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Opinions of the State Council of the Central Committee of the Communist Party of China on deepening the reform of the medical security system

(February 25, 2020)

Medical guarantee is to reduce the burden on the masses for medical treatment、Promoting the well -being of people's livelihood、major institutional arrangements to maintain social harmony and stability。Party Central Committee、The State Council attaches great importance to people's health，Established a basic medical security system covering the whole people。Since the 18th National Congress of the Communist Party of China，The reform of the national medical security system continues to advance，Difficult to crack the doctor、Breakthrough progress has been made on the problem of expensive medical treatment。In order to thoroughly implement the party's 19th National Congress of the Communist Party of China on the decision -making deployment of the comprehensive establishment of the medical security system with Chinese characteristics，Focus on solving problems with imbalanced development of medical security，The following opinions on the reform of the deepening medical security system。

1. Overall requirements

(1) Guidance thought。Guided by Xi Jinping's new era of socialism with Chinese characteristics，Comprehensively implemented the 19th National Congress of the Communist Party of China and the 2nd Middle School of the 19th National Congress、Third Middle School、Plenary Session of the Fourth Central Committee，Adhere to people's health as the center，Accelerate the establishment of the whole people、Urban and rural coordination、Clear power and responsibility、Moderate guarantee、Sustainable multi -level medical security system，Through a unified system、sound mechanism、sound mechanism、Improve service，Enhance the fairness of medical security、Coordination，Give play to the strategic purchase of the medical insurance fund，Promoting high -quality coordinated development of medical security and medical services，Promoting the implementation of health China，Make the people more sensible、Happiness sensation、A sense of security。

(2) Basic principles。Persist in guaranteeing all guarantees、Guarantee Basic，Basic medical security covers the whole people in accordance with the law，Do your best、Delivery，To see the scope and standard of the guarantee。Perseverance and persistence、Prevent risk，Scientific determination of fundraising level，Balanced parties' payment liability，Strengthening overall planning，Make sure the fund is sustainable。Persist in promoting fairness、Build the bottom line，Fairness of the strengthening system，Gradually narrow the treatment gap，Enhance the basic nature of the poor、Foundation of Pocket Bare。Persist in governance innovation、Quality improvement and efficiency，Give play to the decisive role of the market，better play the role of the government，Improve medical insurance governance socialization、rule of law、Standardized、Intelligent level。Adhere to system integration、Coordinated efficiency，Enhanced medical insurance、Medical、The overallness of the reform of the pharmaceutical linkage、Systemic、Collaborative，Guarantee the masses to obtain high quality、Efficient、Medical services that can be affordable。

(3) Reform and development goals。to 2025，The medical security system is more mature and set for，Basically complete treatment guarantee、Funding operation、Medical insurance payment、Fund supervision and other important mechanisms and medical services supply、Reform tasks in key areas such as medical insurance management services。From 2030，Comprehensively built with basic medical insurance as the main body，Medical assistance is the bottom，Sky bet online sports Sky bet online sports betting APP download betting APP download Supplementary medical insurance、Commercial Health Insurance、Charity Donation、Medical Guidance System for Medical Assistance，Fair and moderate treatment protection，Fund runs steadily and continuous，Solidity of management services，Modernization of medical insurance governance has increased significantly，To achieve better protection of the disease of the disease。

2. Improve fair and moderate treatment guarantee mechanism

Fair and moderate treatment guarantee is the inherent requirements for improving people's health and well -being。To promote the statutory medical security system more mature and set，Improve the medical insurance and rescue system for heavy diseases，Coordinating planning of high -quality development of various medical security，According to the level of economic development and the ability to withstand the ability of the fund, it steadily improves the level of medical security。

(4) Improve the basic medical insurance system。Persist and improve the whole people、The basic medical insurance system and policy system participated in accordance with the law，Classification guarantee for employees and urban and rural residents，Links of treatment and payment，Fund to build accounts separately、Entry account calculation。Unified basic medical insurance overall level、Medical Insurance Catalog，Standardize the method of determining the medical insurance payment policy。Gradually incorporate outpatient medical expenses into the payment scope of the basic medical insurance overall fund，Reform the basic medical insurance personal account of employees，Establish and improve the guarantee mechanism for outpatient help mechanisms。

(5) Implementation of medical security treatment list system。Establish and improve medical security treatment list system，Standardize government decision -making permissions，Basic System of Scientific Definition、Basic policy、Fund payment items and standards，Promoting the legalization of the medical security system、Scientific decision -making、Standardized management。Make sure that political orders are unblocked，Policies that are not allowed to exceed the scope of the list of lists without approval。Strictly implement the basic payment scope and standard，Implement fair and moderate guarantee，Correction of excessive guarantee and insufficient guarantee。

(6) A sound medical assistance system that sounds a unified and standardized medical assistance。Establishing rescue objects Timely and accurately identifying mechanisms，Science determines the scope of rescue。Fully implement the policy of funding for key rescue objects participating in insurance payment policy，Improve the medical expense assistance mechanism for key rescue targets。Establish a long -acting mechanism for preventing and resolving poverty due to illness。Enhance the guarantee function of medical rescue support，Through clear diagnosis and treatment plan、Standardous referrals and other measures to reduce medical costs，Improve annual medical assistance limit，Reasonably control the proportion of the cost of self -cost within the scope of the policy scope of the poor。

(7) Improve the guarantee mechanism for medical treatment costs for major epidemics。When an emergency and other emergencies，Ensure that medical institutions are treated first、Tolls later。Improve the Policy for Payment of Medical Insurance, Medical Insurance,，Improve the direct settlement system for medical treatment，Make sure that patients do not affect medical treatment due to expenses。Explore the establishment of special groups、Disease cost exemption system for specific diseases，Targeted exemption of medical insurance directory、Payment limit、Restricted clauses such as medication，Reduce the worries of the people who are difficult to seek medical treatment。Use of medical security funds and public health service funds for use，Improve the payment ratio of the grass -roots medical institutions，Effective connection of public health Sky bet football services and medical services。

Sky bet sports betting APP (8) Promote the development of a multi -level medical security system。Strengthen basic medical insurance、Disease Insurance and Medical Rescue Triple Security Function，Promote the complementary connection of various types of medical security，Improve the level of guarantee of major diseases and diversified medical needs。Perfect and standardize the major illness insurance for residents、Subsidy medical expenses for employees、Civil Service Medical Subsidies and Enterprise Sky bet online sports Sky bet online sports betting APP download betting APP download Supplementary medical Insurance。Accelerate the development of commercial health insurance，Rich health insurance product supply，Personal income tax policies for business health insurance with sufficient use，Research and expand the scope of insurance products。Strengthen market behavior supervision，Highlight health insurance product design、Sales、Compensation and other key link supervision，Improve health security service capabilities。Encourage social charity donation，Coordinated mobilization of charitable medical assistance forces，Support medical mutual assistance and orderly development。Exploring the rare medical drug guarantee mechanism。

Three, sound stable and sustainable funding operation mechanism

Reasonable funding、Stable operation is the basic guarantee for sustainable medical security system。To establish an adaptation to basic national conditions with the primary stage of socialism、Matching ability with all parties、A fundraising mechanism coordinated with basic health needs，Effectively strengthen fund operation management，Strengthen risk warning，Resolutely keep the bottom line of no systemic risk。

(9) Improve funding and sharing and adjustment mechanisms。Employees participating in basic medical insurance shall be paid by employers and individuals。Non -employed persons to participate in basic medical insurance are paid by individuals，The government will give subsidies in accordance with regulations，Payment and economic and social development level and per capita disposable income of residents。Adapt to the development of new formats，Improve the payment method of participating in the insurance for flexible employment。Establish the benchmark rate system for basic medical insurance，Standards Payment Base Policy，Reasonably determine the rate，Implement dynamic adjustment。Balanced Personal、Employer、Government's three parties to raise funds for funds，Optimize personal payment and government subsidy structure，Study a multi -channel fundraising policy that should be raised by aging medical care。Strengthen the investment in medical rescue for finance，Broaden medical assistance funding channels。

(10) Consolidate and improve the overall level。Unified according to institutional policies、Fund unified revenue、Standards for Management Services，Comprehensively do basic medical insurance city -level coordination。Explore the vertical management of the medical security department below the municipal prefecture level。Encourage provinces with conditions (autonomous region、Municipality directly under the Central Government) According to classification management、Responsibility common burden、Coordinated adjustment、The idea of ​​budget assessment，Promote provincial -level coordination。Strengthen the management of medical assistance funds，Promoting the overall level of the overall level of medical assistance and the overall level of the basic medical insurance，Improve the efficiency of the use of rescue funds，Maximum benefits the poor。

(11) Strengthen fund budget management and risk warning。Scientific compilation of medical security fund revenue and expenditure budget，Strengthen budget execution supervision，Comprehensive implementation of budget performance management。Adapt to direct settlement for medical treatment、"Internet+Medical" and the development needs of the service model of medical institutions，Explore sky bet online sports betting the pilot pilot of cross -regional fund budget。Strengthen the Sky bet football fund's medium and long -term actuaries，Constructing the income and expenditure balance mechanism，Improve fund operation risk assessment、Early warning mechanism。

4. Establish an efficient medical insurance payment mechanism for management

Medical insurance payment is to ensure that the masses get high -quality medical services、Key mechanisms for improving the efficiency of fund use。Focus on clinical needs、Reasonable diagnosis and treatment、Appropriate technology，Improve the medical insurance directory、Agreement、Settlement Management，Implement more efficient medical insurance payment，better guarantee the rights and interests of insured persons，Enhance the incentive and restraint of medical insurance in the field of medical services。

(12) Improve the dynamic adjustment mechanism of medical insurance directory。Based on the fund tolerance，Adapt to the basic medical needs of the masses、Promoting clinical technology，Adjust the optimization of the medical insurance directory，High clinical value、Economic evaluation of good medicine、Diagnosis and Treatment Project、Medical consumables are included in the scope of medical insurance payment，Standardize the payment scope of medical service facilities。Improve the dynamic adjustment mechanism of medical insurance directory，Improve the medical insurance access negotiation system。Reasonably divide the responsibilities and permissions of the central and local directory adjustment，Directory or adjustment of medical insurance drug limited payment scope must not be formulated by itself，Gradually realize the basic unified scope of medical insurance for medical insurance。Create Medical Insurance and Drugs、Diagnosis and Treatment Project、Medical consumables evaluation rules and indicator system，Improve the exit mechanism。

(13) Innovation Medical Insurance Agreement Management。Improve the management of basic medical insurance agreements，Simplify the fixed application application、Professional evaluation、Consultation negotiation procedures。Incorporate eligible medical institutions into the management scope of the medical insurance agreement，Support the development of new service models such as "Internet+Medical"。Establish and improve the management mechanism of cross -regional medical agreement。Formulate the evaluation method of a designated pharmaceutical institution to perform the agreement，Promoting behavioral specifications、Service quality and cost control assessment evaluation，Improve the exit mechanism of fixed -point pharmaceutical institutions。

(14) Continue to promote the reform of medical insurance payment methods。Improve the total budget method of the medical insurance fund，Improve the negotiation and negotiation mechanism between medical security agencies and medical institutions，Promoting collective consultation of medical institutions，Scientific formulation total budget，and medical quality、Agreement to perform performance assessment results link。Vigorously promote the application of big data，Perform the multi -composite medical insurance payment method based on the disease -based payment，Promoting paid for groups related to disease diagnosis，Medical Rehabilitation、Chronic mental illness and other long -term hospitalized hospitalization and daily payment，Outpatient special chronic diseases are paid by the first person。Explore the separation of medical services and medicines。Adaptation to the development of medical service model development and innovation，Improve the payment method and settlement management mechanism of the medical insurance fund。Explore the total payment of the tight medical consortium，Reasonable overpasses，Residance Reserves、Reasonable overpasses，A conditional areas can pay some medical insurance funds to the medical institution in accordance with the agreement，Relieve the pressure of its funds。

Sky bet football Five, sound strict and powerful fund supervision mechanism

Medical Security Fund is the "life -saving money" Sky bet sports betting APP of the people，Must always take the safety of maintenance fund as the primary task。The system cage for the supervision of the medical insurance fund，Focus on promoting the reform of the regulatory system，Establish and improve the medical security credit management system，Strictly crack down on fraudulent behavior with zero tolerance，Make sure the fund is safe and efficient、Reasonable use。

(15) Reform and improve the medical insurance fund supervision system。Strengthen the supervision capacity of the medical insurance fund，Further improve the fund supervision system and mechanism，Practice the security of the fund、Improve the fund use efficiency。Strengthen the construction of internal control institutions in public service agencies for medical security，Implementation Agreement Management、Cost monitoring、Strengthen social supervision。Implement cross -departmental collaborative supervision，Actively introduce third -party regulatory forces，Strengthen social supervision。

(16) Improve the supervision method of the Innovation Fund。Establish a normal mechanism for supervision and inspection，Implementing big data real -time dynamic intelligent monitoring。Improve the monitoring mechanism for medical services，Establish an information forced disclosure system，Public medical expenses to the society in accordance with the law、Calculating structure and other information。Implementation of the entire process of performance management management，Establishing a performance evaluation system for the medical insurance fund。Improve medical security social supervision and incentive mechanism，Improved fraudulent insurance report reward system。

(17) Responsibilities of investigating fraudulent behavior in accordance with the law。Formulate and improve the relevant laws and regulations of the supervision of medical insurance funds，Standardize supervision permissions、program、Penalty Standards, etc.，Promoting the law can be dependent on、Administrative according to law。Establish a medical security credit system，Promote trustworthiness joint incentives and dishonest joint punishment。Strengthening the joint law enforcement of the department，Comprehensive application protocol、Administrative、Justice and other means，serious accountability of fraudulent insurance units and personal responsibilities，Criminal responsibility for suspected crime，Resolutely crack down on fraudulent protection、Actions that endanger the rights of the masses in insurance。

6. Collaborative promotion of the supply -side reform of pharmaceutical services

The implementation of the people's health and medical security functions of medical services。To give full play to the medicine、Purchase of centralized band procurement of medical consumables in deepening the reform of the supply side of pharmaceutical services，Promoting medical insurance、Medical、Integration of Medicine Links Reform System，Strengthen policy and management synergy，Guarantee the masses to obtain high -quality and affordable medical services。

(18) Deepening medicine、Medical consumables concentrated with volume procurement system reform。Persist in recruitment and harmony、Loss of volume and price，Practice for comprehensive implementation、Medical consumables concentrated with volume purchase。Based on medical insurance payment，Establish bidding、Procurement、Transaction、Settlement、Provincial tendering procurement platform，Promote the construction of regional、National Alliance Procurement Mechanism，Form full competition、Reasonable price、Specific and orderly supply guarantee system。Promote the direct settlement of medical insurance funds and pharmaceutical companies，Improve medical insurance payment standards and centralized procurement prices coordinated mechanism。

(19) Improve the price formation mechanism of medical services。Establish Sky bet sports betting APP a market -oriented medicine、Medical consumables price formation mechanism，Establish a national transaction price information sharing Sky bet sports betting APP mechanism。Governing drugs、High -value medical consumables price virtual high。Improve medical service project access system，Accelerate the review of new medical service price projects，Create price science determination、Dynamic adjustment mechanism，Continuous optimization of medical service price structure。Establishing medical price information、Industrial Development Index monitoring and disclosure mechanism，Establishing drug prices and recruitment credit evaluation system，Improve price letter、Interview system。

(20) Enhance medical services can be available。Improve the modern medical service system for the division of labor in the general and specialized medical services，Strengthening grass -roots general medical services。Evaluation of regional medical service capabilities，Reasonable planning various medical resources layout，Accelerate the development of social medical doctors，Accelerate the development of social medical doctors，Standardize the development of new service models such as "Internet+Medical"。Improve the management of medical equipment configuration in the regional public hospital，Guidance reasonable configuration，Strictly control the extraordinary over -amount。Make up care、Pediatrics、Elderly、Psychiatry and other shortcomings of medical services。Do a good job of the consistency of the quality and efficacy of the generic drugs, the consistency evaluation acceptance and review，By improving medical insurance payment standards and drug bidding procurement mechanisms，Support high -quality generic drug research and development and use，Promoting generic drug replacement。Improve the shortage of drug monitoring and early warning and hierarchical response system。

(21) Promote the improvement of medical service capabilities。Standardize the diagnosis and treatment of medical institutions and medical staff，Implementing the prescription review system，Promoting reasonable medication。Strengthen the internal professionalization of medical institutions、Refined management，Classification and perfect scientific and reasonable assessment and evaluation system，The assessment results are linked to the medical insurance fund payment。Reform the current department and personal accounting method，Perfect incentive compatibility、Flexible and efficient、Personnel compensation system that conforms to the characteristics of the medical industry，Improve performance assessment and allocation system。

7. Optimized medical security public management service

Medical Security Public Management Services Relationship Relationship Billions of People Vital Revles。To improve the management and public service system，Between provides precision、Refined service，Improve information service level，Promoting the innovation of medical insurance governance，Provide convenient and efficient medical security services for the people。

(22) Optimized medical security public service。Promote the standardization of public services for medical security，A one -stop service of medical security、One window process、A single system settlement。Adapt to the needs of population flow，Do a good job in the transfer of various types of people's insurance and medical insurance relations across regions，Accelerate the improvement of direct settlement services for medical treatment。Deepen the construction of the medical security system，Establish a unified medical security service hotline，Accelerate the promotion of service matters online，Improve operational efficiency and service quality。

(23) High starting point Promoting standardization and information construction。Unified medical security business standards and technical standards，Establish a national unity、Efficient、Sky bet sports betting APP Compatible、Convenient、Safe medical security information system，Realize the interconnection of national medical security information，Strengthen the orderly sharing of Sky bet online sports betting APP download data。Standardized data management and application permissions，Protect the basic information and data security of insured persons in accordance with the law。Strengthen big data development，Highlighting application orientation，Strengthen service support function，Promoting the common service of medical security can be equal to。

(24) Strengthen the construction capacity building。Build a national unified medical security management system，Vigorously promote service sink，Realize province、City、County、Township (street)、Village (community) full coverage。Strengthen the construction of the service team，Create a professional team that is compatible with the requirements of medical security public services in the new era。Strengthen the configuration of public management service capabilities for medical security，Establish an incentive restraint mechanism for the performance of management service performance。The government arranges the budget reasonably，Make sure that the medical security public service agency runs normally。

(25) Continue to promote the innovation of medical insurance governance。Promote the legal person governance of the medical security agency，Actively introduce social forces to participate in the service，Explore the establishment of a medical insurance governance pattern for co -construction and co -governance。Specifications and strengthening with commercial insurance institutions、Cooperation of social organizations，Improve the incentive restraint mechanism。Explore the establishment of a cross -regional medical insurance management collaboration mechanism，Realize the whole process、Seamless public service and fund supervision。better play the decision support and technical support of high -end think tanks and professional institutions。

8. Organization

(26) Strengthen the party's leadership。Party committees and governments at all levels should take the reform of the medical security system as an important task，Implement the party's leadership into the entire process of reform and development of medical security。Strictly deployed in strict accordance with unified deployment，Improve the working mechanism，Formulate practical policy measures in combination with actual situation。Incorporate the reform of the medical security system into the key task of guarantee and improve people's livelihood，Make sure the reform target is achieved as scheduled。

(27) Strengthening collaboration。Strengthen legislative work in the field of medical security，Accelerate the formation of the formation of the reform of medical security、The legal and regulatory system that is conducive to the standardization of the system。Establishing a departmental collaboration mechanism，Strengthen medical insurance、Medical、Coordination and comprehensive supporting facilities between the pharmaceutical system and policy。The competent department of medical security for the State Council is responsible for coordinating the reform of the medical security system，Conquer the relevant departments to study and solve the inter -departmental inter -department during the reform、cross -region、major issues of cross -industry，Guide policy connection specifications in various regions、The level of guarantee is appropriate and appropriate。

(28) Create a good atmosphere。All regions and departments must take the initiative to do a good job of interpretation and service promotion of medical security policies，Timely respond to social concerns，Reasonable guidance expectations。Fully mobilize the enthusiasm and initiative of supporting and cooperating with the reform，Gathering social consensus。Important reform matters should be widely listened to opinions，Do a good job of risk assessment in advance。Encountered a Sky bet online sports Sky bet online sports betting APP download betting APP download major situation，Timely to the Party Central Committee、Please report on the State Council。

(Xinhua News Agency, Beijing, March 5th)

Editor in charge: Wang Shiyang