The National Healthcare Security Administration (NHSA) has released a notification to promote the real-time settlement reform of the basic medical insurance (BMI) fund. The goal is to achieve real-time settlement in about 80% of the overall planning areas in China by 2025, with all areas expected to implement the reform by 2026.
Reform Objectives and Timelines
The NHSA requires all regions to optimize traditional settlement methods and innovate new approaches, fully compressing processes and reducing the time from the next day after the application deadline for designated medical institutions to the disbursement of medical insurance funds. This timeline will be reduced from no more than 30 working days to 20 working days. Additionally, the combination of fund prepayment and instant settlement will be implemented, increasing the total cash flow of medical institutions through prepayment and accelerating the cash flow rate through instant settlement.
Implementation Strategy
The NHSA will adhere to a combination of pilot and comprehensive promotion, guiding localities to start from reality and reasonably determine settlement models. This approach will involve gradual implementation according to set time nodes to complete the relevant work. The first batch of pilot reforms for BMI fund real-time settlement will be carried out in 6 provinces and 76 coordinated regions.
Strategic Implications
The real-time settlement reform is a significant step towards improving the efficiency and transparency of the basic medical insurance system in China. By reducing the time and complexity of fund disbursement, the NHSA aims to enhance the financial stability of medical institutions and ensure timely access to healthcare services for patients. This reform is expected to contribute to the broader goal of optimizing healthcare delivery and resource allocation in the country.-Fineline Info & Tech
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