Medical security is a major institutional arrangement to reduce the burden of medical treatment on the people, improve people's well-being, and maintain social harmony and stability. The CPC central committee and the state council attach great importance to people's health and have established a basic medical security system that covers the whole population. Since the 18th national congress of the communist party of China (CPC), continued progress has been made in the reform of the national medical security system, and breakthroughs have been made in addressing the difficulty and high cost of medical services. In order to fully implement the decisions and arrangements made at the 19th national congress of the communist party of China on the comprehensive establishment of a medical security system with Chinese characteristics and focus on solving the problem of unbalanced and inadequate development of medical security, the following Suggestions are put forward on deepening the reform of the medical security system.

First 

General requirements

(1) guiding ideology. New era in jinping the ideas of socialism with Chinese characteristics as a guide, fully implement the party's in the 19th and the 19th session of 2, 3, plenary meeting spirit, adhere to people's health as the center, to speed up the universal, the completion of urban and rural areas as a whole, clear responsibilities, ensure moderate and sustainable multi-level medical security system, through a unified system, perfecting the policy, perfecting mechanism, improve service, enhance the fairness, coordination of health care, give play to the role of strategic purchase medical insurance fund, promoting the coordinated development of health care and medical service quality, promote health strategy implementation in China, make people have more sense, happiness and security.

(2)Basic principles. We will ensure that basic medical insurance covers the entire population in accordance with the law, do our best and do what we can to ensure that the coverage and standards are determined based on facts. We will ensure that the fund is sound and sustainable, guard against risks, determine funding levels in a scientific way, balance the responsibility of all parties to pay contributions, and strengthen coordination to ensure that the fund is sustainable. We will continue to promote equity, make the bottom line stronger, strengthen institutional equity, gradually narrow the pay gap, and provide more basic and basic support to the poor. We will continue to make governance innovative, improve quality and increase efficiency, give play to the decisive role of the market, better play the role of the government, and make health care governance more social, legal, standardized, and intelligent. We will continue to integrate systems and work in a coordinated and efficient manner, make the reform of medical insurance, medical care and medicine more comprehensive, systematic and coordinated, and ensure that people have access to high-quality, efficient and affordable medical services.

(3)Goals for reform and development. By 2025, the medical security system will be more mature and well-formed, and the reform of such important mechanisms as the guarantee of benefits, the operation of financing, the payment of medical insurance, and the supervision of funds, as well as the supply of medical services and the management of medical insurance will be basically completed. In 2030, completed in the basic medical insurance as the main body, the medical treatment for palm, supplementary medical insurance, commercial health insurance, charitable donations, mutual medical system of the common development of the medical security system, welfare fairness modest, steady continuous fund running, convenient management service optimization, health care management modernization level significantly increased, and achieve the goal of better security in sickness.

Second

We will improve the mechanism for ensuring fair and appropriate treatment

Fair and appropriate treatment is an inherent requirement for improving people's health and well-being. We will make the legal medical security system more mature and well-formed, improve the medical insurance and assistance systems for major and very serious diseases, make overall plans for the high-quality development of all types of medical security, and steadily raise the level of medical security in line with the level of economic development and the affordability of funds.

(4)Improving the basic medical insurance system. We will adhere to and improve the basic medical insurance system and policy system that covers the entire population and is available to all in accordance with the law. We will ensure that employees and urban and rural residents enjoy separate benefits, and that their benefits are linked to their contributions. We will unify the pooling level of basic medical insurance and the catalogue of medical insurance, and standardize the method for determining the payment policy for medical insurance. We will gradually bring outpatient medical expenses into the scope of payment by the pooling fund of basic medical insurance, reform the individual accounts of basic medical insurance for employees, and establish and improve an outpatient mutual aid guarantee mechanism.

(5)Implement the system of medical insurance payment list. We will establish and improve the list system of medical insurance benefits, standardize the government's power to make decisions, scientifically define the basic system, basic policies, fund payment items and standards, and promote the legalization, scientific decision-making, and standardized management of the medical insurance system. All regions shall ensure the smooth flow of administrative orders and shall not issue policies beyond the scope of the list without approval. We will strictly implement the basic payment scope and standards, implement equitable and appropriate guarantees, and correct excessive and inadequate guarantees.

(6)Improve the unified and standardized medical assistance system. Establish a timely and accurate identification mechanism for the rescue objects and scientifically determine the rescue scope. We will fully implement the policy of subsidizing the participation of key recipients in insurance premiums, and improve the mechanism for subsidizing medical expenses for key recipients. To establish a long-term mechanism for preventing and defusing poverty caused by diseases. We will improve the support function of medical assistance, reduce medical costs by clarifying treatment plans and standardizing referrals, raise the annual limit for medical assistance, and appropriately control the proportion of out-of-pocket expenses in the policy range of poor people.

(7)Improving the mechanism for guaranteeing the cost of medical treatment in major epidemic situations. In the case of an emergency such as an outbreak of disease, ensure that medical institutions first treatment, after the charge. We will improve the medical insurance payment policy for medical treatment in major epidemic situations, and improve the direct settlement system for out-of-town medical treatment, so as to ensure that patients do not have to pay for medical treatment due to cost. We will explore ways to set up a medical fee exemption system for special groups and specific diseases, and exempt them from restrictive provisions such as the list of medical insurance, payment quotas and the amount of medicine used, so as to ease the worries of people in need of medical treatment. We will coordinate the use of medical security funds and public health services, increase the proportion of payments to primary-level medical institutions, and ensure that public health services and medical services are effectively connected.

(8)Promoting the development of a multi-level medical security system. We will strengthen the triple coverage of basic medical insurance, major disease insurance and medical assistance, promote the complementarity and complementarity of all types of medical insurance, and improve coverage of major and very serious diseases and diverse medical needs. We will improve and standardize major illness insurance for residents, subsidies for large medical expenses for employees, medical subsidies for civil servants, and supplementary medical insurance for enterprises. We will accelerate the development of commercial health insurance, enrich the supply of health insurance products, make full use of the individual income tax policy for commercial health insurance, and study ways to expand the scope of insurance products. We will strengthen oversight over market behavior, and give prominence to oversight over key links such as the design, sale and compensation of health insurance products, so as to improve our ability to provide health care services. We will encourage charitable donations from the general public, mobilize charitable medical assistance, and support the orderly development of mutual medical assistance. To explore the drug protection mechanism for rare diseases.

Third

Improve the sound and sustainable financing operation mechanism

Reasonable financing and steady operation are the basic guarantee for the sustainable medical security system. We need to establish a financing mechanism that is appropriate to the basic national conditions of the primary stage of socialism, matches the capacity of all parties, and coordinates with basic health needs. We need to effectively strengthen the operation and management of funds, strengthen early warning of risks, and resolutely guard against systemic risks.

(9)Improve the mechanism for financing sharing and adjustment. Obtain employment personnel to attend insurance of primary medical treatment to expend jointly by unit of choose and employ persons and individual. Non-employed personnel attend insurance of primary medical treatment to expend by individual pay, the government gives allowance by the regulation, pay cost is linked with level of economic and social development and dweller per capita disposable income. To adapt to the development of new business models, we will improve the payment method for employees with flexible employment. We will establish a benchmark rate system for basic medical insurance, standardize the payment base policy, reasonably determine the rate, and implement dynamic adjustment. We will balance the responsibility of individuals, employers and the government to raise funds, optimize the structure of individual contributions and government subsidies, and study policies for raising funds through multiple channels to cope with the medical burden of aging people. We will increase government spending on medical assistance and broaden the channels for financing medical assistance.

(10)Consolidating and improving overall planning. In accordance with the standards of system and policy unification, unified fund collection and expenditure, and integrated management and service, we will make overall planning for basic medical insurance at the municipal and prefecture-level. We will explore ways to promote vertical management of medical security departments below the municipal level. We will encourage qualified provinces (autonomous regions and municipalities directly under the central government) to promote provincial-level pooling in accordance with the principles of tiered management, Shared responsibility, overall planning and adjustment, and budget assessment. We will strengthen the management of the medical assistance fund, promote coordination between the overall planning of medical assistance and the overall planning of basic medical insurance, and improve the efficiency of the use of relief funds to the greatest extent benefit the poor.

(11)Strengthening budget management and early warning of risks. We will scientifically compile budgets for the revenues and expenditures of the medical security fund, strengthen oversight over budget implementation, and fully implement budget performance management. To meet the needs of direct settlement of out-of-place medical treatment, the development of "Internet + medical" and the service model of medical institutions, we will explore and carry out trials of trans-regional fund budgets. We will strengthen the medium - and long-term actuarial calculations of the fund, establish a balance between income and expenditure mechanism, and improve the risk assessment and early warning mechanism for the fund's operation.

Fourth

Establish effective and efficient medical insurance payment mechanism

Medical insurance payment is a key mechanism to ensure the public access to quality medical services and improve the efficiency of the use of funds. We should focus on clinical needs, reasonable diagnosis and treatment, and appropriate technology, improve the management of medical insurance catalogue, agreement and settlement, implement more efficient medical insurance payment, better protect the rights and interests of insured personnel, and enhance the incentive and restraint role of medical insurance in the medical service field.

(12)Improving the dynamic adjustment mechanism of the medical insurance directory. Based on the capacity of the fund, we will adapt to the basic medical needs of the people and the progress of clinical technology. We will adjust and optimize the list of medical insurance. We will include drugs, medical treatment items and medical consumables with high clinical value and excellent economic evaluation into the scope of medical insurance payment, and we will standardize the scope of payment for medical service facilities. We will improve the mechanism for dynamically adjusting the list of medical insurance schemes and improve the system for negotiating medical insurance market access. We will rationally divide the responsibilities and powers of central and local government catalogs and adjust them, and each region will not be allowed to set up a catalog or adjust the payment scope of medical insurance drugs on its own, so as to gradually realize the basic unification of the scope of medical insurance drugs nationwide. We will establish evaluation rules and indicators for medical drugs, medical treatment programs, and medical consumables, and improve the exit mechanism.

(13) innovating the management of medical insurance agreements. We will improve the management of basic medical insurance agreements, and simplify and optimize procedures for designated applications, professional assessments, consultations and negotiations by medical institutions. We will bring qualified medical institutions under the management of medical insurance agreements, and support the development of new service models such as "Internet + healthcare". Establish and improve the cross-regional medical treatment agreement management mechanism. We will formulate measures for assessing the performance of agreements among designated medical institutions, highlight the assessment of standards of conduct, service quality and cost control, and improve the withdrawal mechanism for designated medical institutions.

(14)We will continue to reform the way medical insurance is paid for. We will improve the method for budgeting the total amount of medical insurance funds, improve the mechanism for consultation and negotiation between medical security agencies and medical institutions, promote collective consultation among medical institutions, and formulate a total budget scientifically, which is linked to the quality of medical care and the performance of the agreement. We will vigorously promote the application of big data. We will implement a multi-component medical insurance payment method that focuses on payment by disease. We will promote payment by disease diagnosis group. Explore separate payments for medical services and drugs. We will adapt to the development and innovation of medical service models and improve the payment method and settlement management mechanism of medical insurance funds. We will explore ways to implement total payment for the compact medical consortium, strengthen supervision and assessment, keep the remaining balance and reasonably share the overexpenditure. Regions with conditions can prepay part of the medical insurance funds to the medical institutions according to the agreement, so as to ease the pressure of their fund operation.

Fifth

Improve the strict and effective fund supervision mechanism

Medical security fund is the people's "guarantee money", must always maintain the security of the fund as the primary task. We will strengthen the institutional cage for the supervision of the medical insurance fund, promote the reform of the regulatory system, establish and improve the management system for medical insurance credit, and crack down on fraudulent insurance practices with a zero-tolerance attitude, so as to ensure the safe, efficient and rational use of the fund.

(15)Reform and improve the supervision system for medical insurance funds. We will strengthen capacity building for the supervision of the medical insurance fund, further improve the fund supervision system and mechanism, effectively safeguard the safety of the fund, and improve the efficiency of its use. We will strengthen the construction of internal control institutions in public service institutions for medical care, and implement the responsibilities of agreement management, cost monitoring, and auditing. We will implement coordinated supervision across departments, actively introduce third-party supervision forces, and strengthen public oversight.

(16) Improving and innovating ways of fund supervision. We will establish a normal supervision and inspection mechanism and implement real-time, dynamic and intelligent monitoring of big data. We will improve the monitoring mechanism for medical services, establish a mandatory information disclosure system, and disclose to the public information on medical expenses and cost structure in accordance with laws and regulations. We will implement performance management in the whole process of fund operation and establish a performance evaluation system for medical insurance funds. We will improve the incentive mechanism for social supervision of the medical security system and the reward system for reporting fraud.

(17) to investigate the liability for fraudulent insurance ACTS in accordance with the law. We will formulate and improve laws and regulations related to the supervision of medical insurance funds, standardize the scope of supervision, procedures, and standards for punishment, and promote law-based administration. We will establish a credit system for medical care, and implement joint incentives for keeping promises and joint punishments for breaking promises. We will strengthen joint law enforcement by all departments, use a combination of agreements, administrative and judicial means, seriously investigate the responsibility of units and individuals that engage in fraud and deception, and investigate the criminal responsibility of those who are suspected of committing crimes in accordance with the law.

Sixth

Promoting supply-side reform of medical services in a coordinated manner

Medical service supply is related to the realization of people's health and medical security. We need to give full play to the leading role of centralized procurement of medicines and medical supplies in deepening supply-side reform of medical services, promote the integration of the system for the interconnected reform of medical insurance, medical care and medicine, and strengthen policy and management coordination to ensure that people can obtain high-quality and affordable medical services.

(18)Deepening the reform of the centralized procurement system for pharmaceuticals and medical supplies. We will adhere to the principle of combining procurement with procurement, linking the quantity with the price, and comprehensively carry out centralized procurement of medicines and medical supplies. On the basis of medical insurance payment, we will establish a provincial-level bidding and procurement platform integrating bidding, procurement, transaction, settlement and supervision, and promote the construction of regional and national alliance procurement mechanisms, so as to form a well-competitive, reasonably priced, standardized and orderly supply security system. We will promote direct settlement between medical insurance funds and pharmaceutical companies, and improve the mechanism for coordinating medical insurance payment standards and centralized procurement prices.

(19)Improving the pricing mechanism for medical services. We will establish a market-based pricing mechanism for pharmaceuticals and medical supplies, and establish a national trading price information sharing mechanism. Control drug, high value medical consumable price is high falsely. We will improve the market access system for medical services, speed up the review of new medical service prices, establish a mechanism for scientifically determining and dynamically adjusting prices, and continue to improve the price structure of medical services. We will establish a mechanism for monitoring and disclosing information on pharmaceutical prices and industrial development indexes, establish a system for evaluating drug prices and credit for drug recruitment, and improve the system for price consultation and interview.

(20)Improving access to medical services. We will improve the modern medical service system featuring the division of labor between general and specialized medical services, and strengthen community-level general medical services. We will strengthen the evaluation of regional medical service capabilities, make rational plans for the distribution of medical resources, promote the sharing and utilization of resources, accelerate the development of nongovernmental medical services, and standardize the development of new service models such as "Internet + medical care." We will improve the allocation and management of medical equipment in regional public hospitals, guide the rational allocation, and strictly control the excessive allocation of medical equipment. Make up for the shortage of medical services in nursing, pediatrics, geriatrics and psychiatry. We will accept and review the consistent evaluation of the quality and efficacy of generic drugs, support the development and use of high-quality generic drugs and promote the substitution of generic drugs by improving the standards for medical insurance payments and the mechanism for drug bidding and procurement. We will improve the system for monitoring, warning and grading responses to drug shortages.

(21) enhancing the capacity of medical services. We will standardize the treatment practices of medical institutions and medical personnel, implement a prescription review system, and promote rational use of drugs. We will strengthen specialized and refined management within medical institutions, improve a scientific and rational assessment system based on classification, and link assessment results to medical insurance fund payments. We will reform the current accounting methods of departments and individuals, improve the personnel compensation system that is compatible with incentives, flexible and efficient, and in line with the characteristics of the medical industry, and improve the performance appraisal and distribution system.

Seventh  

Optimizing public administration services of medical security

The public administration and service of medical care concern the vital interests of hundreds of millions of people. We need to improve operational management and public service systems, better provide precise and refined services, improve the level of information-based services, promote innovation in medical insurance governance, and provide convenient and efficient medical security services to the people.

(22) Improving public services for medical care. We will promote the standardization and standardization of medical care public services, and achieve one-stop medical care services, one-window processing, and one-bill settlement. To meet the needs of population mobility, we will ensure that all types of people participate in the insurance system and transfer their medical insurance coverage across regions, and accelerate the improvement of services for direct settlement of out-of-town medical care. We will deepen the work style of the medical security system, establish a unified hotline for medical security services, speed up the online handling of service items, and improve operational efficiency and service quality.

(23)Promoting standardization and it application at a high starting point. We will unify the business and technical standards for medical security, establish a national medical security information system that is unified, efficient, compatible, convenient and safe, ensure the interconnection of medical security information across the country, and enhance orderly sharing of data. We will standardize data management and application rights, and protect the basic information and data security of the insured in accordance with the law. We will strengthen the development of big data, give prominence to application orientation, strengthen service support, and ensure equal access to public services for medical care.

(24)Strengthening capacity building. We will establish a national unified medical care management system, vigorously promote the decline of services, and ensure full coverage of all provinces, cities, counties, townships (streets), and villages (communities). We will strengthen the construction of an agency service team and build a professional team that meets the public service requirements of medical care in the new era. We will strengthen the allocation of public management service capabilities for medical care and establish an incentive and restraint mechanism linked to the performance of management services. The government has made reasonable budget arrangements to ensure the normal operation of the health care public service institutions.

(25) Continue to promote innovation in medical insurance governance. We will promote the legal person governance of medical security agencies, actively introduce social forces into their services, and explore ways to establish a medical insurance governance pattern that is jointly built, governed, and Shared. Standardize and strengthen the cooperation with commercial insurance institutions and social organizations, and improve the incentive and restraint mechanism. We will explore the establishment of a cross-regional cooperation mechanism for health care management, and achieve whole-process, seamless public services and fund supervision. We will give better play to the decision support and technical support of high-end think tanks and professional institutions.

Eighth

Organizational guarantee

(26.)Strengthening the party's leadership. Party committees and governments at all levels should regard the reform of the medical security system as an important task and carry out the party's leadership in the whole process of the reform and development of the medical security system. We will strictly follow unified arrangements, improve working mechanisms, and formulate practical policies and measures in light of actual conditions. We will make implementing the reform of the medical security system a priority in ensuring and improving people's well-being, and ensure that the reform goals are met on schedule.

(27)Strengthening coordination and cooperation. We will strengthen legislation in the field of medical security, and accelerate the formation of a system of laws and regulations that are consistent with the reform of medical security and conducive to finalizing and improving the system. We will establish a mechanism for departmental collaboration, and strengthen overall coordination and comprehensive support among medical insurance, medical and pharmaceutical policies. The competent department of medical security under the state council shall be responsible for promoting the reform of the medical security system in a coordinated manner, and shall, together with relevant departments, study and solve major cross-departmental, cross-regional and cross-industry problems in the reform, and guide all regions to regulate the policy convergence and ensure that the level of insurance coverage is appropriate.

(28)Create a good atmosphere. All regions and departments should take the initiative to interpret medical security policies and publicize services, respond to social concerns in a timely manner and guide expectations in a reasonable way. We will fully mobilize the enthusiasm and initiative of all parties to support and cooperate with the reform and build social consensus. We must listen to opinions on important reform issues and make risk assessments in advance. In case of major situation, timely report to the party central committee and the state council.