Document No.2023 16 issued by Shanxi Medical Insurance Bureau is a policy document on medical insurance reform. This document mainly deals with the use and management of medical insurance funds, aiming at improving the efficiency of the use of medical insurance funds and better ensuring the basic medical needs of the broad masses.

I. Background and objectives of the document

Gold medical insurance number. 2023 16 is a local policy document under the guidance of the National Medical Insurance Bureau and combined with the actual situation in Shanxi Province. Its goal is to standardize the use and management of medical insurance funds, improve the efficiency of fund use, further reduce the medical burden of the masses and promote the sustainable development of medical insurance system.

Second, the main content interpretation

Scope of use of medical insurance fund

The document clearly stipulates the scope of use of medical insurance funds, including basic medical insurance, serious illness insurance and medical assistance. At the same time, it emphasizes the payment principle of medical insurance fund, that is, eligible insured persons pay according to the prescribed payment standards and procedures.

Medical insurance fund management

The document requires local medical insurance fund management departments to establish and improve the fund management system, standardize the use and supervision of funds, and ensure the safe and rational use of funds. Specific measures include establishing fund accounting, budget, final accounts and supervision system, strengthening internal audit and external audit, and ensuring the transparency and legitimacy of the fund.

Management of designated medical institutions for medical insurance

The document stipulates that the supervision and management of designated medical institutions should be strengthened, medical behaviors should be standardized, the quality of medical services should be improved, and patients should be ensured to obtain high-quality medical services. Specific measures include establishing an assessment system for designated medical institutions, comprehensively evaluating the service quality, service attitude and technical level of medical institutions, and interviewing and rectifying unqualified medical institutions.

Reform of payment method of medical insurance

The document proposes to promote the reform of medical insurance payment methods, change the traditional payment method by project, implement payment by disease type and payment by head, and improve the efficiency of medical insurance fund use. Specific measures include establishing a payment system that combines multiple payment methods, implementing different payment methods for different diseases and people, and encouraging medical institutions to adopt more efficient management models and service methods.

Third, summarize and evaluate.

Publication of document number. Shanxi Medical Insurance 2023 16 marks that the reform of medical insurance system in Shanxi Province has entered a new stage. The publication of this document will help to standardize the use and management of medical insurance funds, improve the efficiency of fund use, further reduce the medical burden of the masses and promote the sustainable development of the medical insurance system. At the same time, the implementation of this document requires the relevant local departments to strengthen supervision and management to ensure the implementation and implementation effect of various measures.

Fourth, the legal basis

According to the Social Insurance Law of People's Republic of China (PRC) and the Medical Insurance Law of People's Republic of China (PRC) and other relevant laws and regulations, the documentNo. 12 of 2005 was formulated and published in medical insurance bureau. 2023 16. The publication of this document conforms to the requirements of national laws and regulations and the spirit of policies, and is helpful to promote the reform and improvement of the medical insurance system.