Innovative medical payment process in Shanghai: how to “see through” a mobile phone?


“As long as there is an application code and appointment registration through mobile phone, you don’t need to bring any certificates or bank cards. It can be directly linked to the medical insurance card and mobile payment, and there is no need to queue up for payment. In the hospital, there is only one waiting time for medical treatment and taking medicine, which is half an hour to one hour less than in the past. ” “In the ward, we can complete the settlement of hospitalization expenses, which is fast and labor-saving. We don’t need to drag the patients to a long line.”
“As long as the medical insurance card is bound on the mobile phone, the medical insurance payment can be made directly by scanning the mobile phone in Renji Hospital, which is very convenient!”
“After seeing the disease, I can pay medical fees in the official account of the hospital in Yan Chai Hospital, and receive a medical electronic bill, which is mobile phone card package, which is very convenient, and no longer worry about not finding it.”
In the registration hall of Shanghai Renji Hospital, patients described this to the first financial reporter. These voices also represent the achievements of Shanghai in promoting the revolutionary reengineering of medical institutions’ business processes.
Medical treatment process revolution
In the traditional medical service process, the medical payment business process includes queuing guidance, queuing payment (registration fee), queuing waiting for diagnosis, queuing payment (inspection and inspection fee), queuing inspection and inspection, queuing payment (drug fee), queuing for taking medicine In the process of medical treatment, the proportion of passive “queuing” waiting time is relatively large. The average treatment time of outpatients in top three hospitals in Shanghai is about 3 hours, of which the queuing time accounts for 75% and the treatment time only accounts for 25%.
Since there is no “off card payment” policy path before the end of 2019, all medical institutions only carry out mobile payment for patients at their own expense. However, in the view of Shanghai, “but still can not meet the one-time mobile payment needs of medical insurance patients.” According to the director of the Xijian Municipal Health Commission, Shanghai is cold.
In order to further meet the one-time mobile payment needs of medical insurance patients, on June 16, Shanghai municipal government issued the notice on printing and distributing the “one thing” business process reengineering work plan for medical payment in Shanghai, saying that it is necessary to promote “one network universal processing” of medical payment, birth and medical expense reimbursement, and realize the revolutionary business process reengineering. We will create the Shanghai model of “no medical treatment once” and expand the scope of off card payment for outpatient, emergency and inpatient services. Ten matters related to the birth of a child, such as birth medical certificate, medical insurance registration and application for maternity insurance benefits, are integrated into “one thing” of birth. To achieve the basic medical insurance expenses reimbursement settlement, outpatient registration of serious diseases and other matters “one thing at a time”, so that more data running, less people running errands. In 2020, we will complete the “one thing” and “one network” for medical payment, birth and medical expenses reimbursement.
“From the perspective of an application code, it is a very simple job, but the workload of the background is huge. It is not easy to integrate medical insurance information, bank information and personal information into one code.” Leng Xiliang said.
Although the integration work is not an easy task, this work is the key task of deepening the reform of “all in one network” this year.
“In order to avoid detours and avoid long-term development, the municipal working class has adopted the mode of batch pilot,” one mature family will go to the next batch, and one step will take a big step forward. “Six districts and 11 municipal medical institutions will be selected for the first batch of pilot projects. As of August 24, more than 400 public medical institutions in the city have achieved full coverage. As of October 9, more than 282000 people had “taken off their cards” and completed outpatient and emergency registration, charges and hospitalization settlement Leng Xiliang said.
This process revolution involves not only medical institutions, but also the docking scheme of medical insurance system, bank docking scheme and credit payment business docking scheme.
“At the same time, we will identify 19 local promotion channels such as WeChat and Alipay to assist the” bid application “to be approved by the national health insurance agency to promote local channels in Shanghai. Leng Xiliang said.
As of September 30, more than 4.76 million insured persons in Shanghai have completed the application and activation of e-Voucher for medical insurance. Credit medical treatment, rich experience. Give full play to the advantages of financial center and credit reporting system, and support patients to choose the signing channel of “credit medical treatment” by relying on China UnionPay and the third-party payment platform.
“This coverage is for the whole population. Aiming at the children patients who have not been covered by the national” medical insurance e-Voucher “, we have explored the function of” application code and relatives application code “to create the” Shanghai program “of children’s medical insurance electronic voucher in China, so as to realize the full coverage of all age groups of medical insurance patients in this city. For patients with insufficient quota or without credit card, we will coordinate China UnionPay and commercial banks to launch online credit card withdrawal and online digital credit card application Leng Xiliang said.
This process based revolution has once again created the Shanghai scheme of payment for medical treatment. Up to now, more than 89000 people have signed up for non payment and more than 16000 transactions have been made.
The last kilometer of electronic bill
Renji Hospital Outpatient self-service registration machine first appeared in 2010, which was still a “new thing” at that time. However, Renji Hospital was the “first person to eat crabs”. When online payment was not developed at that time, the self-service payment method of cash pre charging was adopted, which saved the time for patients to queue up for registration and payment at the window, and received unanimous praise from patients.
Under the premise that the self-service registration machine has been online for 9 years and accumulated a lot of successful experience, Renji Hospital has taken the lead in realizing self-service in and out of hospital and ward settlement in 2019. So that patients can at any time in the ward or self-service machine for real-time settlement, to avoid the phenomenon of long lines in the checkout window, greatly facilitate the inpatient settlement process, save time.
On June 9, 2020, Renji Hospital, as the first tertiary hospital in the pilot reform of “medical payment for one thing” in Shanghai, took the lead in realizing the off card payment of medical insurance e-Voucher, online payment of medical service number, and credit insensitive payment and online payment along with the application of citizens cloud. This measure really realizes the non-contact payment of medical insurance, which not only solves the embarrassment of patients who need to see a doctor but finds that they don’t have a medical insurance card, and more effectively reduces the risk of cross infection.

“The medical insurance electronic voucher is generated by the national medical insurance information platform, and is an electronic medium for medical insurance identity identification generated for all insured personnel based on the basic information database of medical insurance. Through real name and real person authentication technology and encryption algorithm, the electronic certificate of medical insurance has the important characteristics of security, reliability and unique authentication, which can completely replace the physical medical insurance card. Since then, the days of “no medical insurance card and no way of medical insurance settlement” have gone Renji Hospital vice president Wang Yu said.
In order to make the medical insurance card card payment online faster, Renji Hospital carried out the five phase upgrade of the medical insurance system, which promoted the reform of online and offline medical care. On the evening of June 9, the hospital successfully completed the upgrading and switching, becoming the first tertiary hospital in the city to apply phase V medical insurance. On June 10, the first day after the card withdrawal payment was launched, 8455 medical insurance registration transactions, 7358 medical insurance charges, 350 medical insurance admissions and 310 medical insurance discharge tests were completed. The total outpatient number on that day reached 16496, and the order of medical treatment was stable and orderly. At the same time, as one of the first six online hospitals in Shanghai, the Internet hospital also synchronously switched to the fifth phase of medical insurance, making online payment more smooth.
“After the fifth phase of medical insurance goes online, medical insurance patients will not have to wait in the queue at the window or self-service machine. After signing the credit contract with the app, they can also realize diagnosis and treatment first and then pay. After seeing a doctor, they can complete the cost settlement with one click, so as to realize the new experience of” payment based on credit insensibility “, which is practical and convenient for patients.” Wang Yu said.
However, Wang Yu believes that “after the medical insurance e-Voucher and card withdrawal payment, we still need to get through the last kilometer, that is, electronic bills. Only by completing these three links can we truly realize zero queuing of medical payment.”
On May 7, 2020, Renji Hospital, as one of the first batch of e-bill pilot units in Shanghai, issued the first e-bill. On July 9, the hospital completed the online application of outpatient and emergency e-bill and Internet hospital e-bill, thus thoroughly opening the “last kilometer” of medical process informatization construction.
Patients often have the experience of having to queue up at the window and spend a lot of time to get a paper bill or a detailed list. Along with Renji Hospital’s online settlement of ward, off card payment of medical insurance electronic voucher and online payment of medical expenses, the final step of bill acquisition has become the constraint of the whole optimization process. After the e-bill was put online, the “last kilometer” in the medical treatment process was completely opened, so that patients could avoid the whole process of queuing. For patients who need paper bills for reimbursement, they can also print paper invoices quickly and conveniently through the e-bill self-service printer in the hospital.
Through the implementation of the special work of “medical payment”, Ren Ji Hospital has initially explored the integrated online and offline service mode of “service, payment and ticket”, laying the foundation for the comprehensive implementation of the “Internet plus medical insurance” mode. At the same time, it also built the whole queuing free Shanghai model and built the city’s “credit based” without any sense of credit. Pay “credit medical service system to make contributions.