广州市医保经办一体化垂直管理的实践与创新

Practice and Creation on Vertical Management of Medical Insurance Service Management Integration in Guangzhou

广州市医保中心以市级统筹为契机,打破体制壁垒,建立起全市一体化垂直管理的医保经办新模式。多年来,通过在信息化建设、标准化体系建设、经办风险防控上持续发力,形成了全市统一的医保经办管理体系、医保经办信息平台和医保经办标准体系;深化"放管服"改革,优化营商环境,逐步建起"一个平台、两级管理、三级经办、多点服务"的经办管理服务格局,实现医保事项一次办好、经办业务全城通办、政务服务事项一网通办及困难人员医疗保险、医疗救助待遇"一站式"结算,走出了一条有广州特色的新时代医保经办管理之路。

Guangzhou Medical Insurance Service Center based on municipal overall planning and breakage of system barriers, established a new medical insurance service model in the whole city featuring integrative and vertical management. A unified medical insurance management system, medical insurance service information platform, and medical insurance management standard system have been formed throughout the city, thanks to continuous efforts over the years in information technology optimization, standardized system construction, as well as risk management and control. With deepening reform on the service management and optimization of the operation environment, a service pattern featuring "one platform, two-level management, three-level agency and multi-site service" has gradually been built up, which realized one-time solution to medical insurance services, onewindow operation covering city wide, one-gateway for all medical insurance services, and one-stop settlement of medical insurance and medical aid for the needy, and thus created a new era of medical insurance management with Guangzhou characteristics.