The uniform standard of medical insurance benefits will be issued, and the National Medical Insurance Bureau clarifies that these items are not reimbursed
One year and four months after soliciting opinions on the medical insurance benefit list, it has now entered the final stage of its official release. This list will propose national uniform standards for medical insurance benefits including inpatient and outpatient deduction lines and reimbursement rates.
Since the beginning of November, the National Medical Insurance Bureau has intensively responded to multiple requests for non-medical insurance items to be included in medical insurance reimbursement Proposal motion. The National Medical Insurance Administration follows the principles in the previously announced”Medical Security Benefit List” (draft for comments), and gives clear negative answers to items that should be borne by public health funds or fitness physical examinations.
The medical security benefit list will define the responsibility boundary of government medical security to achieve a fair and appropriate level of protection. While realizing the integration of the national medical security level, it will also guide the localities and the masses to achieve reasonable and stable expectations.
The formulation of the National Medical Insurance Benefit List has been an important task since the establishment of the National Medical Insurance Administration. It has been included in the programmatic document of my country’s medical insurance reform”Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical Security System” . Previously affected by the epidemic, this reform has been shelved. According to China Business News, the National Medical Insurance Bureau is currently intensively promoting the introduction of the medical insurance benefit list.
The State Council is also adding weight to this reform. The State Council executive meeting held on November 6 proposed that on the basis of the national basic public service list, combined with actual exploration and establishment of a livelihood expenditure list management system, pilot projects in the fields of education and medical insurance and gradually expand the scope.
Physical examination, early screening and other items are not included in medical insurance reimbursement
Listed in the”List of Medical Insurance Benefits” (draft for comments) published in July last year Seven items that the medical insurance fund does not pay, including those that should be paid from the work-related injury insurance fund, those that should be borne by a third party, those that should be borne by public health, and those who seek medical treatment abroad, such as sports fitness, health care consumption, and health checkup , Does not meet the basic medical insurance drug catalog, the scope of diagnosis and treatment items, the scope of items specified in the standards for medical service facilities, etc.
As in previous years, during the two sessions this year, many representatives of the committees still put forward a variety of proposals to include non-medical insurance items in medical insurance reimbursement, such as including rural medical examinations and early screening for chronic diseases. Medicare.
The National Medical Insurance Administration gave negative answers to these proposals. The main basis is that Article 30 of the Social Insurance Law of the People’s Republic of China clearly stipulates that medical expenses that should be borne by public health are not included in the basic The scope of medical insurance fund payment, so items such as physical examination should be resolved through public health services and other channels.
According to my country’s current institutional arrangements, the public health service system is mainly used to gradually solve the problems of disease prevention and control, health education, and the basic medical insurance system to gradually improve the level of disease treatment protection through the development of commercial insurance. Different health needs of different groups of people.
For some local representatives who proposed to include local characteristic Chinese medicines in the medical insurance catalog, the National Medical Insurance Bureau emphasized the importance of national unification of the medical insurance catalog. In the notice issued in 2019 of the”National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog”, it is stipulated that all localities should strictly implement the”Drug Catalog”. They must not formulate their own catalogs or use alternative methods to add drugs in the catalogs, nor should they do so by themselves. Adjust the limited payment scope for drugs in the catalog. For Class B drugs that were added as required in the original provincial drug catalog, they should be gradually digested within 3 years.
Projects such as cancer genetic testing and heavy ion therapy are difficult to include due to the limited capacity of the medical insurance fund. According to the National Medical Insurance Administration, the level of financing for basic medical insurance, especially for urban and rural residents, is relatively low. In 2019, the per capita financing is only about 800 yuan. The current basic medical insurance system is mainly based on providing protection for the treatment of basic diseases.
Establishing a unified national medical insurance treatment standard
Current medical preservation is under the policy of decentralization and fragmentation. Medical insurance treatments vary widely in different regions, and it is difficult for the public to form a unified medical insurance Expected remuneration, this year’s two sessions’ proposals also reflect these issues. In response to the current situation, the”Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System” clearly stated that the medical security benefit list system should be implemented.
Liao Cangyi, a researcher at the Medical Service Governance Research Center of Tsinghua University, said in an interview with China Business News that the list of medical insurance benefits is the national top-down standard for basic medical insurance, critical illness insurance and medical assistance in inpatient outpatient services. The payment ratio and the maximum payment limit, etc., put forward a unified national standard.
In response to the proposal, the National Medical Insurance Administration revealed that it is studying the idea of advancing the management of the medical insurance benefit list. It intends to establish the basic guarantee content, clarify the payment boundary, clarify the policy adjustment authority, and standardize the decision-making process. The system, basic policies, and the scope of fund payment shall guide local governments to further standardize the unified system framework and policy setting, and promote the long-term sustainable development of the system.
Liao Cangyi said that the advantage of establishing a medical insurance benefit list is to define the responsibility boundary of government medical insurance. On the one hand, it must be underinsured, and on the other hand, it must not be over-welfare, reflecting the”basic guarantee” of basic medical insurance. Responsibilities and protection levels are fair and moderate, and problems such as excessive protection and insufficient protection are corrected.
At the same time, it is also conducive to the realization of the policy integration of the national medical security system, promotes the country’s top-down scientific decision-making and management standardization, and promotes the equalization of basic medical services. It is conducive to keeping financing and payment policies in line with the level of economic development, and realizing the sustainable development of my country’s medical insurance system.
China Business News also learned from people familiar with the matter that one of the purposes of issuing the medical insurance benefit list is to prevent localities from competing with each other. Now some economically developed areas will increase medical insurance reimbursement as a political achievement or to attract talents, causing dissatisfaction in surrounding areas. In soliciting opinions, some economically developed areas believed that improving medical insurance benefits through their own financial resources should not be restricted. It can be seen that how to coordinate national standards and local standards is an issue that must be carefully weighed in the process of formulating the medical insurance benefit list.