and “life saving money” of the people. The safety of its use involves the vital interests of the general public and is related to the healthy and sustainable development of the medical safety system. The Central Party Committee and the State Council attach great importance to the supervision and management of the use of medical security funds. In the periodic briefing on policies of the Council of State held on the 20th, relevant officials from the National Medical Insurance Office, the Ministry of Public Security, the Ministry of Justice and the National Health Commission explained and interpreted the document from multiple angles to respond to social concerns. .
Point 1: What are the general considerations when formulating the Regulation?
Shi Zihai, deputy director of the National Health Insurance Administration, said that during the formulation of the Regulation, efforts were made to improve the scientific, standardized and institutionalized level of supervision and management of the use of medical security funds, to ensure safety. of medical security funds, and to promote the effective use of funds. Protect the rights and legitimate interests of the medical safety of citizens. Specifically, there are three main considerations (see chart).
“In the legislative process, we always adhere to the value orientation focused on people’s health.” He said, first, that he embodies “for the people” in terms of legislative purposes. The second is “convenience to the people” in the use of health insurance funds and the enjoyment of health insurance management services. The third is the “benefit to the people” in the provision of medical services.
Point 2: What are the regulations to increase the punishment for illegal acts?
Wang Zhenjiang, director of the Third Legislative Office of the Ministry of Justice, pointed out that the medical security fund is also closely related to the healthy and sustainable development of our medical security system. In the whole process of use, it has many subjects, a long chain and many risk points, especially for some behaviors of use, which also have a strong professionalism in identifying legal compliance. These features have increased the difficulty of supervision. In recent years, the illegal use of medical security funds has also occurred from time to time, causing the loss of funds to some extent, affecting the security of funds, and damaging legitimate rights and interests. of the insured and the equity of the Sex system.
He said that for the different illicit entities, illicit acts and illicit situations, a comprehensive use is made of a variety of penalties, corresponding legal responsibilities and greater punishment for illicit acts, so that offenders pay a higher price, and then guide and urge The main users of the medical security fund are better able to comply with the laws and regulations.
Point 3: How does the public security body address the crime of health insurance fraud?
In recent years, health insurance fraud has occurred frequently. Some designated medical institutions cheated insurance on a large scale, and a group of criminals sold drugs to cheat insurance for profit. Qin Yunbiao, political commissioner of the Criminal Investigation Bureau of the Ministry of Public Security, said that the Ministry of Public Security has always attached great importance to fighting health insurance fraud. In 2020 alone, public security agencies across the country have investigated 1,396 cases of this type. , arrested 1,082 suspected criminals and recovered more than 400 million yuan in health insurance funds.
He noted that in the next step, public security organs will work with the medical security department to implement special rectification actions against fraudulent insurance, focusing on cracking down on various crimes of medical insurance fraud and resolutely curbing the high incidence of cases.
Point 4: What standards of behavior must the different entities follow?
Shi Zihai said that the health insurance fund uses a very long chain and involves many topics, including at least four main categories, namely health insurance administrative departments, health insurance agencies, designated medical institutions, and insured persons. Therefore, the responsibilities of these entities in the use of the fund must be clearly defined, the responsibilities of all parties must be clearly defined, and each party must fulfill its functions and standardize behavior, in order to ensure safe use. and cash from the fund.
He noted that the “Regulations” clearly stipulated the rules of conduct for various subjects (see table). Believed that after the implementation of the “Regulation”, all relevant issues strictly abide by the prescribed standards of behavior and problems in the use of medical security funds will be resolved Fundamentally improved.
Point 5: Does the health insurance fund have sufficient capacity to protect you?
Shi Zihai said that, according to the statistical bulletin, the fund’s total income last year was 2.4 trillion yuan, and the spending was about 2.1 trillion yuan. The balance for that year was 270 billion yuan. The accumulated balance in recent years exceeded 3 trillion yuan. The fund is currently running smoothly and the balance is general. Relatively generous, the use of the surplus will not affect people’s current health insurance treatment.
“At the same time, we should also keep in mind that, although the current reinvestment balance is relatively large, 1/3 of it is in personal accounts, with a general fund balance of about 2 trillion yuan, and the regional distribution of Fund balances are very uneven, mainly concentrated in the influx of some people. Provinces, the degree of concentration continues to increase. With high-speed economic growth at medium-high speed, increasing aging of the population, changes in spectrum diseases, advancement of medical technology, etc. Medical expenses continue to grow and the growth rate of fund income is less than the growth rate of expenses. It will become the new normal and there will be certain pressures on the medium and long-term balance of medical security funds “.
Shi Zihai stressed that the next step will be to carefully analyze the operation of the health insurance fund and actively cooperate 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. medium and long term. (Text: Yang Xiaobo Poster Design: Deng Haomaa)
