▍ medical insurance standardization, energy saving
According to the notice of the National Medical Insurance Bureau, this opinion is mainly to thoroughly implement the national standardization strategy and accelerate the formation of a unified national medical security standardization system.
In accordance with the "Notice of the State Council on Printing and Distributing the Reform Plan for Deepening Standardization Work" (Guo Fa [2015] No. 13) and the "National Standardization System Construction and Development Plan (2016-2020)" and other documents, combined with the needs of medical security reform and development, instructions.
According to the cypress blue query Guofa [2015] No. 13 document, the state attaches great importance to the significance of standardization - standardization plays an increasingly important role in ensuring product quality and safety, promoting industrial transformation and upgrading, economic upgrading and efficiency, and serving foreign trade and foreign trade. Important role.
It is not difficult to see that the combination of standardization and informatization can save energy and reduce consumption. If the standardization of medical insurance is standardized, it can also greatly reduce the loss of medical insurance funds and improve the use efficiency of medical insurance funds.
The National Standardization System Construction and Development Plan (2016-2020) has defined standardization priorities in various fields, including medical devices, biotechnology, and basic medical care.
The key points of standardization in the basic health field are:
Revision of health and Chinese medicine related standards, including health information, medical institution management, medical services, TCM special advantages diagnosis and treatment services, and “prevention of disease prevention” health care services, clinical testing, blood, hospital infection control, nursing, infectious diseases, parasitism Standards in the fields of worm disease, endemic disease, vector control, occupational health, environmental health, radiation health, nutrition, school hygiene, disinfection, health emergency management, health quarantine, etc. Formulate important relevant product standards, including standards for seed and seedlings of Chinese herbal medicines, grading standards for Chinese herbal medicines and Chinese herbal medicines, and certification standards for authentic Chinese medicines, to improve the fairness, accessibility and quality of basic medical and health services.
▍ Establish a national unified medical insurance standardization system
The National Medical Insurance Bureau mentioned in the notice that China's medical security system has been in operation for more than 20 years, and has not yet formed a unified standardization system, which is difficult to adapt to the modernization requirements of medical security governance.
All localities should fully understand the importance and urgency of the standardization of medical security, use scientific means, and take effective measures to promote the standardization of medical security.
Actively adapt to the needs of medical security reform and development, unified planning, unified classification, unified release, unified management, formulate various medical security standards, promote the implementation of standards, form a unified national medical security standardization system, and provide support for the high-quality development of medical security in the new era.
Now, China's medical security information exchange has begun to use the common language - business coding standards to achieve "full vertical and horizontal full coverage" of medical insurance business.
In the end, the National Medical Insurance Bureau will take the lead in completing medical insurance disease diagnosis, surgical operation classification and code, medical service project classification and code, medical insurance drug classification and code, medical insurance medical consumable classification and code, medical insurance system unit classification and code, medical insurance system staff code , designated medical institution code, fixed-point retail pharmacy code, medical insurance doctor code, medical protection staff code, medical insurance pharmacist code, medical insurance door slow disease special disease list, medical insurance according to the disease settlement list, medical insurance day surgery disease directory, medical insurance settlement list Preparation work.
At present, four coding standards have been completed, namely medical insurance disease diagnosis, surgical operation classification and code, medical service project classification and code, medical insurance drug classification and code, medical insurance medical consumable classification and code.
In terms of medical insurance drug classification and coding, this work covers all drugs approved by the drug regulatory authority, and realizes one thing and one code, which can facilitate public inquiry, provide resource sharing, service for medical treatment and support data analysis.
The State Health Insurance Bureau mentioned in its opinion that by 2020, on the basis of the construction of the national unified medical security information system, the 15 information service coding standards such as disease diagnosis and surgical operation will be gradually implemented.
During the "14th Five-Year Plan" period, a list of national medical security standards was formed, and the research and development and trial use of some medical security standards were initiated.
▍Standardization of key areas of medical insurance
According to the opinion, the National Medical Insurance Bureau will focus on standardization in four aspects.
1. Basic common standards. Establish a national unified standard of medical insurance basics, and form a “common language” for the joint construction and sharing of the national medical security system and the exchange of relevant departmental units. Including medical insurance information business coding standards, unified identification, file management practices, etc., as well as technical standards for network security, data exchange, operation and maintenance involved in the construction of medical security information.
2. Manage work practices. Improve the work norms covering the management of medical insurance funds, business management, medical prices and procurement management. Including audit settlement payment, transfer connection, off-site settlement, payment method management and other fund management and operation business specifications, management organization construction, handling personnel behavior and other system design, medical service items and prices, and pharmaceuticals, medical supplies Bidding procurement management specifications, etc.
3. Public service standards. Optimize fast, efficient, convenient and practical medical service public service standards. Including basic medical insurance participation registration, information disclosure, personal information inquiry and other public service standards, medical insurance management departments and designated medical institutions and other third-party agencies agreement management norms, long-term care insurance disability assessment standards, service project standards.
4. Evaluation of supervision standards. Establish medical performance performance appraisal and service evaluation standards. It includes credit evaluation standards for insured persons, insured units, designated medical institutions and their staff, as well as medical monitoring fund operation monitoring and management regulations and medical service price monitoring specifications.
