The new policy reforms in Sichuan aim to significantly enhance the coverage and digitalization of the workers’ compensation system. These reforms expand the scope of beneficiaries to include cross-province treatment, injury recurrence cases, and long-term outpatient care. Additionally, the policy explicitly includes pre-hospital emergency fees, ICU monitoring costs, and hospital AC charges in fund coverage, ensuring comprehensive support for injured workers.
To accelerate claims processing, the policy mandates online settlement for over 90% of cases, even those requiring pre-determination. This digital-first approach aims to streamline the claims process and reduce administrative burdens, ensuring faster access to care for workers.
Standardized Treatment Protocols
The reforms emphasize strict adherence to standardized treatment protocols, including the Work Injury Treatment Project Directory, Drug Formulary, and Inpatient Care Standards. These guidelines ensure consistent and high-quality care for injured workers.
In terms of cost rules, online settlements will utilize the treatment location standards, while manual reimbursements will follow the insurance enrollment location rates. This dual approach ensures fairness and transparency in the reimbursement process.
Enhanced Oversight
The policy is valid for five years, until 2030, with biannual reviews to ensure ongoing effectiveness and adaptability. The oversight structure includes a clear division of responsibilities between provincial and municipal levels, ensuring robust governance and accountability.
To combat fraud, the policy introduces blockchain verification for high-cost claims, such as those involving prosthetics. This technological solution enhances the security and integrity of the claims process.
Why It Matters
These reforms have significant implications for workers, healthcare providers, and the overall system. Over 2.3 million Sichuan laborers will gain faster access to care, addressing chronic pain points like delayed emergency reimbursements. Additionally, over 1,200 contracted medical institutions will need to upgrade their IT systems by Q3 2025 to comply with the new digital requirements. This modernization effort will future-proof the system and improve efficiency.
The reforms are also expected to enhance fund security by reducing fraudulent claims by approximately ¥80 million annually. This measure ensures that resources are allocated effectively and sustainably.
Implementation and Transition
The reforms balance compassion with accountability, as noted by a Sichuan HRSS official. Employers have a 60-day grace period for compliance adjustments, ensuring a smooth transition to the new system. This period allows stakeholders to adapt to the changes while maintaining operational continuity.
Overall, these measures demonstrate a commitment to improving the workers’ compensation system through expanded coverage, standardized protocols, enhanced oversight, and digital innovation.
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