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商业保险机构承办大病保险 官方强调加强监管--亲稳舆论引导监测室
2012-08-30

  中新网8月30日电 据国家发展和改革委员会网站消息,国家发展和改革委员会等六部委今日公布《关于开展城乡居民大病保险工作的指导意见》。意见指出,要加强对商业保险机构承办大病保险的监管,强化对医疗机构和医疗费用的管控,建立信息公开、社会多方参与的监管制度。

Beijing, aug. 30, according to the national development and reform commission website news,The national development and reform commission and so on six ministries and commissions to be released today《About urban and rural residents to carry out a serious illness insurance work guiding opinions》。Opinion pointed out that,To strengthen the commercial insurance institutions undertaking serious illness insurance regulatory,To strengthen the medical institutions and medical cost control,Set up information public、Social participating supervision system。

  今日,国家发展和改革委员会、卫生部、财政部、人力资源和社会保障部、民政部、保险监督管理委员会正式公布《关于开展城乡居民大病保险工作的指导意见》。

today,The national development and reform commission、The ministry of health、The ministry of finance、Human resources and social security、The ministry of civil affairs、The insurance supervision and management committee officially announced《About urban and rural residents to carry out a serious illness insurance work guiding opinions》。

  意见指出,要加强对商业保险机构承办大病保险的监管。各相关部门要各负其责,配合协同,切实保障参保(合)人权益。卫生、人力资源社会保障部门作为新农合、城镇居民医保主管部门和招标人,通过日常抽查、建立投诉受理渠道等多种方式进行监督检查,督促商业保险机构按合同要求提高服务质量和水平,维护参保(合)人信息安全,防止信息外泄和滥用,对违法违约行为及时处理。

Opinion pointed out that,To strengthen the commercial insurance institutions undertaking serious illness insurance regulatory。The relevant departments shall individual,Work together,Ginseng protect(close)People rights。health、Human resources department of social security as the new agriculture together、The department in charge of medical insurance for urban residents and the tenderer,Through the daily check、Establish complaints accepts the channel and so on many kinds of ways for supervision and inspection,Supervise and urge the commercial insurance institutions according to the contract requirements to improve service quality and level,Maintenance ginseng(close)People information security,Prevent information disclosure and abuse,For illegal breach timely treatment。

  意见指出,保险业监管部门做好从业资格审查、服务质量与日常业务监管,加强偿付能力和市场行为监管,对商业保险机构的违规行为和不正当竞争行为加大查处力度。财政部门对利用基本医保基金向商业保险机构购买大病保险明确相应的财务列支和会计核算办法,加强基金管理。审计部门按规定进行严格审计。

Opinion pointed out that,Insurance supervision department completes the practice qualification examination、Service quality and daily business supervision,Strengthen the solvency and market behavior regulation,Commercial insurance institutions for the illegal behavior and ACTS of unfair competition and increase strength。Financial department to use basic medical insurance fund to commercial insurance institutions to purchase a serious illness insurance clear corresponding financial recovery and the accounting method,Strengthening fund management。Audit department according to the provisions of the audit strictly。

  意见称,要强化对医疗机构和医疗费用的管控。各相关部门和机构要通过多种方式加强监督管理,防控不合理医疗行为和费用,保障医疗服务质量。卫生部门要加强对医疗机构、医疗服务行为和质量的监管。商业保险机构要充分发挥医疗保险机制的作用,与卫生、人力资源社会保障部门密切配合,加强对相关医疗服务和医疗费用的监控。

Suggestions that,To strengthen the medical institutions and medical cost control。The relevant departments and institutions should strengthen the supervision and management through a variety of means,Prevention and control unreasonable medical behavior and cost,Ensure the quality of medical service。Health departments should strengthen the medical institutions、Medical service behavior and quality supervision。Commercial insurance institutions should give full play to the role of the medical insurance system,And health、Human resources department of social security close cooperation,Strengthen the related medical service and medical cost monitoring。

  在社会监督方面,意见强调,要建立信息公开、社会多方参与的监管制度。将与商业保险机构签订协议的情况,以及筹资标准、待遇水平、支付流程、结算效率和大病保险年度收支情况等向社会公开,接受社会监督。

In the social supervision aspect,Opinion emphasize,To establish information openness、Social participating supervision system。Will and commercial insurance agency agreement situation,And financing standard、Treatment level、Payment process、Settlement efficiency and serious illness insurance annual balance and so on to the public,Accept social supervision。


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