The medical insurance was terminated four times a year, and the hospital was suspended!

A network biography of the official seal of Chongqing Shuangshan Traditional Chinese and Western Medicine Hospital shows that due to the terminationI have to suspend business.

The notification shows that from October 21, 2024, the hospital will no longer receive patients, which also means that the hospital will have no source of income.If the employee is willing to stay, the basic salary can only be paid 2,300 yuan per month."Unfortunately, this big family is about to dissolve. I hope that employees can understand."

Companies checked information shows that Chongqing Shuangshan Traditional Chinese and Western Medicine Hospital was established in 2015. Previously, the hospital name was the name of the hospital as the name of the hospital.Chongqing Kangdong Traditional Chinese and Western Medicine Hospital. In April 2023, the hospital was renamed the current name. The official website of the hospital showed that there were 76 open beds.

According to the medical industry, on October 21, the Medical Security Bureau of Dadukou District, Chongqing announced the list of medical insurance for the termination of the medical insurance designated agreement in 2024.Western Medicine Integrated Hospital has suspended the networking of medical insurance. At the same time, it was canceled (including local and different places) after completing the payment of medical insurance settlement.

Why does the hospital stop medical insurance payment?Public information shows that the hospital has been publicized in 4 times in 2024. Although the amount of violations is not high, there are many times.

In February 2024, the hospital was ordered by the District Medical Insurance Bureau to correct and return the medical insurance fund for 2,334 yuan for overcubation and excessive diagnosis and treatment.

In April 2024, the hospital was ordered by the District Medical Insurance Bureau to make corrections and return the medical insurance fund at 4635.74 yuan for over -diagnosis and treatment, excessive examination, and super standard charges, with a fine of 4635.74 yuan;

In July 2024, the Medical Security Bureau of Dadukou District, Chongqing also notified the violations of illegal and default hospitalization of empty beds in Chongqing Shuangshan Traditional Chinese and Western Medicine Hospital;

In October 2024, the Medical Security Bureau of Dadukou District, Chongqing City reported that during the night investigation, the Chongqing Shuangshan Traditional Chinese and Western Medicine Integrated Hospital had an illegal and violated contract in bed hospitalization, involving 16,000 yuan in the use of medical insurance funds in violation of regulations.The Medical Security Bureau of Dadukou District ordered the return of 16,000 yuan to the medical insurance fund, and the violation of 33,000 yuan in violations of regulations.

In other words, in less than a year, the hospital was notified four medical insurance violations. Before the hospital was renamed, when the Chongqing Kangdong Traditional Chinese and Western Medicine Integrated Hospital was operated, it was also operated.There have been reports of medical insurance violations.From the perspective of various signs, the hospitals outcome of the suspension of medical insurance settlement in the medical insurance agreement may not be surprising.

Lift the medical insurance agreement, many hospitals are "one sword -sealed"

What does it mean?

On October 31st, the Guangyuan Municipal Health and Health Commission announced a announcement of a proposed medical institution. The announcement showed that Guangyuan Cardiovascular Disease Hospital will be canceled.It is understood that Guangyuan Cardiovascular Disease Hospital has 100 beds, which is a private specialized medical institution. In June 2021, the hospital applied to the Guangyuan Health Commission for suspension of operation due to operating problems.

As for why it is suspended, the reason is also related to medical insurance.Sichuan News Network reported that in the two years of 2013 and 2014, Guangyuan City Cardiovascular Disease Hospital deceived the medical insurance fund of 7.49 million yuan.Stap in 2021 and canceled in 2024.

Some people in the industry told "seeing the medical community" that for private hospitals that are still operating, the lifting of medical insurance service agreements can be described as "one sword closure".Earlier, a number of private hospitals had been lifted by the Medical Insurance Bureau because of fraudulent insurance. The news that could not be managed shortly afterwards, and entered the situation of dismissal employees and closed the hospital.

In February 2019, the Social Insurance Fund Management Center of Jiangdu District, Yangzhou City announced that Jiangdu New City Hospital was lifted by the medical insurance settlement service agreement by the Medical Insurance Center.Less than half a year after being lifted in medical insurance services, Jiangdu New City Hospital Hospital was in a state of being unable to pay.The doctor of the hospital told the media for help that the hospital closed overnight, and more than 50 doctors "were" laid off, and the "rice bowl" was lost.

In June 2019, the medical insurance department in Qingdao reported publicly in accordance with the law.The accounts do not match, the bed is hospitalized, the patients negative costs are not charged in accordance with regulations, and the inspection and inspection reports are the same as thunder.

According to the regulations, the medical insurance department recovered more than 1.92 million yuan in the medical insurance fund to relieve the medical service agreement signed with the hospital.After being punished by medical insurance, the hospital was quickly revealed that it was unable to operate, and it had entered the state of dismissal employees and closed the hospital.

In March 2020, the Kunming Medical Security Bureau reported that Kunming Xinkangsheng Eurva Hospital was induced and organized to be hospitalized by promoting free hospitalization and free delivery patients.In accordance with relevant regulations, the medical insurance department ordered the refund of 14.7856 million yuan in illegal fees, deducting 529,300 yuan in service quality margin, and a total recovery fee of 15.3149 million yuan, and the medical insurance service agreement was terminated to close the medical insurance payment system.

This house was once a large three -level otolaryngology hospital. After the medical insurance penalty, the hospital could no longer be maintained.An investor in the hospital revealed to the "seeing the medical community" that the hospital was originally in a state of losing money. Coupled with medical insurance penalties, the hospital had gone bankruptcy and liquidated and suffered heavy losses.Not long after, the Kunming Health and Health Commission issued an announcement on canceling the Kunming Xinkangsheng ENT Hospital.

"Speaking of" comes out, sooner or later to pay back , with the intelligent management of medical insurance supervision, the strict management trend is not diminished, the use of medical insurance funds seriously illegal and illegal to survive by deceiving insuranceFor private medical institutions, good days is over, and a group of private hospitals may be "destruction of the group".

Social medical medical insurance seriously depends on medical insurance

How much does private hospital rely on medical insurance. It may be possible from some data.A glimpse.

Taking the data of 2018 as an example, according to the "Statistics of the Development of the National Basic Medical Security Business in the National Medical Insurance in June 2019" in June 2019, the National Basic Medical Insurance Fund GeneralThe expenditure was 1782.2 billion yuan.

So how do this nearly 1.8 trillion medical insurance funds spend?

First, look at how much medical insurance spends medical insurance for medical insurance pharmacies.Take employee medical insurance as an example. In 2018, the medical insurance fund expenditure was 1070.7 billion yuan, of which personal account spent 164.5 billion in pharmacies. Because urban residence insurance and Xinnonghe had no personal accounts, and some of the remaining areas of the remaining areas (outpatient accounts) (outpatient accounts)The amount of funds is small, so it can be roughly calculated that 341,000 medical insurance fixed -point pharmacies spent about 170 billion medical insurance funds in 2018.

So how much does the public hospital spend?Take a look at the data from the Ministry of Finance.According to the data released by Fu Jinling, director of the Ministry of Social Security of the Ministry of Finance, in 2018, the revenue from various medical insurance funds from various medical insurance funds reached 1233.9 billion yuan, accounting for 51.5%of the medical revenue of public hospitals.

In this way, the medical insurance share of non -public medical institutions in 2018 was roughly clear: about 370 billion yuan, accounting for about 21%of the total expenditure of the medical insurance fund.

According to statistics from the "2019 China Health and Health Statistical Yearbook", the revenue of non -public medical institutions in 2018 was 506.5 billion yuan, which means that medical insurance income accounted for non -public medical institutions income incomeThe proportion of more than 70%is the main "gold master".

Kunming Xinkangsheng Earneys Hospital, which mentioned bankruptcy and liquidation mentioned above, according to Kunming Medical Insurance Bureau announced in the first half of 2018 Basic Medical Insurance Sureting Hospital Cost Cost Cost Cost, Kunming Xinkangsheng Ear -Nose Hospital has the lowest self -negative rate at 3.38%.It can be seen that the hospital seriously relies on medical insurance income.

It can also be seen that the current social medical dependence on medical insurance.

In the era of new medical insurance, legal operation is the premise

Behind such medical insurance, there is an indisputable disappointmentFacts: Most private hospitals grow up with the construction of the medical security system. The popularity is "feed" by medical insurance.Many medical institutions have developed from small clinics to annual revenue of 100 million yuan, which is the medical insurance dividend.

But with the establishment of the State Medical Insurance Bureau, all of them are becoming a double -edged sword. Many hospitals are also medical insurance, and they are also defeated.

In an industry insider, in the context of the medical insurance departments increasing cracking blows, a group of living soils of private hospitals survived by cheating will no longer existThere is only one dead end.Although there are many public hospitals who have been investigated for defrauding insurance, the possibility of canceling medical insurance qualifications is relatively small. Even if it is canceled, it is a high probability event to restore medical insurance qualifications in the future.Deadly, on the one hand, it cannot be affordable. On the other hand, the probability of restoring the qualifications of medical Baodao points will be very small.

At the same time, he also suggested that the medical insurances crackdown on fraudulent behaviors will only be larger and larger.Strike may be fatal.

Well -known medical reform experts, Xu Yucai, former deputy director of the Health and Health Bureau of Shanyang County, Shaanxi Province, told "seeing the medical community". Under the big data "Tianyan", the medical service behavior is almost ""Paradox", the inconsistent record of diagnosis and treatment services and medical insurance charges will become evidence of illegal use of medical insurance funds or even fraudulent insurance. In the era of new medical insurance, medical institutions legally compliant operations are the king of long -term living.

Regarding the way out of private medical care, industry experts suggest that in additionFor example, in the health insurance pattern, private medical development has made great progress, surpassing public medical care providing people with high -quality and affordable medical services.

In addition, how private medical care develops and grows under the basic medical insurance pattern, not only the private medical community needs innovation exploration, the medical insurance department should also actively seek cooperation path with private medical care.After all, the efficiency advantage of private medical care is obvious, which is great for saving medical insurance funds.(This article is published in "Seeing the Medical Community", reprinted must be authorized, and the author and source are indicated at the beginning of the article.)