As an important part of China′s multi-level medical insurance system, commercial health insurance has developed rapidly in recent years, but its guarantee level is still limited, and its role in the multi-level medical insurance system is not fully played. Huimin Insurance, as a new public private partnership health insurance, takes into account the dual characteristics of commercial operation and inclusive protection, and provides an important supplement to meet the needs of the masses for multi-level protection, alleviate the economic burden of serious diseases, and promote the innovation and development of the pharmaceutical industry. The author systematically analyzed the characteristics of social and commercial integration in the development of Huimin Insurance in China from the aspects of value-oriented mechanism, policy complementary mechanism and operation support mechanism, and analyzed the problems of in the current development process of Huimin Insurance based on the holistic governance framework of multi-level medical security system in three dimensions of " hierarchy-institutional-tool". It is suggested that the functional positioning of multiple subjects should be clarified, the ability of information integration should be enhanced, and the product design and serviceshould be optimized, so as to fully enlarge the supplementary security efficiency of Huimin Insurance, and explore a new path for the formation of a multi-level medical insurance system with Chinese characteristics.

With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.

By means of analysis of related national policies on medical alliances, and investigation of their current development in China, the authors summarized the conceptual category of existing medical alliances. Typical cases were selected for comparative analysis in terms of urban medical groups, medical communities, specialized alliances and telemedicine collaboration networks. In view of such setbacks found as lack of health services, ambiguity of power and duties of stakeholders, and low penetration rate of composite medical insurance payment, as well as lack of effective incentives and poor online diagnosis and treatment mechanism, the authors recommended on development of medical alliances in respect of framework improvement and mechanism optimization among others.

Objective:To analyze the filing mechanism for cross provincial immediate reimbursement of medical insurance in China, so as to provide reference for optimizing the filing mechanism and improving the filing accessibility of insured personnel.Methods:Taking the filing policy of cross provincial immediate reimbursement of medical insurance in 2019 as the research object, on the basis of a comprehensive understanding of the national filing policy background, 90 coordinating regions in Zhejiang Province, Hubei Province and Ningxia Hui Autonomous Region were taken as survey samples to evaluate the relevant policies and extract key parameters, including filing identification methods, filing-related settlement benefits and filing ways. The parameters were compared and analyzed by using descriptive statistical methods.Results:The results of the survey showed that in terms of identity recognition methods, the provision of various supporting materials(residence permit, work certificate, etc.)was still the main way to carry out identity recognition for medical insured persons in different places.Filing-related reimbursement benefits were mainly adjusted by limiting the area of medical insurance treatment and adjusting the benefits parameters(reimbursement ratio). In terms of filing channels, 51(56.7%)sample co-ordination areas had realized at least one remote filing mode.Conclusions:The inclusiveness of filing identity verification mechanism for the floating population needs to be further improved, the filing-related treatment policies need to be further improved, and the convenience and standardization of filing channels need to be strengthened.

After recent years′ development, China′s Internet medical service and medical insurance policy system has begun to take shape, but it still needs to be further improved. By combing the connotation and mode of Internet medical services, the evolution of medical insurance payment system and the content of medical insurance payment policy in the United States, the authors put forward that China could further improve the medical insurance payment policy system of Internet medical care, strengthen the multi-point practice management of licensed doctors on the Internet, give full play to the role of commercial insurance in promoting Internet medical care, and rely on information technology means to improve the medical insurance supervision of Internet medical services, then promote the development and management of Internet medical insurance services in China.

Objective:To provide a reference for establishing the evaluation system of the implementation effect of cross provincial direct settlement policy.Methods:By referring to the public policy evaluation model and using the expert consultation method, the authors built an evaluation index system for the implementation effect of cross provincial direct settlement policy for urban and rural residents. The multi-attribute group decision-making analytic hierarchy process, Matlab software and Yaahp software, combined with Spearman correlation coefficient method, were used to cluster the expert opinions and further determine the weight of each element at different levels.Results:The evaluation index system of the implementation effect of direct settlement policy for urban and rural residents′ cross provincial medical insurance was constructed, including 3 first-class indicators, 9 second-class indicators and 20 third-class indicators, and the weight of each index was calculated.Conclusions:The designed index system is suitable for grasping the implementation level of the cross provincial direct settlement policy from a macro perspective, and find out the problems in the implementation process. Efforts should be made to refine the evaluation criteria of the indicators in the index system.

The present use of artificial intelligence at primary health care institutions covers auxiliary treatment, voice electronic medical records, rational drug use, chronic disease management assistance, and auxiliary diagnosis of medical images. The authors analyzed the main factors restricting the development of primary medical artificial intelligence products, and put forward solutions from the perspectives of optimizing product functions, organizing expert resources from the national level. These efforts can assist in the examination and approval of medical artificial intelligence products, and improve the medical artificial intelligence system, so as to promote the healthy and sustainable development of artificial intelligence in primary medical and health institutions.

This paper defined the main stakeholders of basic medical insurance mobile payment using the stakeholder theory, namely the government ( medical insurance bureaus, human resources and social insurance authorities, and healthcare regulators ), medical insurance agencies, pilot hospitals, medical workers, patients, and third-party social resources ( third-party payment entities, commercial insurers, web-based medical enterprises, and state-own financial institutions). SWOT analysis is used in analysis of stakeholders, to uncover the strength, weakness, opportunity and threats in advancing basic medical insurance mobile payment, thereby proposing how to guarantee the healthy and sustainable development of such mobile payment.

From the perspective of management, the authors established an analysis framework for the option mechanism of this information system, and analyzed the option mechanism of the system in such aspects as organization and management, optional and maintenance management, resources management, and shared interactive management. It is held that a medical insurance information system is already established to cover both rural and urban residents in China, along with a comprehensive operation mechanism. However such a mechanism is still defective in terms of communication mechanism, investment and resources development. It is recommended to make up in terms of improving stakeholders coordination mechanism, building diversified investment and financing mechanism, enhancing data quality, as well as system promotion and application, data sharing and business synergy capabilities.

OBJECTIVE:To provide a reference for setting codes in national New Rural Cooperative Medical System (NRC-MS) drug catalog. METHODS:Current conditions of drug catalog coding at home and abroad were introduced,the problems in the process of setting codes in national NRCMS drug catalog were analyzed and the countermeasures were put forward. RESULTS& CONCLUSIONS:Existing drug catalog codes mainly include those published by World Health Organization(WHO)in anatomi-cal,therapeutic and chemical classification system,and those in Chemical (Raw Material and Preparation) Classification and Code of China,Classification and Code of Drugs Covered by Social Insurance,meanwhile,the setting code method of relevant drugs can be also learnt from Chinese Pharmacopoeia and National Essential Drug List,etc. In setting codes in national NRCMS drug catalog,there were problems such as difficulty in classifying and mapping drug codes,insufficient authority of references for drug codes,too many reference standards for drug codes,and poor normalization of drug code extension. We should further refer to definitely authoritative standards for drug codes,establish appropriate rules on drug code integrated mapping,develop uniform and perfect drug code category set,and establish a system subject to continuous update and an effective evaluation mechanism,to solve the problems in the process of setting codes in national NRCMS drug catalog.