taking the pulse of the people and asking about their "life-saving money", the standing committee of the beijing municipal people's congress launched a special inquiry into medical insurance
2024-09-09
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on july 25, the beijing municipal people's congress standing committee conducted a special inquiry in conjunction with the review of the municipal people's government's report on the supervision and management of the use of medical insurance funds. photo courtesy of the beijing municipal people's congress standing committee
why are the drugs in hospitals more expensive than those in pharmacies and online? how to provide convenience for people to seek medical treatment in other places? on july 25, chen xuedan, a villager of dongbao village, lucheng town, tongzhou district, beijing, sat together with members of the standing committee of the beijing municipal people's congress, deputies to the people's congress, and government officials. in two hours, more than 10 questions were asked about how to use and manage the "medical money" and "life-saving money" of the people. "everything that we ordinary people want to say was said out," chen xuedan said sincerely.
the special inquiry conducted by the beijing municipal people's congress standing committee on the supervision and management of the use of medical insurance funds was asked by dozens of beijing municipal people's congress standing committee members and municipal people's congress representatives from different fields. seven government departments in beijing responded, including the medical insurance bureau, health commission, drug administration, public security bureau, finance bureau, market supervision bureau, and traditional chinese medicine bureau.
these questions stem from the extensive research conducted by members of the beijing municipal people's congress standing committee and deputies to the municipal people's congress in medical institutions, enterprises and the public since this year. they have innovated the way of on-site research to touch upon real problems. this special inquiry was not only broadcast live online, but also specially invited citizen representatives to listen on site, putting the issues that the people are most concerned about on the table for discussion, focusing on solving the people's "urgent needs".
how to reform the linkage of the “three medical systems”
when the special inquiry began, representatives pressed the question button one after another. the list of questions on the big screen became longer and longer.
deng naiping, a member of the standing committee of the beijing municipal people's congress, first raised the issue of the linkage between the "three medical systems", that is, how medical care, medical insurance, and medicine can work together, which was a major focus of previous research.
during his investigation, he found that at present, some hospitals have problems with multiple inspections and imperfect management mechanisms. for example, the hospital's information system is not well connected with the medical insurance supervision system, the review and interception function for unreasonable prescriptions is not perfect, and the advance reminders are not in place; there are duplicate inspections between the health and medical departments inspecting irregular diagnosis and treatment behaviors and the medical insurance departments inspecting unreasonable expenditures, and some hospitals and doctors have reported that this has caused them a burden.
"in response to these problems, what measures have the medical insurance and health departments taken to further promote the coordinated reform of the 'three medical systems'?" deng naiping asked.
ma jiye, party secretary and director of beijing medical insurance bureau, responded that in response to the problems of poor information flow and repeated inspections, the municipal government holds monthly information work meetings in the field of "three medical services" to coordinate the sharing and co-governance of "three medical services" data. through big data analysis in the medical field and smart medical insurance supervision, problems can be discovered in advance. in addition, a pilot program of one-stop comprehensive inspection of medical institutions was carried out, and the beijing municipal drug administration, market bureau, law enforcement corps and other institutions established a case clue consultation mechanism and carried out multiple joint law enforcement actions.
li ang, member of the party committee and deputy director of beijing municipal health commission, turned on the microphone and added an example. in the special rectification work on illegal and irregular behaviors of medical insurance funds, the beijing municipal health commission and the medical insurance bureau established a joint inspection mechanism, using "flying inspections" to discover clues to problems, exchange feedback, and jointly handle them. they handled and urged rectification of the bad behaviors of medical institutions in illegally obtaining medical insurance funds in accordance with the law.
in response to regulatory issues in the centralized management and procurement of drugs and consumables, we fully utilize existing big data verification methods to verify prescriptions and conduct special management of hospitals.
"in the entire medical system, information construction is still a shortcoming," li ang said frankly. the beijing municipal medical insurance bureau, the drug administration, and the health commission jointly listed a list of information improvement in 2024, including 28 scenarios and 38 tasks. the goal is to truly share information, fully recognize inspection results, effectively manage medical insurance funds, reduce repeated inspections, reduce the burden on the people, make the people's wallets safer, and make medical treatment more convenient.
"in terms of policy coordination, information construction, inspection and law enforcement, etc., by the end of this year, everyone will see some more obvious results." in li ang's view, this is not only the linkage of the "three medical systems", but also the joint efforts of multiple departments to build a good medical system.
what other bottlenecks need to be solved for medical treatment at home?
in order to listen to opinions widely, the standing committee of the beijing municipal people's congress organized representatives at the city, district and township levels to participate in an online questionnaire survey. the survey showed that the inconvenience of reimbursement in other places ranked among the top three, and is currently the most concentrated problem reflected by the public.
some patients reported that they did not understand the reimbursement policies for medical expenses in other places. sometimes, due to the lack of relevant documents, they needed to go to other hospitals to print out reimbursement. some hospitals' self-service payment systems were not connected to other hospitals, so they had to go to the window to queue up for reimbursement.
how to improve work and provide greater convenience for people to seek medical treatment in other places? this is a question that li wen, a member of the standing committee of the beijing municipal people's congress, is particularly concerned about.
for a long time, the heavy burden of advance payment and running errands for medical treatment in other places has always been a pain point and difficulty for migrant workers, long-term residents in other places, and elderly people who have moved with their families. at present, relying on the national medical insurance information system, many places across the country have realized information interconnection and network settlement.
as of the end of june this year, all designated medical institutions with beds in beijing have opened direct settlement of hospitalization expenses, and all designated medical institutions that can provide services to the outside have opened direct settlement of general outpatient medical expenses in other places.
the expansion of disease types is the next focus of cross-provincial medical services. according to du xin, deputy director of the beijing medical insurance bureau, beijing continues to increase the coverage of medical institutions for cross-provincial direct settlement of five chronic and special diseases, such as hypertension and diabetes, and strives to open relevant services in all designated medical institutions in beijing that meet the conditions for receiving patients by the end of this year. the expansion of the types of diseases for cross-provincial direct settlement of outpatient chronic and special diseases will be implemented, and cross-provincial direct settlement of outpatient chronic and special diseases will be implemented.
so, what are the bottlenecks that need to be cleared in the transition from local medical treatment to medical treatment at home?
beijing municipal people's congress representative chang yi learned in preliminary research that with the deepening of the tiered diagnosis and treatment system, people are more willing to choose to see a doctor at their doorstep. however, some people also reported that there are still problems such as incomplete variety of drugs in primary medical institutions. although they can register for drug shortages, the waiting time is long and there are no alternative drugs in the meantime.
how to make it more convenient for people to see a doctor near their homes is a problem that beijing is working hard to solve.
li ang provided a set of data. in 2023, 51.1% of patients in beijing received medical treatment in primary medical institutions, which is more than half. in the first half of 2024, this proportion is still increasing. "the current goal is to make the drug catalog of community health service institutions completely consistent with that of secondary and tertiary hospitals," he said.
beijing's drug sunshine procurement platform can generally meet the drug needs of medical institutions across the city. du xin emphasized that all drugs on the sunshine procurement platform are open to primary medical institutions regardless of the nature or level of the medical institution, and the procurement scope is fully connected with secondary and tertiary hospitals. primary institutions can realize real-time procurement of all varieties based on clinical needs.
however, the problem that follows is that the pharmacy space of community health service institutions is relatively small and the storage capacity is relatively limited. in this regard, li ang said that we should focus on the effective management of drugs that the people are particularly concerned about, such as drugs related to chronic diseases such as hypertension, diabetes, and coronary heart disease, and try to unify the drug varieties between secondary and tertiary hospitals and community health service centers.
at the same time, relying on the management model of beijing's medical alliance, the leading core hospital should provide drug service guidance to all institutions within the medical alliance. community health service institutions should be equipped with corresponding drugs according to the requirements of superior and core hospitals, and comprehensively promote prescription continuation services to ensure that transferred patients can use their medicines conveniently.
regarding the important measure of registering out-of-stock medicines, beijing municipal health commission is promoting all community health service institutions to use information systems to register out-of-stock medicines and optimize the diagnosis and treatment process.
"when there is a clinical need, there is no need to go through the registration procedures first. instead, the necessary medicines can be provided to the patients first, and the procedures can be completed later. this is both in compliance with the law and regulations, and enables the people to get the required medicines as quickly as possible and reduce waiting time," said li ang.
how to better “diagnose and diagnose” the medical insurance fund
the issue of medical insurance funds involves a wide range of areas and is highly professional. members of the beijing municipal people's congress standing committee and deputies to the municipal people's congress asked questions on behalf of the public, and government departments interpreted data, disclosed information, and answered questions, giving "reassurances" one after another between the questions and answers.
medical insurance consists of two types of insurance: urban employees and urban and rural residents' basic medical insurance, which are calculated separately. by the end of 2023, beijing's medical insurance will cover 20.588 million people. among them, employees account for about 3/4 of the insured persons, and residents account for about 1/4.
ji yan, a member of the standing committee of the beijing municipal people's congress, found during the initial review of the 2024 budget that expenditures on basic medical insurance for urban and rural residents were growing very rapidly, and the pressure to balance revenue and expenditure was increasing, necessitating the use of rolled-over surpluses to achieve balance.
in response to this, guan dezhi, deputy director of the beijing municipal finance bureau, said that the participants of the residents' medical insurance are the elderly, students, children, farmers and unemployed residents. the system design is more about reducing the burden on residents and increasing the government's protection efforts.
according to statistics, beijing's fiscal subsidies account for more than 80% of the income of urban and rural residents' medical insurance funds. urban and rural residents pay about 409 yuan per person per year, and the government invests about 2,468 yuan per person. in recent years, beijing's fiscal revenue has to set aside about 10 billion yuan each year to supplement urban and rural residents' medical insurance.
guan dezhi introduced that at present, it is expected that by the end of 2024, the surplus of residents' medical insurance will basically remain between 6 billion yuan and 7 billion yuan, and the reserve period will reach 6.3 months, which is in line with the reserve period of more than 6 months required by the national medical insurance administration and is in a reasonable range.
"the medical insurance fund has a balanced income and expenditure, a slight surplus, and operates smoothly." ma jieye said that the capital's medical insurance fund supervision has achieved certain results, and efforts to combat fraud and insurance fraud have continued to increase, but the medium- and long-term balance and supervision pressure of the medical insurance fund still exist. fraud and insurance fraud are prone to occur frequently, and the methods are constantly updated and more covert, making supervision more difficult. the supervision of medical insurance funds "is always on the road."
some members of the standing committee of the municipal people's congress and deputies were unable to ask questions due to time constraints, and the relevant departments said they would answer them one by one after the meeting. the relevant departments said that these questions and suggestions are the focus of follow-up work.
"the special inquiry is a diagnosis and consultation of the government's medical insurance work. it has identified the problem and grasped the key points." jin wei, member of the standing committee of the beijing municipal party committee and deputy mayor of the municipal people's government, said that it is necessary to manage and use the medical insurance funds well and continuously enhance the sense of gain of the people, enterprises, medical institutions and medical staff.
