The General Office of the State Council recently issued the "Guiding Opinions on Promoting the Reform of the Medical Security Fund Regulatory System" (hereinafter referred to as the "Opinions"). Implement the work requirements of the Party Central Committee and the State Council on strengthening the supervision of medical insurance funds, comprehensively improve medical insurance governance capabilities, deeply purify the operating environment of the system, and strictly observe the red line of fund safety.

The "Opinions" pointed out that the medical security fund is the people’s "medical care money" and "life-saving money". Since the establishment of the basic medical security system, the coverage has been continuously expanded and the level of protection has been gradually improved, which is important for safeguarding people’s health rights and alleviating poverty caused by illness. , Promoting the reform of the medical and health system played a positive role. However, restricted by factors such as imperfect regulatory systems and imperfect incentive and restraint mechanisms, the efficiency of the use of medical insurance funds is not high, and the fund supervision situation is relatively severe.

The "Opinions" emphasized that it is necessary to take Xi Jinping’s new era of socialism with Chinese characteristics as the guidance, fully implement the spirit of the 19th National Congress of the Communist Party of China and the 2nd, 3rd, and 4th Plenary Sessions of the 19th Central Committee, and accelerate the reform of the medical insurance fund regulatory system. By 2025, the medical insurance fund supervision system and law enforcement system will be basically established, with the rule of law as the guarantee, credit management as the foundation, multi-form inspection, big data supervision as the backing, party committee leadership, government supervision, social supervision, industry self-discipline, and personal trustworthiness The combined comprehensive supervision pattern realizes the legalization, specialization, standardization and normalization of medical insurance fund supervision, and it has been continuously developed and improved in practice.

The "Opinions" require clarification of supervisory responsibilities. Strengthen the leadership of the party, and continuously improve the leadership system and working mechanism for the supervision of party building of the medical insurance fund. Strengthen government supervision and give full play to the government's leading role in fund supervision, legal construction, standard setting, administrative law enforcement, and information sharing. Promote industry self-discipline management, guide and support medical and health industry organizations to play a better role in promoting industry self-discipline.

The "Opinions" proposed to promote the reform of the regulatory system. Establish a sound supervision and inspection system, comprehensively establish an intelligent monitoring system, establish and improve a reporting and reward system, establish a credit management system, establish a comprehensive supervision system, and improve a social supervision system.

The "Opinions" emphasized that safeguard measures should be improved. Strengthen the supervision and regulation of medical insurance funds, strengthen the supervision and inspection capabilities of medical insurance funds, increase penalties for fraudulent insurance fraud, coordinate the advancement of relevant medical security system reforms, and coordinate the advancement of medical service system reforms.

The "Opinions" require that local people's governments at all levels should fully understand the importance of promoting the reform of the medical insurance fund regulatory system, strengthen leadership, unified deployment, and coordinated advancement. It is necessary to establish an incentive and accountability mechanism and incorporate the work of combating fraudulent insurance into relevant work assessments. It is necessary to vigorously promote the importance of strengthening the supervision of medical insurance funds, actively respond to social concerns, and strive to create a good atmosphere for reform.

Source: Xinhua News Agency