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"In the era of value medical, the most important influence is our medical insurance department." At the Autumn Summit of the China Development High -level Forum on September 16, Liu Yuanli, Dean of the School of Public Health of Beijing Union Medical College, said.
He pointed out that in the future, medical security should also pay attention to controlling costs while improving quality.The medical insurance fund should be changed from traditional passive claims and passive payments to active procurement.
Liu Yuanli believes that in the past 40 years of reform and opening up, China's medical reform goals have mainly solved the problem of lack of medicine and medicine from the 21st century, until the 21st century has achieved the coverage of medical insurance, and transformed into a "value medical" at this stage.
"The so -called value is to achieve effective balance in improving quality and control costs." Liu Yuanli said.
During the reform of government agencies in March this year, the State Medical Security Agency appeared for the first time as the newly established department.As a payment party for medical services, the industry expects that it can represent the patients and form a checks and balance of medical service providers led by the National Health and Health Commission.
The newly established medical insurance bureau was given high hopes, in addition to including basic medical insurance for urban employees, basic medical insurance for urban residents and new rural cooperative medical insurance management rights.Huge improvements.
Public information shows that China currently has about 1.5 trillion medical insurance funds.Liu Yuanli said that with the establishment of the National Medical Insurance Bureau, medical insurance funds have become the world's largest investment fund, and the scale of the fund will continue to rise.How to use medical insurance funds efficiently and promote changes in payment methods have become the key to realizing value medical care.
He believes that in the past, the managers of the medical insurance fund were relatively decentralized, and the medical insurance agency was responsible for the county level or urban level. The medical insurance fund did not achieve effective management, making the agency become a passive claimer.
"In the past, the workers' concerns were not to collapse, do not appear deficit, but not considering where investment returns came from. In the era of value medical care, the social security agency department must change the function, from passive claims and passive payment to one in the past to onePurchase ", Liu Yuanli said.
According to the newly issued three plans of the State Medical Insurance Bureau, the Medical Insurance Bureau will play a huge role in the use of medical insurance funds.Specific functions include organizing and implementing the supervision and management methods of medical security funds, establishing and improving the safety prevention and control mechanism of medical security funds, and promoting the reform of the payment method of medical security funds.
Liu Yuanli suggested that the medical insurance fund in the new stage needs to play three major procurement functions.
First, improve procurement efficiency on the basis of fair procurement, and realize that medical services have shifted from project payment to packed paid, allowing medical service providers to actively control the cost of motivation and pressure.
Second, the quality of procurement and procurement innovation.Social requirements for safer, higher -quality products and services are getting higher and higher. Assume that the medical insurance department is only a patented drug that purchases imitation drugs or patents is about to expire, which will seriously affect industrial innovation.
Third, purchase healthy.The most important return of investment funds is the improvement of people's health, and promoting the change of payment methods may achieve this goal.For example, the Shenzhen Luohu Medical Group model, after implementing the total prepaid of the medical insurance fund, actively controls the cost of medical care, strengthens the prevention of the crowd, and makes the person in charge as little as possible.■
