国务院办公厅关于推进医疗保障基金监管制度体系改革的指导意见

河南快三guobanfa〔2020〕20hao

河南快三gesheng、zizhiqu、zhixiashirenminzhengfu,guowuyuangebuwei、gezhishujigou:

yiliaobaozhangjijin(yixiajianchengyibaojijin)shirenminqunzhongde“kanbingqian”、“jiumingqian”,dangzhongyang、guowuyuangaoduzhongshiyibaojijinanquan。jibenyiliaobaozhangzhidujianliyilai,fugaifanweibuduankuoda,baozhangshuipingwenbutisheng,duiweihurenminqunzhongjiankangquanyi、huanjieyinbingzhipin、tuidongyiyaoweishengtizhigaigefahuilejijizuoyong。tebieshizaikangjixinguanfeiyanyiqingguochengzhong,jishichutaiyouguanzhengce,baxinguanfeiyanzhenliaojiuzhinaruyibaojijinzhifufanweibingyufubufenzijin,quebaohuanzhebuyinfeiyongwentiyingxiangjiuyi、shouzhiyiyuanbuyinzhifuzhengceyingxiangjiuzhi,tixianlewoguoshehuizhuyizhidudeyouyuexing。danyeyaokandao,shoujianguanzhidutixibujianquan、jiliyueshujizhibuwanshandengyinsuzhiyue,yibaojijinshiyongxiaolvbugao,qizhapianbaowentipufapinfa,jijinjianguanxingshijiaoweiyanjun。weiquanmiantishengyibaozhilinengli,shendujinghuazhiduyunxinghuanjing,yanshoujijinanquanhongxian,jingguowuyuantongyi,xianjiutuijinyibaojijinjianguanzhidutixigaigetichuruxiayijian。

一、总体要求

河南快三(yi)zhidaosixiang。yixijinpingxinshidaizhongguoteseshehuizhuyisixiangweizhidao,quanmianguanchedangdeshijiudaheshijiujieerzhong、sanzhong、sizhongquanhuijingshen,anzhaodangzhongyang、guowuyuanjuecebushu,jiakuaituijinyibaojijinjianguanzhidutixigaige,goujianquanlingyu、quanliuchengdejijinanquanfangkongjizhi,yanlidajiqizhapianbaoxingwei,weihushehuigongpingzhengyi,buduantigaorenminqunzhonghuodegan,cujinwoguoyiliaobaozhangzhidujiankangchixufazhan。

(er)jibenyuanze。jianchiwanshanfazhi、yifajianguan,baozhengjijinjianguanhefahegui、gongpinggongzheng。jianchizhengfuzhudao、shehuigongzhi,kaichuangjijinjianguangongzuoxingeju。jianchigaigechuangxin、xietonggaoxiao,buduantishengjijinjianguannengliyujixiao。jianchichengjieshixin、jilichengxin,yindaojianguanduixiangzengqiangzilvyishi,yingzaolianghaofenwei。

河南快三(san)zhuyaomubiao。dao2025nian,jibenjianchengyibaojijinjianguanzhidutixihezhifatixi,xingchengyifazhiweibaozhang,xinyongguanliweijichu,duoxingshijiancha、dashujujianguanweiyituo,dangweilingdao、zhengfujianguan、shehuijiandu、xingyezilv、gerenshouxinxiangjiehedequanfangweijianguangeju,shixianyibaojijinjianguanfazhihua、zhuanyehua、guifanhua、changtaihua,bingzaishijianzhongbuduanfazhanwanshan。

二、明确监管责任

河南快三(si)jiaqiangdangdelingdao。jianchihejiaqiangdangdequanmianlingdao,buduanwanshanyibaojijinjianguandangjiangongzuolingdaotizhihegongzuojizhi。ducuyiliaobaozhangbumen、dingdianyiyaojigouqieshijiaqiangjicengdangzuzhijianshe,chongfenfahuidangzuzhizhandoubaoleizuoyonghedangyuanxianfengmofanzuoyong。wanshangonglidingdianyiyaojigoulingdaobanzihelingdaorenyuantebieshizhuyaofuzerenjianduyueshujizhi,jiaqiangduiqilvxingzhengzhizeren、jijinjianguanzerendejiandukaoheyuzhijiwenze,zhulaojianguandixian。

河南快三(wu)qianghuazhengfujianguan。chongfenfahuizhengfuzaijijinjianguanfazhijianshe、biaozhunzhiding、xingzhengzhifa、xinxigongxiangdengfangmiandezhudaozuoyong,yifajianduguanlinaruyibaozhifufanweideyiliaofuwuxingweiheyiliaofeiyong,guifanyibaojingbanyewu,yifachachuweifaweiguixingwei,yangefalvzeren,jiadachufalidu。qianghuayiliaobaozhangbumenduijijinjianguandezeren,qieshifahuijianguanzuoyong。jianliyouyiliaobaozhangbumenqiantou、youguanbumencanjiadejijinjianguangongzuojizhi,tongchouxiediaojijinjianguanzhongdaxingdong、zhongdaanjianchachudenggongzuo。zhidingquanzeqingdan,mingqueyibaojijinjianguanzhize。

河南快三(liu)tuijinxingyezilvguanli。jijituidongyiyaoweishengxingyezuzhifazhan,yindaohezhichiqizaizhidingguanliguifanhejishubiaozhun、guifanzhiyexingweiheguanlifuwu、cujinxingyezilvdengfangmiangenghaofahuizuoyong。dingdianyiyaojigouyaoqieshiluoshiziwoguanlizhutizeren,jianlijianquanyibaofuwu、renliziyuan、caiwu、xitonganquandengneibuguanlijizhi,lvxingxingyezilvgongyue,zijuejieshouyibaojianguanheshehuijiandu。

三、推进监管制度体系改革

河南快三(qi)jianlijianquanjiandujianchazhidu。tuixing“shuangsuiji、yigongkai”jianguanjizhi,jianlihewanshanrichangxuncha、zhuanxiangjiancha、feixingjiancha、zhongdianjiancha、zhuanjiashenchadengxiangjiehededuoxingshijianchazhidu,mingquejianchaduixiang、jianchazhongdianhejianchaneirong。guifanqidongtiaojian、gongzuoyaoqiuhegongzuoliucheng,mingquegefangquanliyiwu,quebaogongkai、gongping、gongzheng。jianlibumenliandongjizhi,kaizhanlianhejiancha,xingchengjianguanheli。jijiyinruxinxijishufuwujigou、huijishishiwusuo、shangyebaoxianjigoudengdisanfangliliangcanyuyibaojijinjianguan,jianlihewanshanzhengfugoumaifuwuzhidu,tuixinganfuwujixiaofufei,tishengjianguandezhuanyexing、jingzhunxing、xiaoyixing。

(ba)quanmianjianlizhinengjiankongzhidu。jiakuaituijinyibaobiaozhunhuahexinxihuajianshe,yangeluoshizhengwuxinxixitongzhenghegongxiangyaoqiu,zuohaoyuyuanyouxiangguanxitongdexianjie,jiaqiangbumenjianxinxijiaohuanhegongxiang,bimianzhongfujianshe。jianlihewanshanyibaozhinengjiankongxitong,jiaqiangdashujuyingyong。jiaqiangduidingdianyiliaojigoulinchuangzhenliaoxingweideyindaoheshenhe,qianghuashiqian、shizhongjianguan。zhenduiqizhapianbaoxingweitedian,buduanwanshanyaopin、zhenliaoxiangmuheyiliaofuwusheshidengjichuxinxibiaozhunkuhelinchuangzhinandengyixuezhishiku,wanshanzhinengjiankongguize,tishengzhinengjiankonggongneng。kaizhanyaopin、yiyonghaocaijinxiaocunshishiguanli。tuiguangshipinjiankong、shengwutezhengshibiedengjishuyingyong。tuijinyidijiuyi、gouyaojishijiesuan,shixianjiesuanshujuquanbushangxian。jiakuaijianlishengjinaizhiquanguojizhongtongyidezhinengjiankongxitong,shixianjijinjianguancongrengongchoudanshenhexiangdashujuquanfangwei、quanliucheng、quanhuanjiezhinengjiankongzhuanbian。

(jiu)jianlihewanshanjubaojianglizhidu。tongchoudiqujiyishangyiliaobaozhanghecaizhengbumenyingdangjianlibingbuduanwanshanyiliaobaozhangweifaweiguiweiyuexingweijubaojianglizhidu,yizhaoxiangguanguidingduijubaorenyuyijiangli。changtongtousujubaoqudao,guifanshouli、jiancha、chuli、fankuidenggongzuoliuchenghejizhi,jiaqiangyinsibaohu,qieshibaozhangjubaorenxinxianquan。wanshanjubaojianglibiaozhun,jishiduixianjianglizijin,cujinqunzhongheshehuigefangjijicanyujiandu。

河南快三(shi)jianlixinyongguanlizhidu。jianlidingdianyiyaojigouxinxibaogaozhidu。jianliyiyaojigouhecanbaorenyuanyibaoxinyongjilu、xinyongpingjiazhiduhejifenguanlizhidu。chuangxindingdianyiyaojigouzonghejixiaokaopingjizhi,jiangxinyongpingjiajieguo、zonghejixiaokaopingjieguoyuyusuanguanli、jianchajihe、dingdianxieyiguanlidengxiangguanlian。jiaqiangheguifanyiliaobaozhanglingyushouxinlianhejiliduixiangheshixinlianhechengjieduixiangmingdanguanligongzuo,yifayiguishishishouxinlianhejiliheshixinlianhechengjie。gulixingyexiehuikaizhanxingyeguifanhezilvjianshe,zhidingbingluoshizilvgongyue,cujinxingyeguifanheziwoyueshu。

(shiyi)jianlizonghejianguanzhidu。shiyingyibaoguanlifuwutedian,jianlihewanshanbumenjianxianghupeihe、xietongjianguandezonghejianguanzhidu,tuixingwanggehuaguanli。tuijinxinxigongxianghehulianhutong,jianquanxietongzhifagongzuojizhi。duichashideqizhapianbaoxingwei,gexiangguanbumenyaoanzhaofalvfaguiguidinghezhizequanxianduiyouguandanweihegerencongyancongzhongchuli。jianlijianquandajiqizhapianbaoxingxingxianjiegongzuojizhi。yiliaobaozhangbumenfuzejianduguanlinaruyibaozhifufanweideyiliaofuwuxingweiheyiliaofeiyong,guifanyibaojingbanyewu,yifayiguichachuyiliaobaozhanglingyuweifaweiguixingwei。weishengjiankangbumenfuzejiaqiangyiliaojigouheyiliaofuwuxingyejianguan,guifanyiliaojigoujiqiyiwurenyuanyiliaofuwuxingwei。shichangjianguanbumenfuzeyiliaoweishengxingyejiagejiandujiancha,yaopinjianguanbumenfuzezhiyeyaoshiguanli,shichangjianguanbumen、yaopinjianguanbumenanzhaozhizefengongfuzeyaopinliutongjianguan、guifanyaopinjingyingxingwei。shenjijiguanfuzejiaqiangyibaojijinjianguanxiangguanzhengcecuoshiluoshiqingkuanggenzongshenji,ducuxiangguanbumenlvxingjianguanzhize,chixuguanzhugeleiqizhapianbaowenti,bingjishiyisongxiangguanbumenchachu。gonganbumenfuzeyifachachudajigeleiqizhapianbaodengfanzuixingwei,duiyisongdeshexianfanzuianjianjishikaizhanzhencha。qitayouguanbumenanzhaozhizezuohaoxiangguangongzuo。

(shier)wanshanshehuijianduzhidu。gulihezhichishehuigejiecanyuyibaojijinjiandu,shixianzhengfujianguanheshehuijiandu、yulunjianduliangxinghudong。jianlixinxipiluzhidu。jingbanjigoudingqixiangshehuigonggaojijinshouzhi、jieyuheshouyiqingkuang,jieshoushehuijiandu。jianliyibaojijinshehuijianduyuanzhidu,pinqingrendadaibiao、zhengxieweiyuan、qunzhonghexinwenmeitidaibiaodengdanrenshehuijianduyuan,duidingdianyiyaojigou、jingbanjigou、canbaorenyuandengjinxingguangfanshenrujiandu。zhudongyaoqingxinwenmeiticanyufeixingjiancha、mingchaanfangdenggongzuo,tongguoxinwenfabuhui、meititongqihuidengxingshi,fabudajiqizhapianbaochengguojidianxinganjian。

四、完善保障措施

(shisan)qianghuayibaojijinjianguanfazhijiguifanbaozhang。zhidingyiliaobaozhangjijinshiyongjianduguanlitiaolijiqipeitaobanfa。wanshandingdianyiyaojigouxieyiguanlizhidu,jianlihewanshandingdianyiyaojigoudongtaiguanlihetuichujizhi。wanshanyibaoduiyiliaofuwuxingweidejiankongjizhi,jiangjianguanduixiangyouyiliaojigouyanshenzhiyiwurenyuan,jiangjianguanzhongdiancongyiliaofeiyongkongzhizhuanxiangyiliaofeiyongheyiliaofuwujixiaoshuangkongzhi。chutaibingluoshiyiliaoweishengxingyezhenliaobiaozhun,zhubukaizhanlinchuanglujingguanli,wanshanbingluoshilinchuangyaoshizhidu、chufangdianpingzhidu,qianghualinchuangyingyonghepingjiadengbiaozhunguifanyunyong。

(shisi)jiaqiangyibaojijinjiandujianchanenglibaozhang。jiaqiangjijinjiandujianchanenglijianshe,jianlijianquanjijinjianguanzhifatixi,jiaqiangrenyuanliliang,qianghuajishushouduan。lishunyibaoxingzhengjianguanyujingbanxieyiguanlideguanxi,mingquexingzhengjianguanyujingbanjihedezhizebianjie,jiaqianggongzuoxianjie。luoshijingbanjigouxieyiguanli、feiyongjiankong、jichashenhegongzuozeren。jianlijianquanjingbanjigouneibukongzhizhidu,dingqipinqingdisanfangjigouduijingbanjigouneikongfengxianjinxingpinggu,zhulaojijinjianguanneikongfangxian。jiaqianggejicaizhengzijinbaozhang,tongguozhengfugoumaifuwujiaqiangjijinjianguanliliang。baozhangyiyaojigoutigongyiliaobaozhangfuwusuobixuderenyuan、shebeihexiangguansheshi。

(shiwu)jiadaduiqizhapianbaoxingweidechengchulidu。zongheyunyongsifa、xingzheng、xieyidengshouduan,yanchengzhongfaqizhapianbaodedanweihegeren。yangeluoshiquanguorendachangweihuiguanyuqizhapianbaoxingweidelifajieshi,duishexianfanzuideanjian,yifayijiaosifajiguanzhuijiuxingshizeren。yiliaobaozhangbumenyifayiguijiadaxingzhengchufalidu。jijifahuibumenliandongchufazuoyong,duijingyiliaobaozhangbumenchashi、qizhapianbaoqingjietebieyanzhongdedingdianyiyaojigou,weishengjiankang、yaopinjianguanbumenyingyifazuochutingyezhengdun、diaoxiaozhiye(jingying)zige、congyexianzhidengchufa,tishengchengchuweisheli。duiqizhapianbaoqingjieyanzhongdedingdianyiyaojigouhegeren,narushixinlianhechengjieduixiangmingdan,shishilianhechengjie。

(shiliu)tongchoutuijinxiangguanyiliaobaozhangzhidugaige。shenhuayibaozhifufangshigaige,jiaqiangjijinyusuanguanlihefengxianyujing。jianliyiliaobaozhangdaiyuqingdanguanlizhidu,quedingjibenbaozhangneihan,liqingdaiyuzhifubianjie,mingquezhengcediaozhengquanxian。jiaqiangyibaoduiyiliaoheyiyaodejiliyueshuzuoyong,qianghuatongchoudiqujianguanzhize,youhuajijinjianguangongzuojichu。

河南快三(shiqi)xietongtuijinyiyaofuwutixigaige。shenhuayiyaofuwugongjicegaige。jiakuaituijingongliyiyuanzonghegaige,jianlijianquanxiandaiyiyuanguanlizhidu,guifanzhenliaoxingwei。weiraochangjianbinghejiankangwenti,guifantuiguangshiyiyiliaojishu。buduanwanshanyishichangweizhudaodeyaopin、yiyonghaocaijiagexingchengjizhi,wanshanyibaozhifuyuzhaobiaocaigoujiageliandongjizhi。jiaqiangyiyaoxingyehuijixinxizhiliangjiandujiancha,shenrukaizhanyaopin、gaozhiyiyonghaocaijiagexugaozhuanxiangzhili。

五、工作要求

(shiba)jiaqiangzuzhilingdao。difanggejirenminzhengfuyaochongfenrenshituijinyibaojijinjianguanzhidutixigaigedezhongyaoxing,jiaqianglingdao、tongyibushu、xiediaotuijin。yiliaobaozhangxingzhengbumenshiyibaojijinjianguandezhuyaofuzebumen,fazhangaige、gongan、sifa、caizheng、renliziyuanshehuibaozhang、weishengjiankang、shenji、shuiwu、shichangjianguan、yinbaojian、zhongyiyaoguanli、yaopinjianguandengbumenyifalvxingxiangyingzhize,xietongtuijingaige。yaojiaqiangxinxijiaoliu,shixianliandongxiangying,tuijinzonghejianguanjieguoxietongyunyong。

河南快三(shijiu)jianligongzuojizhi。geshengjirenminzhengfuyaojianlijiliwenzejizhi,jiangdajiqizhapianbaogongzuonaruxiangguangongzuokaohe。yaoqianghuazerendandang,jijizhudongfaxianwenti,yifayiguiyansuchachuwenti,duiqizhapianbaoxingweilingrongren,gongkaipuguangdianxinganjian。qieshiluoshijianguanzhize,zuohaogongzuoxianjie,quebaorenyuandaowei、zerendaowei、cuoshidaowei。

(ershi)zuohaoxuanchuanyindao。gediqugeyouguanbumenyaodalixuanchuanjiaqiangyibaojijinjianguandezhongyaoyiyi,dongyuanshehuigefanggongtongtuijinjianguanzhidutixigaige,jieheshijichuangxinjianguanfangshifangfa,duiyouxiaodejianguanfangfahemoshi,jishizongjietuiguang。yaojiaqiangyulunyindao,jijihuiyingshehuiguanqie,guangfanxuanchuanxianjindianxing,nuliyingzaogaigedelianghaofenwei。

guowuyuanbangongting

2020nian6yue30ri

(cijiangongkaifabu)