In order to improve the unified basic medical insurance system and serious illness insurance system for urban and rural residents, continuously improve the level of medical security, ensure the rational use, safety and controllability of medical insurance funds, and promote the linkage reform of medical care, medical insurance and medicine as a whole. In order to better ensure medical care for the sick, the State Council's institutional reform plan proposes to integrate the responsibilities of basic medical insurance and maternity insurance for urban workers and urban residents in Ministry of Human Resources and Social Security and the new rural cooperative medical care of the National Health and Family Planning Commission.
Formulate agreements and payment management measures for designated medical institutions and organize their implementation, establish and improve the credit evaluation system and information disclosure system of medical insurance, supervise and manage medical service behavior and medical expenses included in medical insurance, and investigate and deal with illegal acts in the field of medical insurance according to law. Responsible for medical security management, public service system and information construction, and organize the formulation and improvement of medical treatment management and expense settlement policies in different places. Establish and improve the transfer and connection system of medical security relations, and carry out international cooperation and exchanges in the field of medical security.
internal mechanism
1, office
Responsible for the daily operation of the organs, and undertake the work of security, confidentiality, letters and visits, openness of government affairs and international cooperation and exchanges.
2. Planning, Finance and Regulation Department
Organize the formulation of medical security work plan, undertake the work of budget and final accounts, finance, asset management and internal audit of organs and directly affiliated units, and promote the informatization construction of medical security. Organize the drafting of laws, regulations, rules and standards, undertake the legality review of normative documents, and undertake administrative reconsideration and administrative litigation.
3. Treatment and Protection Department
Formulate policies on financing and treatment of medical security, and coordinate the treatment standards of urban and rural medical security. Promote the construction of multi-level medical security system as a whole, establish and improve the system of transferring and connecting medical security relations, and organize the formulation and implementation of the reform plan of long-term care insurance system.
4. Department of Medical Service Management
Formulate medical insurance catalogue and payment standard, establish dynamic adjustment mechanism, formulate negotiation rules for medical insurance catalogue access and organize their implementation. Formulate medical insurance agreements and payment management of designated medical institutions, management measures and settlement policies for medical treatment in different places, organize the reform of medical insurance payment methods, and organize economic evaluation of drugs, medical consumables and medical technology.