Medical network - on February 10, 2017 1 announcement of audit, focus on basic medical insurance and urban and rural residents of a serious illness insurance such as medical insurance fund special audit. Special audit, according to the results of 1.578 billion yuan of medical insurance fund involves the problem of illegal, accounts for about 0.46% of the money amount selectiving examination.
According to the auditing situation, our country in recent years, the medical insurance work overall status? What are the problems medical insurance fund management use also? How to look up 20? The relevant person in charge of audit and experts.
1, "PaoMaoDiLou" problem is more typical
ChangSunBaoHou says the party member, deputy audit audit, the audit found that the overall specification of China's health-care orgnaization of business and fund management, health care has achieved significant results. But also found some problems, including cohesion between system of medical insurance fund expenditure to misappropriate, attend insurance of primary medical treatment does not reach the designated position caused by repeated and repeated reimbursement medical expenses, etc.
Audit found that in the aspect of health care system in China, for everyone to enable to provide the system guarantee; In terms of security level, financial support to the residents' basic medical insurance increasing, the medical burden eased further; In huimin policy to promote, in the province of long-distance medical settlement work, the obvious progress in controlling the excessively rapid growth of medical expenses of medical treatment insurance, the role of the aspects such as regulating medical behavior began to emerge; In terms of fund operation, medical insurance fund's ability to resist risk.
"Overall, the audit area covering urban and rural areas of universal health care network has been built, provides institutional guarantee for implementing all sickness." The director-general of the department of social security audit audit Chen Taihui told reporters.
It is important to note that the audit found that violate compasses problem of illegal funds 1.578 billion yuan, although only accounted for about 0.46% of the total amount selectiving examination, but from the multiple level reflects the medical insurance fund management specification.
Audit of public announcement, xinhua news agency reported 189 cases, roughly three kinds of problems. The first category belong to the "internal" problem, in parts of medical treatment insurance premium collects pay does not reach the designated position, turned over, not in time subsidies subsidies money does not reach the designated position; Use insufficient standard parts of medical insurance fund expenditure, a handful of misappropriation is diverted, some funds are expanding their spending for other social security system. As of June 2016, for example, the worker of tianjin health care and insurance fund income households in urban and rural areas in late balance a total of 1.9904165 billion yuan, failed to timely to fiscal revenue.
Problem belongs to the second category of "system", between the system performance is not join attend insurance of primary medical treatment caused by repeated and repeated reimbursement medical costs, some closed operation enterprises has such problems as default orgnaization medical expenses. As of June 2016, for example, guodian jiangxi electric power co., LTD., four companies such as medical insurance each closed operation, involving contributors in 151900.
The third class belongs to the "external" problems, in part of the designated institution or individual diddle show the medical insurance fund; Some medical institutions violation charge. For example, 2015 to June 2016, the shandong province zibo coupling pharmacy is built three pharmacy upload the false drug sales records, illegal arbitrage worker medical insurance fund 2.6569 million yuan, accounting income as a unit.
"Above the audit found that medical insurance fund related issues, belongs to the typical 'PaoMaoDiLou problems, these problems for erosion and damage to the medical insurance fund, cannot be ignored." Peking University school of economics professor cheng wai said.
2, universal health care system has perfect space
Sun Baohou said, looked from the overall, medical insurance fund management or a more orderly, the reason will appear some problems, mainly because of a few personnel viewpoint of discipline is weak, no strict rules, this relatively bullish at the grassroots level; Policies to promote fast enough, as most provinces has a health care in the province beyond the direct settlement, but its coverage, there are few medical institutions and some criminals is using the loopholes in the system, through false other invoices to defraud insurance fund; Relevant reform measures not enough cohesion, such as public hospitals at the county level in our country and government grass-roots medical institutions should be in accordance with the provisions, cancel the drug price, but due to finance the investment is still not fully in place, also failed to timely adjust medical service price, leading to problems such as "taking medicine cure" still exists in a certain extent.
Experts interviewed think at the same time, the problems exposed by the audit, universal health care system has perfect space.
Gu Xue the national health and family planning commission health development research center, said Dr. Exposed parts and the audit unit health-care fund does not reach the designated position, parts of medical insurance fund expenditure use insufficient standard, these problems influence the sustainability of medical insurance fund, also involves the fairness.
, she thinks, caused by system to connect and does not reach the designated position, worker health and the medical insurance of urban and rural residents to repeat ginseng, to a certain extent reflects the flow of population, urbanization, the household registration system reform background, need to change in the way information connectivity and ginseng management to solve.
In tsinghua university professor Yang inhibitor, fraud means renovates ceaselessly phenomenon of medical insurance fund is particularly alarming. "Around the large hospital, have rent medicare card issued to make money, doctor-patient collusion excessive drug gangs, useful false medical records hanging bed of the producers, their business is more developed, the more a loophole in the medical insurance fund." She said, "between different areas, between different medical institutions, medical institutions and health care between the orgnaization of agency of lack of information sharing platform, criminals in namely, it become one of the obstacles to implement long-distance medical billing."
Gu Xue not think, the problem of low incidence of reflects the lack of each link in the health care work, need to be targeted improvement and strengthening management measures; And the problems with higher incidence of means, universal health care in system level, there are still continue to improve the space.
3, overall security medical insurance fund
In the face of the audit, the problems exposed by the public concerns on the safety of medical insurance fund.
Sun Baohou said, say, the current funds are generally safe. Problem of the medical insurance fund audit violation fund 1.578 billion yuan, although in absolute Numbers look bigger, but from the point of the relative, only accounted for 0.46% of the number of audit sampling funds if compared to the total number of medical insurance fund income over the same period of audit area, accounting for less than.
Health care, he said, the audit found problems, system execution problem, there is also the question of reform of the system is not in place. Should intensify efforts, promote the reform of the following areas to improve. First should speed up the health care system and the integration of management institution, accelerate the basic health care integration between urban and rural areas, in the realization of coverage, financing policy, to ensure treatment, medical insurance directory, fixed management, fund management, on the basis of "six reunification", speed up the integration of the basic medical insurance management institutions. Second payment reform health care, should through the reform of medical insurance payment, the medical institutions to strengthen the cost management, under the premise of guarantee quality of medical services to strengthen cost control.
Many experts have questioned mentioned linkage policy for the implementation of "3 d" the importance of the resultant force. Sun Baohou, according to medical treatment, health care, medical reform, closely related, inadequate finance to public hospitals, drug prices and circulation management chaos, etc., to the health care system and medical insurance fund has an important influence. Can't talk on health care, must be overall coordination, strengthen the reform of "3 d" collaborative, systematic, standard to ensure the medical insurance fund management. |
