National Medical Insurance Administration- Strengthening the management of social supervisors of medical security funds
On October 9, the National Medical Insurance Administration shared important updates on its official website concerning the management of social supervisors overseeing medical insurance funds. This initiative is designed to bolster social oversight and actively engage various segments of society in monitoring these funds, thereby ensuring their security. These updates align with the State Council’s directives aimed at reforming the regulation system for medical insurance funds and enhancing the regular supervision of their usage.
**Overall Goals:**
Rooted in Xi Jinping’s Thought on Socialism with Chinese Characteristics for a New Era, the administration’s overarching goal is to implement the principles outlined during the 20th National Congress of the Communist Party and subsequent plenary sessions. A primary focus is on safeguarding the integrity of medical insurance funds. To achieve this, the administration emphasizes strengthening institutional mechanisms and fostering innovative management practices that encourage wide-ranging societal involvement in oversight. Regulations governing the management of social supervisors will be strengthened to ensure they can effectively perform their duties, aiming for stability within the supervisory teams and promoting constructive collaboration among government oversight, social monitors, and public opinion.
**Key Initiatives:**
1. **Rigorous Selection Criteria for Social Supervisors:**
The selection of social supervisors will primarily involve representatives from the National People’s Congress, members of the Chinese People’s Political Consultative Conference, media professionals, pharmacy representatives, field experts, insured individuals, and other engaged stakeholders in the medical insurance sector. Candidates must be citizens of the People’s Republic of China, support the Party’s policies, uphold socialist values, demonstrate integrity, comply with laws, maintain confidentiality, and show a keen understanding of relevant legal frameworks. They should also possess professional skills, a strong sense of social responsibility, and the ability to connect with the community in their supervisory roles.
2. **Standardized Selection Processes:**
In alignment with a voluntary approach, social supervisors will be selected through open recruitment, special invitations, self-nominations, and recommendations from their units. Recruitment announcements will be made publicly accessible. Medical insurance departments will evaluate candidates based on their professional experience, age diversity, and regional representation, ensuring a focus on professionalism and inclusivity. A public disclosure system for selected supervisors will be established.
3. **Clarifying Social Supervisors’ Responsibilities:**
Social supervisors are encouraged to become well-acquainted with the laws and policies governing medical insurance fund supervision. Their responsibilities include overseeing fund utilization by designated medical institutions and insured individuals, reporting any fraudulent activities, and monitoring the lawful performance of duties by medical insurance departments. Supervisors are also expected to provide insights for improving medical insurance policies and engage actively in various promotional, training, discussion, and inspection initiatives.
4. **Enhancing Management Mechanisms for Social Supervisors:**
The entities that appoint social supervisors will be responsible for organizing and managing them, specifically designating staff for ongoing communication and feedback. Medical insurance departments at the city level and above will determine the necessary number of supervisors and their tenure based on operational needs, establishing performance evaluation and exit frameworks, while also maintaining an updated database of social supervisors.
5. **Strengthening Support for Social Supervisors:**
Medical insurance departments at all levels are tasked with providing essential support for supervisors in carrying out their duties. Given that this work is viewed as public service, individuals who report credible fraud incidents will receive rewards in accordance with established guidelines. The aim is to foster a system of incentives for social oversight, recognizing contributors who achieve notable outcomes and providing financial support where feasible.
**Operational Requirements:**
The National Medical Insurance Administration will oversee the management of social supervisors nationwide, coordinating efforts, and promoting the sharing of best practices. Provincial medical insurance departments are responsible for managing local supervisors and updating relevant regulations to establish a stable workforce. All medical insurance departments must appreciate the significance of this oversight role, enhance leadership, and ensure that responsibilities are effectively executed to institutionalize social supervision practices.