National Medical Insurance Bureau: Traditional Chinese medicine medical institutions can temporarily dispense with DRG payment

In the context of DRG reform, it will leave a "safe haven" for Chinese medicine.

"TCM medical institutions can temporarily dispense with payment by disease diagnosis-related grouping (DRG)." On December 30, the Guiding Opinions on Medical Insurance Supporting the Innovative Development of Traditional Chinese Medicine (hereinafter referred to as the "Opinions") jointly issued by the National Medical Insurance Bureau and the State Administration of Traditional Chinese Medicine (hereinafter referred to as the "Opinions") was clarified.

At the end of November 2021, the National Medical Insurance Bureau issued the Notice on Printing and Distributing the Three-Year Action Plan for the Reform of DRG/DIP Payment Methods, requiring that by the end of 2025, the DRG/DIP payment method will cover all eligible medical institutions that carry out inpatient services, and basically achieve full coverage of disease types and medical insurance funds. The release of the "Opinions" is like leaving a "safe haven" for Chinese medicine in the context of DRG reform.

In addition to payment methods, the Opinions also clearly state that traditional Chinese medicine should be favored in terms of payment scope, service price management, and medical insurance fixed points.

On January 4, the stock prices of 12 Chinese medicine stocks such as A-share Xinguang Pharmaceutical, Hansen Pharmaceutical, Qianjin Pharmaceutical, China Resources Sanjiu, Jiuzhitang, Tongrentang and Longjin Pharmaceutical rose and fell.

If DRG is not implemented, it may not be implemented for the time being.

Appropriate increases in factors and scores that have been implemented

The "Opinions" are divided into six aspects, and "improving the payment policy suitable for the characteristics of traditional Chinese medicine" is one of them. According to the "medical think tank", the highlights of the payment policy are as follows:

First, in terms of the total budget of medical insurance, there are relevant policies for medical institutions, grass-roots level and medical community level to encourage the development of traditional Chinese medicine. For traditional Chinese medicine medical institutions, it is necessary to reasonably determine the total amount of indicators according to their characteristics; for grass-roots medical and health institutions, it is necessary to increase the support for the development of traditional Chinese medicine services; and for the compact county medical community led by traditional Chinese medicine medical institutions, it is necessary to appropriately tilt the total budget.

Second, in the reform of payment methods, the pace of Chinese medicine can be suspended. Traditional Chinese medicine medical institutions may temporarily not implement DRG payment, and general Chinese medicine medical service projects can continue to pay by project; for areas that have already implemented DRG and payment by disease type, appropriately increase the coefficient and score of Traditional Chinese medicine medical institutions and traditional Chinese medicine diseases, and fully reflect the characteristics and advantages of traditional Chinese medicine services.

Third, from the perspective of payment policy, support grass-roots medical institutions to provide traditional Chinese medicine services, and support the construction of a close-knit medical consortium led by traditional Chinese medicine medical institutions.

"When DRG first came out, our TCM hospital was very scared." In October 2021, Wen Lixin, secretary of the Party Committee of Sanming Integrated Traditional Chinese and Western Medicine Hospital, publicly stated that the inpatients in the Traditional Chinese Medicine Hospital basically follow the diagnosis and treatment norms of Western medicine, and then add traditional Chinese medicine according to the requirements of traditional Chinese medicine. The resource consumption of 1+1 is definitely greater than 1, and under the DRG system, it may cause losses in the hospital in the long run.

Chinese medicine enterprises also said that the medical insurance bureau, as a payer, pays attention to the 'effect / cost ratio' of drugs, this value must be greater than 1, therefore, to make the medical insurance bureau willing to pay, the drug still has to reflect the clinical value, which is actually testing the medical ability of traditional Chinese medicine enterprises, and many traditional Chinese medicine companies are still weak in medical capabilities. Kaiyuan Securities also said that although there are already more than 9,000 varieties of traditional Chinese medicines in China, there are nearly 60,000 approval numbers of traditional Chinese medicines, and there seems to be no shortage of traditional Chinese medicine varieties, but from the current clinical needs, proprietary Chinese medicines with high clinical value are still lacking.

Some analysts said that the "Opinions" made it clear that the payment reform of traditional Chinese medicine does not force the DRG reform, gives medical institutions more buffer period, is conducive to fully exploring the reform method that meets the characteristics of traditional Chinese medicine services, and opens a separate "safe haven" for the traditional Chinese medicine industry, which is very conducive to the development of traditional Chinese medicine.

On the other hand, the "Opinions" show that the reform of the payment method of TCM medical insurance still needs to continue to advance: explore the implementation of TCM diseases to pay according to the score of diseases, select TCM diseases, reasonably determine the score, and implement dynamic adjustments. On December 28, the National Medical Insurance Bureau and the Chinese Medicine Administration requested that the classification and code of the medical insurance version of Chinese medicine diseases be updated and be used on January 1, 2022. According to the analysis of the "Health Bureau", the classification and code of TCM diseases have been unified nationwide, which is to prepare for the future promotion of DRG/DIP reform.

Previously, some traditional Chinese medicine medical institutions represented by Sanming Integrated Traditional Chinese and Western Medicine Hospital were achieving a "breakthrough" under the DRG policy. Wen Lixin said that he had asked Xu Zhiluan, director of the Sanming Municipal Medical Insurance Bureau, several times to "grind hard bubbles" in the hope of increasing the cost of the TCM patient group. Xu Zhiluan refused on the grounds that TCM needed better efficacy and lower costs. So Wen Lixin changed his thinking, and finally improved the service capacity of Chinese medicine and reduced resource consumption to avoid losses and strive for balances, which gave Chinese medicine a lot of encouragement.

Simplify the review process on new price items,

Open up green channels

Deepening the reform of medical service prices is also one of the important medical policies issued by the Medical Insurance Bureau and other departments in 2021. The "Opinions" show that it is necessary to simplify the review procedure for new price items for some TCM technologies and open up green channels, provided that they must be traditional TCM technologies derived from ancient classics, which are still widely used today and have exact curative effects, as well as innovative and economic advantages of new TCM technologies.

In the context of the comprehensive cancellation of drug markup in public hospitals since 2019, the "Opinions" make it clear that public medical institutions purchase Chinese medicine tablets from formal channels, and do not exceed 25% of the actual purchase price; Chinese medicine tablets and prepared Chinese medicine preparations prepared and used by medical institutions are independently priced.

In addition, the Opinions also support the development of traditional Chinese medicine in terms of medical insurance designated institutions and medical insurance payment scope. For example, it is emphasized that qualified TCM medical institutions should be included in the management of medical insurance fixed-point agreements in a timely manner, the scope of direct settlement of off-site medical treatment, and unreasonable restrictions must not be set on medical insurance payments for TCM medical service projects.

"Inheriting and innovating the development of traditional Chinese medicine is an important part of the cause of socialism with Chinese characteristics in the new era, a major event in the great rejuvenation of the Chinese nation, and an inevitable requirement for building a health and health development model with Chinese characteristics that complements and coordinates the development of traditional Chinese medicine and Western medicine." With its unique advantages and role, Chinese medicine has played an important role in the fight against the new crown pneumonia epidemic. The "Opinions" wrote, "Medical insurance departments at all levels and departments in charge of traditional Chinese medicine should earnestly improve their political positions, unify their thoughts and actions with the decision-making and deployment of the Party Central Committee and the State Council, firmly establish the development ideology centered on people's health, deepen the reform of the medical security system with greater strength and stronger determination, and support and promote the inheritance and innovative development of traditional Chinese medicine." ”

Recently, new policies in traditional Chinese medicine have continued, and some media believe that the reform of traditional Chinese medicine will enter a substantive stage. In December, Shanghai, Zhejiang, Jiangxi, Hunan, Guangdong, Sichuan and other 7 provinces won the qualification of the first batch of national comprehensive reform demonstration zones of traditional Chinese medicine; the network news that the third Chinese patent medicine collection alliance after Hubei and Guangdong - Shandong Proprietary Chinese Medicine Collection Alliance will soon be launched.

Bozhong Investment expects that benefiting from the successive landing of policies in the traditional Chinese medicine sector, the industry will achieve sustained, healthy and high-quality development.

Dongguan Securities believes that after the release of the guidance, it can be seen that the national policy supports the development of traditional Chinese medicine from top to bottom, and various specific measures are being implemented continuously, one is the comprehensive expansion of the scope of medical insurance coverage terminals, it is expected that the medical insurance coverage of traditional Chinese medicine products will increase, and the price of some traditional Chinese medicine medical services is expected to increase; second, chinese medicine tablets still maintain a bonus ratio of no more than 25%, China's traditional Chinese medicine formula granules are included in the management of drinking tablets, and the future Chinese medicine formula granules are expected to continue to maintain a rapid growth trend in hospital channels Third, TCM medical institutions temporarily do not implement DRG payment, and the implemented areas have appropriately increased the TCM disease coefficient and score, indicating the government's attitude towards TCM support and the overall support of medical insurance for TCM.

References:

[1] The Health Insurance Bureau issued a document to support! The reform of traditional Chinese medicine has entered a substantive stage_Opinion_State_Service https://www.sohu.com/a/514316892_564023

[2] How much has medical insurance supported the innovation and development of traditional Chinese medicine boosted the industry? Chinese medicine stocks have set off a rising tide again https://baijiahao.baidu.com/s?id=1721017053774626927&wfr=spider&for=pc

[3] Shandong Province leads the Interprovincial Alliance of Proprietary Chinese Medicines to collect documents and flow out! https://mp.weixin.qq.com/s/6f8QK5RCVhsIMmwVM_iU7g

Source: Medical Community Think Tank

Editor-in-charge: Wan Shunshun

Proofreader: Zang Hengjia

Plate making: Xue Jiao