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    贛州市人社局疾病補充保險項目績效評價報告

    文章來源:    發布時間:2018-08-30 17:06

    一、部門主要職責

    贛州市醫療保險事業管理局,為市人力資源與社會保障局管理的副處級事業單位。主要職責是:(一)宣傳、貫徹落實國家、省醫療、工傷、生育保險和離休干部醫療保障服務管理的政策法規,負責組織實施全市醫療、工傷、生育保險政策實施和離休干部醫藥費單獨統籌管理工作。(二)負責制定全市醫療、工傷、生育保險工作計劃,指導、監督、檢查各縣(市、區)醫療保險經辦機構業務工作。負責對全市醫療保險經辦機構工作人員的業務素質考核的指導和組織實施工作。(三)負責承辦中央、省駐市單位和市本級、贛州開發區的城鎮醫療、工傷、生育等保險業務。(四)負責市本級離休干部醫藥費單獨統籌管理工作。(五)負責辦理團體補充醫療保險及其他各類補充醫療保險業務工作。(六)負責全市醫療保險計算機信息網絡的建設、管理和人員培訓工作。(七)參與工傷認定、勞動能力鑒定和職業病、傷殘等級評定工作;指導參保單位的事故預防、職業病康復與傷殘職工的管理服務工作。(八)參與定點醫療機構、定點零售藥店的審定工作。負責市本級、贛州開發區的定點機構服務協議的簽訂、定期考核及日常監督檢查管理工作。(九)承辦市委、市政府和主管局交辦的其他事項。

    二、部門基本情況

    贛州市醫療保險事業管理局編制數20人,其中:參公編制20人;實有人數20人,其中:在職人數20人;退休人員5人。

    三、疾病商業補充保險項目支出情況

    2017年度項目資金2800萬已全部執行到位。

    (一)項目概況

    城鄉貧困人口疾病醫療補充保險是為確保實現脫貧攻堅戰略目標、在現有城鄉居民基本醫保及大病保險(含二次補償,下同)普惠制度基礎上、對城鄉貧困人口給予補充性醫療保障的特惠政策,必須堅持精準扶貧、精準脫貧基本方略,將其作為實施健康扶貧工程、完成脫貧攻堅政治任務的超常舉措;必須完善脫貧攻堅醫療保障兜底機制,進一步織密城鄉貧困人口疾病醫療補充保險與城鄉居民基本醫保、大病保險、醫療救助相互融合,互為補充的健康扶貧醫療保障網;必須著力解決“因病致貧、因病返貧”突出問題,讓城鄉疾病貧困患者得到及時有效救治,自己負擔的醫療費用大幅減輕,提升醫療保障水平為城鄉貧困人口同步邁入全面小康提供健康扶貧醫療保障。

    (二)項目執行情況

    1、實施對象:城鄉貧困人口疾病醫療補充保險的實施對象為各地通過精準識別并建檔立卡的貧困人口和未進入貧困戶建檔立卡系統的城鄉最低生活保障對象、特困人員、孤兒(以下統稱城鄉貧困人口),按照確保精準度和實現全覆蓋的要求給予醫療兜底保障。2、保障時限:城鄉貧困人口疾病醫療補充保險原則上按年度整年投保,保險時間為當年1月1日至12月31日。城鄉貧困人口疾病醫療補充保險費用報銷受理截止時間原則上不超過投保年度次年的3月31日,逾期不受理。城鄉貧困人口疾病醫療補充保險從2017年起執行。3、籌資安排:(1)籌資組織的政策要求,市、縣兩級政府統籌組織籌資,市、縣級政府落實。(2)籌資標準:2017年城鄉貧困人口疾病醫療補充保險籌資標準為每人120元,市、縣財政按2:8比例負擔。以后年度原則上按此標準籌資,也可根據上年度該項保險業務實施績效及當年城鄉貧困人口人數,對籌資標準進行必要的調整。(3)籌資來源:各縣(市、區)政府為城鄉貧困人口購買城鄉貧困人口疾病醫療補充保險的資金與參加城鄉居民基本醫療保險個人繳費的資金,一并由政府全額承擔。涉農資金整合縣所需資金由縣級政府通過統籌財政涉農扶貧資金予以安排。

    (三)項目績效評價

    自評得分100分。

    附件:疾病商業補充保險項目績效自評表

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