The primary political task of the whole party and the whole country now and in the near future is to study, disseminate and implement the spirit of the 20th National Congress of the Communist Party of China. Yangpu District is comprehensively implementing the concept of “a people’s city”, accelerating the construction of the district in an all-round way, and continuously exploring new patterns of city construction with a focus on its key tasks.

At the beginning of 2023, the Publicity Department of the CPC Yangpu District Committee and Yangpu District Integrated Media Center jointly held a seminar on the topic of “Learning, contemplating, understanding and practicing the spirit of the 20th National Congress of the CPC and drawing a new blueprint for development”, and invited the heads of government agencies, civil groups, district state-owned enterprises and party organizations of all sub-districts. The participants studied the spirit of the 20th National Congress of the CPC, exchanged views and explored new ways of development on the basis of their work and the progress of key projects in Yangpu District.

In 2023, the Medical Insurance Bureau of Yangpu District (hereafter as the Bureau) will adhere to the spirit of the 20th National Congress of the CPC as well as decisions and arrangements of the CPC Yangpu District Committee and Yangpu District People’s Government in all aspects and the whole process of medical insurance reform and development, enhance its understanding of the mission and tasks of socialist medical insurance work with Chinese characteristics in the new era, take new steps to promote the high-quality development of medical insurance work, find a new orientation in the construction of a model room for a people’s city in Yangpu District, attach great importance to the “four focuses”, and comprehensively promote medical insurance work in Yangpu District.

Implementing arrangements for the common prosperity strategy and building a medical insurance safety network (2023)

The Bureau will carefully implement the requirement stated in the report of the 20th National Congress of the CPC that we must do everything within our capacity to achieve solid progress in promoting common prosperity, safeguard the “life-saving money” of the medical insurance fund and ensure the safety and sustainability of the fund. It will give full play to the functions of the multi-tiered medical insurance system in a coordinated way and promote the accessibility of medical insurance policies for all.

Improving the medical insurance system to meet diversified needs for medical insurance. The Bureau will promote the implementation of basic medical insurance, major disease insurance and medical assistance schemes, ensure the coverage of people in need, reduce the burden of critically ill people with major disease insurance, and enhance medical assistance to support people in distress. It will provide medical assistance that does not require application, establish an early warning mechanism for poverty caused by illness, take the initiative to find people in need and enhance the precision and convenience of medical assistance. It will optimize the mechanisms for financing and adjusting benefits for medical insurance. Besides, it will promote the reform of outpatient mutual aid, improve the calculation method for personal accounts and comprehensively implement the medical insurance card mechanism for college students seeking medical advice.

Medical insurance service hall

Carrying out pilot reform of long-term care insurance. The Bureau will strive to enhance the training of nurses, improve the quality of nursing services, actively cope with the aging of the population and ensure the happiness of disabled elderly people. It will develop a second version of the long-term care insurance assessment and whole nursing process supervision scenario based on management via a single website, break data barriers and strengthen the refined management of needs assessment.

Long-term care insurance care action aimed for centenarians

Improving the fund supervision system and mechanisms. The Bureau will empower medical insurance fund supervision with specialization, standardization and informationization, and continue to carry out targeted, precise and strong rectification actions and full-coverage inspections. It will improve its working mechanisms to create a social atmosphere in which people dare not to deceive, do not want to deceive, and are unable to deceive. In addition, it will promote the establishment of a medical insurance credit system, standardize ex post supervision in medical insurance and strengthen the use of credit evaluation results.

Serving the economic and social development of Yangpu District and enhancing the support and protection functions of medical insurance (2023)

The Bureau plans its work related to medical insurance in the context of the development of Yangpu District, practices the concept of a people’s city, seizes opportunities, acts quickly and continuously carries out visits and inspections to promote the high-quality development of the medical insurance cause of Yangpu District.

A study visit to WeDoctor

Implementing epidemic prevention and control. The Bureau will coordinate epidemic prevention and control and economic and social development, implement new requirements for the new stage, and comprehensively implement policies aimed to optimize medical insurance for patients infected with COVID-19.

Implementing practical projects of the district government. The Bureau will deepen the concept of health and medical insurance, promote the Community (Sports) Health Engineer Program, promote the in-depth integration of sports and medicine, give play to the collaborative promotion model of “government + university + third-party institution”, strengthen supply-side talent training, optimize the construction of digital platforms, promote the application and pricing of technology projects, and let more “sports prescriptions” and “champion technologies” get into ordinary people’s homes.

The Community (Sports) Health Engineer Program was rated as one of the top 10 innovative measures of medical insurance reform in Shanghai

Carrying out coordinated regional medical insurance. The Bureau will refer to the advanced experience of medical insurance reform in Sanming, Fujian according to local conditions, promote the cooperation between Yangpu and Sanming to implement the high-quality development strategy for medical insurance, and fully support the revitalization and development of old revolutionary areas. It will conduct mutual visits and exchanges with Shanghai Municipal Medical Insurance Bureau and other districts through group study, discussion salons and other activities.

Optimizing the layout of designated medical insurance resources. The Bureau will formulate the development plan and work guidelines for designated medical institutions and retail pharmacies in Yangpu District from 2023 to 2025, and include more high-quality medical and pharmaceutical resources in the medical insurance service agreement. It will accelerate the inclusion of retail pharmacies in the “dual channel” management of medicines under national medical insurance negotiations and the “Internet +” platform, seize new opportunities, exert new energy and promote the development of the health industry in Yangpu District.

A “dual-channel” pharmacy

Giving play to the leveraging role of medical insurance resources and promoting coordinated development and governance of medical insurance, medical care and medicines (2023)

The Bureau has adopted major reform measures such as payment method reform, pooled procurement of medicines and consumables, and dynamic adjustment of medical service prices in Yangpu District, in order to fully release development vitality, generate more reform benefits and achieve a win-win situation for the public, hospitals, pharmaceutical enterprises and fund safety.

Formulating the annual performance appraisal mechanism for designated medical institutions. On the basis of the total budget management of the medical insurance fund, credit supervision of the fund, medical quality evaluation and results of the agreement performance assessment, the Bureau will formulate the annual performance appraisal mechanism for designated medical institutions in Yangpu District so as to realize standardized and scientific management of these institutions.

Implementing total budget management in a scientific way. The Bureau will improve the management mechanism for the total budget of the medical insurance fund, host consultation and coordination meetings of representatives of medical institutions, and dynamically monitor the implementation of the total budget.

A consultation and coordination meeting of hospital directors on the total medical insurance budget

Implementing effective and efficient medical insurance payment. The Bureau will adhere to the implementation plan of Shanghai’s three-year action plan for the DRG/DIP payment method reform, look for diversified medical insurance payment methods, and promote the improvement of medical behavior, quality and operational efficiency of public hospitals.

Carrying out pooled procurement of medicines and consumables. The Bureau will implement a new version of the catalog of medicines covered by the national medical insurance system, organize national and municipal pooled procurement of medicines and consumables, undertake pilot projects of centralized price negotiations and procurement of medicines in the city, and implement the retention of medical insurance fund balances.

Optimizing the price formation mechanism of medical services. The Bureau will implement a dynamic adjustment mechanism for medical service prices, add the price of “Internet +” medical services, and support the development of the new medical service format in Yangpu District.

Promoting the high-quality development of public hospitals. The Bureau will implement the twelve measures aimed to promote the development of public hospitals and use medical insurance to drive the interaction of medical care, medical insurance and medicine reform.

Focusing on people’s yearning for a better life and promoting convenient and efficient medical security governance (2023)

The Bureau strives to achieve solid progress in the reform of the medical insurance system and mechanisms, provides people with all-round high-quality medical insurance services and continuously improves the people’s wellbeing.

Advancing the digital transformation of medical insurance governance. The Bureau will enhance “access to government services via a single website” and “management via a single website”, and introduce a number of medical insurance application scenarios that are effective and well-received. It will strive to realize full coverage of electronic medical bill application scenarios in public medical institutions, and carry out electronic prescription application pilot projects.

Long-term care insurance assessment and whole nursing process supervision scenario

Improving the efficiency and convenience of medical insurance handling services. The Bureau will promote the application of the OCR sporadic reimbursement intelligent identification and approval system at service counters to improve efficiency, make “a single trip at most” possible in medical insurance services, and implement the “integrated teller mechanism” to enable one-stop settlement of all matters. With the help of self-service machines and medical insurance “assistants”, the handling services will be extended to designated medical institutions, party member and non-party member service stations, institutions of higher education and communities to create “medical insurance service centers within 15 minutes’ reach and realize self-service.

Settling medical expenses where they are incurred. The Bureau will see that medical expenses are settled where they are incurred, implement direct settlement of medical expenses by designated pharmacies, and strive for pilot spots for medicine purchase in a city that is not the place of medical insurance payment, so as to effectively solve urgent problems faced by the people.

Establishing a medical insurance full-lifecycle information platform. The Bureau will strive to solve problems in sharing health related information between the insured people, medical institutions, management departments, handling departments and regulatory departments, work on health information aggregation, realize sharing of health information by building an informationized data aggregation platform, and provide all-round and full-lifecycle health management services for the public, medical institutions and regulatory departments.