What is the impact of the prepaid system for the medical insurance fund?Can it alleviate the pressure of medical expenses for designated medical institutions, improve the operating conditions of the hospital, and curb the arrears of the arrears of the incurred in frequent occurrence?
Author ｜ Xu Yucai
Source ｜ See the medical community (ID: vistamed)
NearFor some time, some local hospitals have frequently reported wages.Of course, the hospitals operations are difficult. The reason for salary reduction or inability to pay in time is multi -faceted, but it is undeniable that the medical insurance owe hospitals medical insurance funds and the fund settlement of the fund is one of the important reasons.
Perhaps it is based on this. Out of the purpose of alleviating the pressure of medical expenses for fixed medical institutions, recently, the Office of the State Medical Insurance Bureau and the Office of the Ministry of Finance issued the "About Medical Insurance Fund to do a good job in the medical insurance fundNotice of Prepaid Work "(letter of the medical insurance office [2024] No. 101, hereinafter referred to as the" Notice ").
The "Notice" decides to "establish a prepaid fund", insist on "prepaid funds" as "enable gold", and effectively empower the sustainable development of fixed -point medical institutions, and then then as a way, and then then, then as a result, then, then, then, then, then, then, is then for it.Participating people provide better medical protection, promote the steady operation of drugs and consumables enterprises, and promote the coordinated development and governance of "three medical", and propose "three clarifications" and "three specifications".
So what impact will the medical insurance fund prepaid system affect the medical institution?Can it alleviate the pressure of medical expenses for designated medical institutions, improve the operating conditions of the hospital, and curb the arrears of the arrears of the incurred in frequent occurrence?Today, I will talk to you in conjunction with the information of "Notice".
No money to pay?Dont make the idea of "prepaid money"
According to the "Notice", the basic medical insurance fund prepaid funds (hereinafter referred to as "prepaid funds") are to help fixed medical careInstitutions to relieve the pressure of medical expenses, improve medical service capabilities, and enhance the turnover funds set up by the insured person for medical treatment. They are used for medical expenses such as drug and medical consumables procurement.Non -medical expenses such as debt are produced, and the special prepaid prepaid of drugs and medical consumables to purchase medical insurance funds shall be implemented in accordance with the original regulations.
It can be seen that the prepaid fund of "turnover funds" is mainly used for medical expenses such as drugs and medical consumables.And non -medical expenditure expenses such as repayment of debt, so there is no money to pay the salary of the hospital.
At the same time, in accordance with the "Notice", medical institutions shall promptly withdraw the "prepaid" in time.
Applying for prepaid money requires four major conditions
According to the "Notice", apply for a fixed point for prepayment paymentMedical institutions should meet the following basic conditions:
1. Strictly fulfill the relevant agreement on the service agreement of the designated medical institution for the basic medical insurance, the normal settlement of basic medical insurance is over a natural year, and the performance of medical insurance performance assessmentThe result is above.
2. The financial management system is sound, the operating conditions are normal, and the repayment capacity is capable.It has not been implemented.
3. Actively cooperate with the medical insurance department to implement key medical insurance work, carry out the reform"Scan the sweep, should be passed on."
4. Actively cooperate with the medical insurance department to carry out work tasks such as fund supervision, special inspection, and flight inspection.The situation of being transferred to the judiciary.
Other application conditions can be formulated by the medical insurance departments in all coordinated areas.
At the same time, the "Notice" also stipulates that the "cumulative balance of medical insurance funds" that can be implemented can be implemented.The cumulative balance of the overall fund can be paid by not less than 12 months. "The condition for the prepaid payment of the residents medical insurance fund is" the cumulative balance of residents medical insurance funds can pay a monthly number of not less than 6 months. "It is clearly stipulated that "the current deficit in the last year or the 12 -month rolling measurement method is expected to be prepaid to pay for this years deficit."With these conditions, there are not many places and medical institutions that meet the prepaid money.
The reform of the medical insurance payment has impacted a huge impact, the prepaid money is difficult to relieve operational difficulties
In factThe difficult reason is that there are many aspects, the construction of infrastructure such as excessive expansion of scale has caused the due to the heavy debt burden, there are "sequelae" factors of the epidemic, some reasons for the lack of operating capabilities of medical institutions, and some hospital managers and medical staff facing rapid advancement.The factors that are not suitable for reform, but the most direct impact is undoubtedly medical insurance, and the most important thing about medical insurance is to use the severe fund supervision of the core of flight inspection and the huge penalty accompanied by it. The other is DRG/DIP as the coreThe medical insurance payment system and various deductions and refusal payments accompanied by it.
This is exactly the case. It can not really alleviate the difficulty of operating the medical institution through the prepaid, because it is only "borrowing other peoples money" instead of "earning money" instead"Money", it will be repaid sooner or later by others money.
"Three Clear" and "Three Specifications"
Requirements
In addition to the above analysis, the "Notice" also proposes "three clarifications" and "three specifications" for the implementation of the pre -payment system."Three clarifications", one is to clarify the policy connotation.The prepaid fund is a transfer fund for medical insurance for medical insurance for medical and medical consumables for prepaid medical institutions. It is not used for non -medical expenses such as medical institution ’s infrastructure investment, daily operations, and debt repayment.
The second is to clearly dial the conditions.In principle, in accordance with the cumulative balance of the regional medical insurance funding fund and the risk level of the operational risk of the medical insurance fund as the conditions and standards for allocating prepaid funds.
Third is to clear the expenditure standard.In principle, the approved standards are based on the average monthly expenditure of the relevant medical insurance funds in the previous one to three years. The basic scale of the prepaid fund is reasonably determined, and the prepaid scale should be about one month.
"Three specifications", one is the regulatory process management.Eligible fixed -point medical institutions voluntarily applied to the regional medical insurance department in early January each year.After the medical insurance department reviews the scope of the prepaid medical institution and the scale of prepaid funds, in principle, in principle, the prepaid payment will be allocated to designated medical institutions before the end of the first quarter of each year.
The second is to regulate accounting accounting.The medical insurance department and designated medical institutions shall regularly do a good job in the medical insurance prepaid payment. The designated medical institutions shall set up ledger management separately, strictly use the approval procedures for the use of funds, and strictly prohibit borrowing or extraction for him.
Third, regulate fund supervision.The medical insurance department shall include the medical insurance prepaid deposit into the service agreement and refine the relevant terms.At the same time, it is clear that the medical insurance departments recovery of the prepaid funds is to be unable to recover, and if it cannot be recovered, the medical insurance settlement fee is stopped to designated medical institutions and applied for the judicial procedure to ensure the safety of the medical insurance fund.
In short, with the prepaid funding system, it can alleviate some temporary difficulties in medical institutions, but if you truly crack the hospital operation dilemma, you may have to discuss it.The "valid measures in your hand should be" fighting wisdom "with medical insurance under the premise of" legitimate compliance ". On the one hand, improving the level of hospital management and management, making it difficult for medical insurance to find out problems. On the other handEight martial arts, forcing medical insurance to improve the fund supervision capacity and standardize supervision.
Where can I start?The author believes that it should be signed from the "Medical Insurance Service Agreement". From the current situation, a large number of hospitals signed the "service agreement" signed by medical insurance are an extremely confused agreement.How to advance, how to settle, and how to liquidation are still unclear and clear.(This article is published in "Seeing the Medical Community", reprinted must be authorized, and the author and source are indicated at the beginning of the article.)
