Qiandongnan Prefecture Medical Security Bureau

The Medical Insurance Bureau of Qiandongnan Prefecture implements the policies and decisions of the Central Committee of the Communist Party of China, the State Council, the Provincial Party Committee, and the Provincial Government, as well as the Prefectural Party Committee and the Prefectural Government, regarding medical insurance work. In performing its duties, it upholds and strengthens the centralized and unified leadership of the Party over medical insurance work. Its primary responsibilities are as follows:

(1) Implement national medical insurance laws and regulations, formulate policies related to medical insurance, maternity insurance, medical assistance, and other medical insurance systems, and organize their implementation.

(2) Organizing the formulation and implementation of supervision and management measures for medical insurance funds, establishing and improving safety prevention mechanisms for medical insurance funds, and promoting reforms in medical insurance fund payment methods.

(3) Organizing the formulation of medical insurance funding and benefit policies, improving dynamic adjustment and balancing mechanisms, coordinating medical insurance benefit standards between urban and rural areas, and establishing and improving benefit adjustment mechanisms commensurate with funding levels; organizing the formulation and implementation of reform plans for the long-term care insurance system.

(4) Implement unified medical insurance directories and payment standards for drugs, medical consumables, medical services, and medical facilities in urban and rural areas.

(5) Formulate and implement policies on drug and medical consumable prices, medical service project charges, and medical facility fees; establish a mechanism for reasonably determining and dynamically adjusting medical insurance payment prices for medical services; promote the establishment of a market-driven pricing mechanism for social medical services; and establish a price information monitoring and disclosure system.

(6) Organize the formulation of drug and medical consumables tendering and procurement policies and supervise their implementation, and carry out relevant work related to the construction of drug and medical consumables tendering and procurement platforms.

(7) Formulate agreements and payment management measures for designated medical institutions and organize their implementation, establish and improve a medical insurance credit evaluation system and information disclosure system, supervise and manage medical service behaviors and medical expenses within the scope of medical insurance coverage, and investigate and handle violations of laws and regulations in the medical insurance field in accordance with the law.

(8) Be responsible for medical insurance administration, public service system construction, and informatization; organize and implement cross-regional medical treatment management and cost settlement; establish and improve the medical insurance relationship transfer and continuation system; and conduct international exchanges and cooperation in the field of medical insurance.

(9) Formulate policies related to medical insurance benefits for retired personnel at the state level and supervise their implementation.

(10) In conjunction with departmental responsibilities, carry out relevant work related to military-civilian integration and poverty alleviation; increase investment in science and technology, enhance scientific and technological innovation capabilities, and provide support for promoting innovation-driven development; be responsible for work safety and fire safety within this department and industry sector; carry out relevant work related to big data development and application and government data resource management in accordance with regulations, and promote the standardized management, sharing, and openness of departmental government data in accordance with the law.

(11) Complete other tasks assigned by the State Party Committee, the State Government, and the Provincial Medical Insurance Bureau.

(12) Adjustment of responsibilities. 1. Transfer the responsibilities of the State Human Resources and Social Security Bureau for urban employee and urban resident basic medical insurance and maternity insurance, the responsibilities of the State Health and Family Planning Commission for the New Rural Cooperative Medical Care System, the responsibilities of the State Development and Reform Commission for drug and medical service price management, and the responsibilities of the State Civil Affairs Bureau for medical assistance to the State Medical Insurance Bureau. 2. Transfer the medical insurance administrative responsibilities previously undertaken by the State Social Insurance Bureau, an affiliated public institution of the State Human Resources and Social Security Bureau, to the State Medical Insurance Bureau. 3. Transfer the urban and rural medical assistance administrative responsibilities previously undertaken by the State Social Assistance Administration Bureau (State Rural Low-Income Assistance Bureau), an affiliated public institution of the State Civil Affairs Bureau, to the State Medical Insurance Bureau.

(13) Functional transformation. Improve the unified basic medical insurance system for urban and rural residents and the major illness insurance system, establish and improve a multi-tiered medical insurance system covering the entire population and integrating urban and rural areas, continuously enhance the level of medical insurance, ensure the rational use and safety of medical insurance funds, promote the “three-in-one” reform of medical care, medical insurance, and pharmaceuticals, better safeguard the medical needs of the people across the state, and alleviate the burden of medical expenses.

(14) Division of responsibilities with the State Health and Wellness Bureau. The State Health and Wellness Bureau, State Medical Insurance Bureau, and other departments will strengthen institutional and policy coordination in medical care, medical insurance, and pharmaceuticals, establish communication and consultation mechanisms, and collaborate to advance reforms, thereby improving the efficiency of medical resource utilization and the level of medical insurance coverage.