Study On The Optimization Path Of Direct Settlement Of Medical Treatment In Different Places For Urban And Rural Residents

Basic medical insurance is an important part of China's social insurance system,and it is a necessary guarantee for maintaining social harmony and stability.For urban and rural residents,a fair and reasonable medical security system is an important means of maintaining fairness.With the in-depth development of the market economy and the acceleration of the movement of people,it is becoming more and more common for urban and rural residents to seek medical treatment outside the overall planning area.The increase in medical treatment in different places reflects the contradiction between the imbalance of medical level in China and the demand for quality medical resources by the insured residents.People`s wishes and expectations point to the direction of excising governance.China started promoting inter-provincial medical treatment in 2009.In a short period of ten years,a breakthrough was achieved in on-the-spot settlement of medical expenses of inter-provincial medical treatment.Especially in the new round of medical system reform,as the focus of medical insurance work,on-the-spot settlement of medical expenses in different places is progressing steadily.Since its establishment,the National Medical Security Administration has issued a series of documents on direct settlement of medical treatment in different places.The direct settlement of medical treatment in different places has been written into the government work report for four consecutive years,which has more highlighted its importance.Advancing on-the-spot settlement of medical expenses of inter-provincial medical treatment is related to people's livelihoods,imperative build a service-oriented government,promote joint contribution of medical treatment and make sure medical resources are shared by all.Based on the relevant analysis of the L County Medical Insurance Center in S province,this paper comprehensively uses case study methods and interview methods to find out that there are some problems in the Lcounty in S province in promoting inter-provincial on-the-spot settlement of medical bills through basic medical insurance accounts.The lack of overall planning for medical insurance policies has resulted that on-the-spot settlement can`t be shared by all insured residents;rapid increasing in the number of out-of-town medical treatments raise the risk of medical insurance fund expenditures;violations of laws and rules are outstanding phenomenon due to regulatory vacuum;the medical insurance services are yet to improved for there are huge gaps between national standards and current recording channels in terms of inter-provincial medical treatments and the awareness rate of residents' medical policy treatment is relatively low;the deficiency of the medical treatment platform affects the efficiency of direct settlement.Aiming at above problems,this article attempts to propose solutions from the aspects of policies and systems,medical supervision,optimized services,and platform building.First,from the policy level,government should strengthen the top-level design,implement the provincial-level co-ordination of urban and rural residents' medical insurance,uniform treatment policies of system of medical security,come up with solutions to fragmentation of medical insurance so as to expand the coverage of on-the-spot settlement of medical expenses.It is necessary to scientifically improve services provided both under the tiered diagnosis in order to promote the rational use of medical resources,and avoid the risks of medical insurance fund expenditures caused by the expansion of direct settlement coverage of urban and rural residents.Second,we must improve the mechanism and find new ways of supervision for both the rural and urban residents whose medical expenses can be settled where they are incurred via basic medical insurance accounts.A strong supervision system building,an efficient coordinated management and supervision over mechanism,a new type of intelligent supervision means and the purchase of handling services are effective ways to supervise activities that urban and rural residents receive medical treatment from allopatry.Third,we must optimize medical insurance services and solve problems of a single channels for Off-site medical records and residents' lowawareness rates of policies.Medical insurance staff must firmly establish a sense of service,expand the channels for off site medical records in accordance with national standards,and make good use of online,which is composed of Wechat,Microblog,microvideo,client and so on,and offline promotional channels to disseminate more targeted content and expand the coverage of policies to make sure patients who seek medical treatment in different places know as many policies as possible.Fourth,problems such as poor compatibility of the system platform and slow information transmission are solved through constantly improving the information system,integrating the medical treatment system and medical service code.Building a smart platform not only offers help to supervision on inter-provincial on-the-spot settlement of medical bills,but also improves efficiency of on-the-spot settlement of medical expenses of urban and rural residents.Digitalization including establishing an information platform for cloud computing is key for urban and rural residents to have their medical expenses settled where they are incurred on the spot and enjoy a convenient and safe on-the-spot settlement of medical bills.