About print and distribute the knot to implement the new rural cooperative medical long-distance medical networking scheme of notice

The 2016-06-08 national health and population and family planning commission of the People's Republic of China

The grassroots hair [2016] no. 23

Provinces, autonomous regions and municipalities directly under the central government health and family planning commission, finance bureaus, cities under separate state planning health and family planning commission, bureau of finance, national health budget management of family planning hospital:

For the implementation of the "government work report in 2016" about accelerating the basic medical insurance nationwide network and long-distance medical settlement work requirements and the national health and family planning commission, ministry of finance affairs of the new type of rural cooperative medical care across the province for medical treatment cost verification work guidance and knot "(the guard at the grass-roots level (2015) no. 46) spirit, comprehensively promote the new rural cooperative medical treatment (including family planning department is responsible for the health of urban and rural residents basic medical insurance) is a long-distance medical network knot work, national health and family planning commission jointly with the ministry of finance formulated the" go to a doctor of the new type of rural cooperative medical care beyond the implementation network knot "(which can be downloaded from the national health and family planning commission web site). Hereby printed and distributed to you, please earnestly implement. Encountered in the process of implementation of related questions, Suggestions, please report in a timely manner.

Touch: national health JiCengSi state family planning commission Ivan liu, JiXiaoRong

Tel: 010-62030652, 62030650

The true: 010-62030754

National health and family planning commission the ministry of finance

On May 26, 2016

The new type of rural cooperative medical care long distance medical networking and implementation plan

To speed up the basic medical insurance and long-distance medical networking newspaper work is the important content of China's construction, promote health for deepening the reform of medical health system, the implementation of hierarchical diagnosis and treatment, improve the basic medical insurance system construction, improve urban and rural residents of the acquisition is of great significance. To implement the "government work report in 2016" about accelerating the basic medical insurance nationwide network and the requirements of different treatment and settlement work, promoting the new rural cooperative medical care system (hereinafter referred to as the "new farming close, including family planning department is responsible for the health of urban and rural residents basic medical insurance, hereinafter the same) long-distance network knot at work, now make the following plan.

A, the work target

Through perfecting the long-distance medical treatment compensation management policy, the function of information system and service network, set up effective long-distance running management mechanism, to gradually realize new farming and across provinces nationwide medical network knot. In 2016, to perfect the national and provincial new agricultural information platform, basic build new farming and long distance medical information system, to realize long-distance medical directly in the province, the farmers in new referral hospitalized patients across the province fixed-point medical and reported to the pilot. In 2017, the basic implementation new farming and referral hospital patients across the province fixed-point medical knot.

Second, the basic principles

(a) adhere to the people-centered. Starting from the safeguard the vital interests of the broad masses ginseng, convenient to the masses as the propulsion of different medical knot at work starting point and the foothold, long-distance medical service and improve the patients and convenience, and timeliness.

(2) adhere to the synchronization with hierarchical diagnosis and treatment. Long-distance medical treatment and services mainly for standard referral patients, play to the basic health care for the patient to guide and regulate role, promote the formation of reasonable medical treatment order.

(3) managed to go to a doctor. Across the province was hospitalized in principle is carried out in accordance with the relevant policies of medical requirements, by orgnaization of agency of medical treatment at the provincial level management on behalf of the service area as a whole is responsible for management and services across the province medical patients.

(4) insist on classified guidance. Combined with farmers across new information construction progress, medical institutions, respectively, through different channels and national new farming and information platform (hereinafter referred to as the national platform), to ensure the smooth information exchange channel and effective working mechanism. In accordance with the "mature a province (area, city), unicom a province (area, city), the implementation of a province, autonomous regions and municipalities directly under the" principle, actively push forward.

Three, the main measures

(a) construction perfect long distance medical information system.

1. Improve the network of national and provincial long-distance medical knot. On comprehensively advancing countries according to the national health and family planning commission general office "the new rural cooperative medical information platform construction work notice (countries who do basic functions (2015) no. 870), according to the population health information construction of the top design, the overall framework and accelerate the national platform and provincial new farming and construction of information platform (hereinafter referred to as the provincial platform), relying on the electronic government affairs network or virtual private network to build the new farmers across the province medical data exchange channels. National platform to play a pivotal role, is responsible for cross-regional medical referral, and submitted to the data exchange; Provincial fixed-point networking platform for unicom province medical institutions, instant upload patients to the province provincial referral information, collection and upload provincial referral of patients in medical institutions for medical treatment shall be reported to the provincial fixed-point networking related data; Medical institutions through the platform at the provincial level and the national platform in accordance with the principle of ShuDeHua unicom, budget management in hospital, temporarily do not have conditions of unicom three provinces (autonomous regions and municipalities) belong to medical institutions, unicom directly with national platform.

2. Establish long distance medical information system and perfect function. On the basis of perfecting the national and provincial platform, to speed up the establishment of a new national agriculture and long distance medical information system, make its referral, settlement and other management functions. Responsible for provincial platform across the province to go to a doctor, the function is not perfect for the provincial platform, can be the province of the compensation scheme configuration platform in the country, by the national platform ". For area has not yet completed the provincial platform, can rely on the province (area, city) area population health information platform construction of long distance medical information system. For new farming and management to other departments of provinces, autonomous regions and municipalities), should make full use of already built new farming and information platform for offers from other provinces into the patient referral and submitted to the service work, such as management or coordination of urban health care department completes the related work.

Each region as a whole can also according to the actual situation, the migrant workers centrally by point-to-point signing, selection of leading medical institutions across the province for medical treatment ". Long-distance medical knot in the province to work arranged by the provinces according to the actual situation as a whole.

3. Realize long distance medical information system interconnection and data sharing. Has made use of medical institutions and the national and provincial unicom channel platform, realize the medical institutions and widely connected as a whole the area between the information system. Connected to the medical institutions according to the general office of the national health and family planning commission about print and distribute national unicom technology information platform of the new rural cooperative medical scheme (trial) notice (who do farmers who letter (2013) 2013) requirements, to generate normative data exchange content, submit to the national or provincial platform. For the disease diagnosis group pay medical institutions, according to the standard data exchange format generated content.

4. A unified data exchange frequency. Cross-regional referral hospital, hospital registration and submitted to the real-time information exchange; In the hospital diagnosis and cost information in principle to the daily upload; Out of the hospital medical record home page upload information within five working days after discharge from hospital; Payment of funds collection for appropriate information and to exchange regularly by the month.

(2) make a long-distance medical treatment policy.

1. The specification different ground treatment compensation policy. The provinces (autonomous regions and municipalities) to specification and relatively uniform in the province and outside the province long-distance medical treatment compensation policy, to achieve reunification of the medicine catalogue, diagnosis and treatment projects, standardize the long-distance medical business process. For cross-regional medical patients, reimbursement policy shall be based on fixed-point protocol implementation. On the premise of ensure the smooth operation of fund, can consult medical reimbursement directory, payment proportion still perform accounting regulations; Also can choose to perform a ginseng to provinces (autonomous regions and municipalities) to make the unification of the policy.

2. Establish a long-distance medical referral system. Established the classification system is to do a good job of long-distance medical knot at the basis of the provinces, autonomous regions and municipalities to establish new farming and long-distance medical referral system. Qualified accounting for patients after a ginseng to referral for the record to the province for medical treatment, should a ginseng to orgnaization of agency of instant will be standardized referral information submitted to the platform at the provincial level or national platform, farmers medical institutions through the national or provincial new information platform for patient referral information and provide services. Encourage all the inhabitants health card as the main basis when a long-distance medical service identification and knot to vouchers.

3. A fixed-point networking for medical treatment. Provinces (autonomous regions and municipalities) according to the patients with medical institutions within their respective jurisdictions service ability, service objects and farmers with new platform unicom, determine the jurisdiction to carry out across the province for medical treatment and networking of medical institutions. Networking to include medical institutions at all levels, comprehensive and specialized medical institutions, especially for patients with different service more medical institutions. Is not only to solve the referral of patients with intractable diseases needs three levels of medical institutions, and convenient to the masses and to the nearest emergency medical treatment of a number of secondary and part of grassroots medical institutions have a certain hospital conditions. National health and family planning commission budget management of hospitals and the provinces, autonomous regions and municipalities directly under the people's hospital (provincial hospital), the hospital should take the lead in networking and see the doctor done across provinces junction. The provinces (autonomous regions and municipalities) will meet across the province settlement conditions within their respective jurisdictions of networking list submitted to the national health and family planning commission, medical institutions by the nation's new farming information platform portal website for all to choose from.

Medical institutions in countries around the platform released networking list select province provinces (autonomous regions and municipalities) patients go to a doctor of the medical establishment that decide a dot to sign the agreement, implemented on the basis of the pilot provinces referral for medical treatment at work. Around in advancing beyond the networking in the process of the knot to go to a doctor, to overall consideration and serious illness insurance, medical treatment, such as precision poverty alleviation work of cohesion.

(3) the specification different ground treatment and settlement mechanism.

1. To carry out the management services. For cross-regional referral patients go to a doctor, in principle to provinces (autonomous regions and municipalities) as a unit for docking, managed to give priority to, to go to a doctor a ginseng to cooperate. By the doctor to orgnaization of provincial new farming and management department to be responsible for the management and service work, and submitted to the orgnaization of ginseng to provincial new farming and management department is responsible for the relevant coordinate and cooperate with the work.

For new farming and management to other departments of provinces, should bear the fujian association of foreign languages and new farming in patient referral to the province fixed-point networking and settlement management of medical institutions for medical treatment, the family planning administrative department of public health should actively coordinate the basic medical insurance management department charge corresponding management responsibility, also can entrust a health, insurance or financial institution, and make connection with the national health and family planning commission.

2. Establish settlement center. National health and family planning commission depends on the Chinese academy of medical sciences (national platform construction units) for national different ground settlement management functions, be responsible for the provinces of medical information technical guidance and information system daily operation, maintenance, coordinate all across the country provinces junction at work, have a certain settlement function. Provincial family planning administrative department of public health through clearing in orgnaization of agency of provincial or designate the relevant units to undertake, clear as soon as possible to undertake clearing functions of institutions at the provincial level (hereinafter referred to as the provincial settlement center).

To fully give play to the role of market mechanism, to mobilize social forces to participate in basic medical insurance agency services. Encourage financial insurance and third party to participate in the national and provincial construction settlement center, encourage all entrust commercial insurance agency orgnaization of long distance and submitted to the management service work, go to a doctor to undertake new farming and serious illness insurance of commercial insurance institutions can use existing settlement channels, provide service for different ground treatment and settlement. Actively promote new farming and serious illness insurance and medical treatment "one-stop" work style ". Encourage financial institutions to give play to the role of credit guarantee, payment of individual pay part costs.

3. The specification and settlement process. Via standard referral to the province networking medical institutions for medical treatment of patients, the hospital pays only amount paid when clearing, new farming and fund pays part by the payment of medical institutions, medical institutions to go to a doctor on a regular basis in provincial settlement center application advances funds collection and receivable settlement center application material, and be approved by the month amount allocated to the medical institutions. Ginseng to regularly with the settlement center at the provincial level provincial capital settlement settlement center, and is responsible for fund settlement with the region as a whole in the province.

To do not have to provide direct and submitted to the conditions of the area, the medical institution shall coordinate fixed-point networking provides different referral service, and cooperate well at work. Ginseng to patients after the network medical institutions for medical treatment that decide a dot, a medical institution shall within 5 working days in the national or provincial standardization of medical information platform push and discharge settlement information. Ginseng to orgnaization of agency of information platform to provide medical expenses according to the country, on the compensation fees, local policy shall remit compensation fees directly to the residents of ginseng to patients health card or bank account.

Fourth, scheduling

By the end of June 2016, the provinces, autonomous regions and municipalities directly under the provincial long-distance medical reimbursement policies should be improved and the ensure that policy implementation.

Before the end of July 2016, the provinces (autonomous regions and municipalities) to develop long distance across the province and submitted to the work plan, reporting services provided across the province for medical treatment and submitted to the jurisdiction of networking list of medical institutions and long-distance medical implementation in the province.

Before the end of August 2016, the provinces (autonomous regions and municipalities) to improve the provincial information system platform, make its have cross-regional referral, newspaper, etc. Develop nationwide network and submitted to the relevant data exchange interface, implement national and provincial connectivity between the platform and information system of medical institutions.

Before the end of October 2016, the provinces (autonomous regions and municipalities) to be built at the provincial level and settlement center, or entrust the relevant units across the province for medical treatment and settlement functions. Fully realize long-distance medical knot in the province. Provinces (autonomous regions and municipalities) launched at least two cities, and selected a number of medical institutions, fujian association of foreign languages and networking signed relevant agreement, across the province medical networking and reported to the pilot work; At the same time, to choose a number of medical institutions to provide services for patients with other provinces in the province of networking.

According to "China unicom a province (area, city), announced a province (area, city)", the principle of timely announce the provinces, autonomous regions and municipalities directly under the new farmers across the province for medical treatment and submitted to the work progress. National health and family planning commission will jointly with the relevant departments of the provinces, autonomous regions and municipalities across the province for medical treatment and daily work to supervision. For slow progress, the national health and family planning commission will be urged by way of questioning, reporting, etc, to ensure timely completion of tasks.

Five, the work requirements

(a) to strengthen organization and leadership. Family planning administrative department of public health at all levels to new farming and long-distance medical knot to work as an important task of deepening the reform of medical health system, into the reform objective appraisal management, overall planning, careful organization, coordinated advance, difficult to overcome, to ensure the full realization of the goal task.

To plan as a whole is responsible for the family planning administrative department of public health at the provincial level new farming and long-distance medical and submitted to the organizational leadership and supervision and management work, actively strive for the relevant departments to support, coordinating work across the province for medical treatment and submitted to the plan. Should conscientiously fulfill their duties of local administrator and strengthen medical service behavior and service quality of medical institutions designated networking supervision, control the unreasonable cost growth, but also to coordinate different ground treatment and submitted to the fund collection work. New farming and management to other departments of provinces, autonomous regions and municipalities to establish accounting for other provinces patients service consciousness, actively coordinate supervision fixed-point networked medical institutions within their respective jurisdictions provide services across the province medical networking knot.

New farming orgnaization of agency of each as a whole the area for medical network across the province to create conditions and provide a convenient, actively cooperate with treatment and new farming and orgnaization of agency of fixed-point medical institutions and liquidation work.

Chinese academy of medical sciences institute of medical information to cooperate to implement the family planning administrative department of public health at various levels across the province for medical treatment and at work, establish relevant system standards application, user authority management and data security protection and relevant technical specification, to do a good job of technical support and training, strengthen the regional pilot tracking guidance, regular progress summary published around.

(2) clear responsibility of medical institutions. More attention must be paid to the medical institutions at all levels across the province for medical treatment and at work, actively create conditions to become provinces junction to fixed-point network of medical institutions. Tertiary medical institutions, especially the budget management of the hospital should actively play a leading role, active participation, provinces junction shall be reported to the service for the patients.

Fixed point connected to the medical institutions should timely transformation hospital management information system, actively with the national population health information platform (new farming information platform), interconnection and data transmission. To strengthen internal management, improve the working mechanism, optimize and submitted to the process, to improve service levels. According to the online referral information, priority for the referral of patients to provide medical services. Set of cross-provincial specified window, do a good job in hospital patient identification, and submitted to the timely medical data exchange across the province.

(3) the rest of the population policy cohesion. Long-term migrant workers and staff to establish a stable labor contract relationship, shall participate in medical insurance for urban employees in accordance with the law and enjoy the benefits of the corresponding expenses; Take refuge in children of the elderly and other different long-term living people, can according to the residence with the interim regulations on the residence permit and residence permit to live health insurance, urban and rural residents enjoy the corresponding treatment. Temporarily can't go to basic health care workers' or region can be enjoyed by the referral standards after a ginseng to record the corresponding knot to treatment.

(4) completes the propaganda guidance. Publicity around to take advantage of a variety of forms, make broad ginseng to residents know cross-province medical policies and practices of newspaper work, actively cooperate with relevant work. To do a good job in information disclosure in time public phone number contact information, such as patients with convenient service query supervision, consultation and complaints.

(5) pay attention to information security. Family planning administrative department of public health at all levels, new farming agency orgnaization, clearing center and the medical institutions should attach great importance to patients with long distance medical information security and privacy protection work, in strict accordance with the state information security protection system and released by the national health and family planning commission, the population health information management measure (trial) "requirements, improve the system of safety management, operating procedures and technical specifications. The family planning administrative department of health at or above the county level shall take the responsibility of the department in charge of, medical and health service agencies at various levels as responsibility unit, strengthen the management of information security and privacy protection.