Contact: Li Guijun

Administrative division: 230 182

Address: Changsheng Street, Shuangcheng Town, Shuangcheng City, Heilongjiang Province

Area code: 045 1

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1. What is the function scope of the medical insurance bureau?

1. Implement national, provincial and municipal laws, regulations and policies on medical insurance, maternity insurance and medical assistance. To formulate policies, plans and standards related to regional medical security;

2, organize the formulation and implementation of medical insurance financing and treatment policies, improve the dynamic adjustment and regional adjustment and balance mechanism, co-ordinate urban and rural medical insurance treatment standards, establish and improve the treatment adjustment mechanism suitable for the financing level, and establish a unified medical insurance system in the whole region. Organize the formulation and implementation of long-term care insurance system reform plan;

3. Organize the formulation and implementation of measures for the supervision and management of medical insurance funds, establish and improve the safety prevention and control mechanism of medical insurance funds, promote the reform of payment methods of medical insurance funds, and undertake relevant work for the supervision and management of district-level medical insurance funds;

4, the implementation of higher medical security departments to develop drugs, medical consumables, medical services and medical service facilities and other medical insurance directory, payment standards and charging standards and other policies, the implementation of dynamic adjustment mechanism. According to the authorized organization, formulate the charging policy for medical services. Establish price information monitoring and information release system;

5. Carry out the bidding policy of drugs and medical consumables of the superior medical security department and organize its implementation;

6. Formulate the agreement and payment management measures of designated medical institutions and organize their implementation, establish and improve the credit evaluation system and information disclosure system of medical insurance, supervise and manage the medical service behavior and medical expenses in medical insurance coverage, and investigate and deal with illegal acts in the field of medical insurance according to law.

Second, after the establishment of the Medical Security Bureau, it will become the most concerned government department for pharmaceutical companies and medical device enterprises. There are three reasons:

1, market access

What is market access for domestic pharmaceutical industry? In a narrow sense, it can be understood as: bidding, entering medical insurance.

If the drug fails to pass the tender, it means losing the whole hospital market. Furthermore, if the drug fails to enter the medical insurance catalogue, even if it passes the bidding, it will have a very huge impact on its market.

Bidding and medical insurance catalogue are both market access, but now these two rights are in the hands of medical insurance bureau, and their importance is self-evident.

2. Strictly control medication.

Medical insurance control fee is obviously the key word of 20 18. Under the big action of medical insurance fee control, for pharmaceutical companies, entering the catalogue is only a threshold, and hospital access and medical insurance payment standards are the most important.

The medical insurance bureau has the right to control the cost from the source, and will have direct control over the drugs and auxiliary drugs that were used in large quantities before. In addition, under the medical insurance payment standard, hospitals will be prompted to use the lowest-cost drugs to treat patients on the basis of rational drug use. In the future, under the medical insurance environment, the game of interests of all parties will be more obvious.

3, directly determine the drug price.

Previously, the National Development and Reform Commission was responsible for the pricing of drugs, Ministry of Human Resources and Social Security was responsible for the medical insurance catalogue, and the Health Planning Commission was responsible for bidding and purchasing, and finally it was paid by medical insurance. Therefore, the pressure of medical insurance is increasing.

Nowadays, the Medical Insurance Bureau has taken over the bidding and purchasing of drugs, which embodies the principle of "whoever pays, who trades". On the other hand, under the realistic medical insurance funds, the winning bid price of drugs will be closely tied with the medical insurance payment standard to maximize the interests of all parties.