The State Council has issued the “Implementation Opinions on Strengthening the Normalization Supervision of the Use of Healthcare Security Funds,” outlining a comprehensive approach to enhance the oversight and management of healthcare security funds. The document clarifies the main responsibilities of various departments and sets forth regulatory measures to ensure the rational use of these funds.
Departmental Responsibilities and Regulatory Focus
The opinions paper delineates the responsibilities of healthcare security administrative departments at all levels, which include strengthening the supervision over medical insurance agreements, promoting business standardization, and urging medical insurance agencies to establish robust financial and risk management systems. Designated medical institutions are instructed to improve internal management systems related to the use of medical insurance funds. Departments of health, traditional Chinese medicine, market regulation, drug regulation, and auditing are to focus on combating illegal and irregular issues such as excessive diagnosis and treatment, fraudulent insurance, and illegal drug transactions. For institutions not included in medical insurance agreements but closely related to fund usage, the principle of “who approves, who supervises” will be applied, with clear regulatory responsibilities.
Normalization of Regulatory Measures
The Opinions promote the normalization of five key regulatory measures:
- Unannounced inspections will be regularized, with an annual announcement and exposure system for typical cases.
- Special rectification efforts will be normalized to address specific issues.
- Daily supervision will be strengthened, with a focus on the cost review of medical insurance handling and payment processes.
- Intelligent monitoring will be implemented through national medical insurance anti-fraud projects and data screening and analysis.
- Social supervision will be normalized, exploring a system for publicizing the use of medical insurance funds in designated medical institutions.
Credit Rating Management and Self-Regulation
Additionally, the classification and management of credit ratings for designated pharmaceutical institutions, enterprises, and personnel will be promoted. A notification and commitment system for the supervision of medical insurance funds will be established, with the fulfillment of commitments being incorporated into credit records. This will be linked to the frequency of supervision and inspection, as well as the discretion of punishment. Designated pharmaceutical institutions are encouraged to standardize the use of medical insurance funds through self-inspection and self-correction, actively fulfilling their primary responsibility in the utilization of these funds.-Fineline Info & Tech
