Original Title: Five Key Points of Medical Insurance Fund Regulatory Regulations Announcement Learn about the source: Xinhuanet
Recently, the “Regulations on the Supervision and Administration of the Use of Medical Security Funds” have been deliberated and approved by the State Council executive meeting, and have been announced a few days ago. The medical security fund is the people’s “medical care money” and “life-saving money”. 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 security system. The Party Central Committee and the State Council attach great importance to the supervision and management of the use of medical security funds. At the State Council’s regular policy briefing held on the 20th, relevant officials from the National Medical Insurance Bureau, 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 overall considerations when formulating the Regulations?
Shi Zihai, deputy director of the National Medical Insurance Administration, said that during the formulation of the Regulations, efforts were made to improve the scientific, standardized, and institutionalized level of supervision and management of the use of medical security funds, to ensure the safety of medical security funds, and to promote effective use of funds. Protect the legitimate rights and interests of citizens’ medical security. Specifically, there are three main considerations (see chart).
“In the legislative process, we always adhere to the value orientation centered on people’s health.” He said, first, it embodies “for the people” in terms of legislative purposes. The second is the “convenience for the people” in the use of medical insurance funds and the enjoyment of medical insurance handling services. The third is the “benefit to the people” in the provision of medical services.
Point 2: What are the regulations to increase punishment for illegal acts?
Wang Zhenjiang, director of the Legislative Third Bureau 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 entire use process, it has many subjects, a long chain, and many risk points, especially for some use behaviors, which also have a strong professionalism in the identification of legal compliance. These characteristics have increased the difficulty of supervision. In recent years, illegal use of medical security funds has also occurred from time to time, which has caused the loss of funds to a certain extent, affected the safety of funds, and harmed the legitimate rights and interests of insured persons and the fairness of the system. Sex.
He said that for different illegal subjects, illegal acts, and illegal situations, a comprehensive use of a variety of penalties, corresponding legal responsibilities, and increased punishment for illegal acts, so that offenders pay a greater price, and then guide and supervise The main users of the medical security fund are better able to comply with laws and regulations.
Point 3: How does the public security organ deal with the crime of medical insurance fraud?
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In recent years, medical 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 commissar of the Criminal Investigation Bureau of the Ministry of Public Security, said that the Ministry of Public Security has always attached great importance to combating medical insurance fraud. In 2020 alone, public security agencies across the country have investigated 1,396 such cases, arrested 1,082 criminal suspects and recovered more than 400 million yuan in medical insurance funds.
He pointed out that in the next step, the public security organs will work with the medical security department to deploy special rectification actions against fraudulent insurance, focusing on cracking down on various medical insurance fraud crimes, and resolutely curbing the high incidence of cases.
Point 4: Which behavioral norms need to be followed by different entities?
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Shi Zihai said that the medical insurance fund uses a very long chain and involves many subjects, including at least four major categories, namely, medical insurance administrative departments, medical 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 perform its duties and standardize behavior, so as to ensure the safe and effective use of the fund.
He pointed out that the “Regulations” clearly stipulated the behavioral norms of various subjects (see chart). He believed that after the implementation of the “Regulations”, all relevant subjects strictly abide by the prescribed behavioral norms, and the problems in the use of medical security funds will be resolved. Fundamentally improved.
Point 5: Does the medical insurance fund have sufficient capacity to protect it?
Shi Zihai said that according to the statistical bulletin, the total income of the fund 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 past years exceeded 3 trillion yuan. Relatively abundant, the use of surplus will not affect the people’s current medical insurance treatment.
“At the same time, we must also note that although the current rollover balance is relatively large, 1/3 of it is in personal accounts, with a balance of the overall fund of about 2 trillion yuan, and the regional distribution of fund balances is very uneven, mainly concentrated in the inflow of some people. Provinces, the degree of concentration is still increasing. With economic growth from high speed to medium-high speed, increasing population aging, disease spectrum changes, medical technology advancement, etc., medical expenses continue to grow, and the growth rate of fund income is lower than the growth rate of expenditure 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 emphasized that the next step will be to carefully analyze the operation of the medical insurance fund, and actively cooperate with relevant departments to strengthen the supervision and management of the use of medical insurance funds to ensure the sustainable and balanced operation of the fund in the medium and long term. (Text: Yang Xiaobo Poster Design: Deng Haomaa)
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