Insight into the value of Internet medical treatment: Internet medical care is conducive to promoting the rational use of medical insurance funds

Editor's note: The epidemic has activated online diagnosis and treatment, coupled with the frequent favorable policies, Internet medical care has ushered in a new stage of development. Public hospitals, Internet companies, private medical and medical informatization enterprises have entered the market, and more and more participants have entered the market. At the end of 2021, when the industry ecology is gradually improving, the health industry and Jingdong Health jointly launched the "Insight into the Value of Internet Medical Treatment", which aims to start from multiple groups with the deepest influence of Internet medical treatment, gain multi-dimensional insight into the latest trends in the development of Internet medical care, and witness the practical value of Internet medical development at multiple levels. This issue is the value of Internet medical care to medical insurance, so please pay attention to it.

An Internet care company once told the health community such a thing:

When they compared the readmission rates of two types of patients with type II diabetes in one city, they found that the indicators for patients who booked home care services through the Internet were much lower than those who did not receive related services. The conclusion is that the continuation of nursing care has reduced local health insurance expenditures.

So the health community made a bold assumption:

The efficacy of Internet diagnosis and treatment is similar to that of Internet care – many people can complete consultation, consultation, prescribe medicine and other actions online without going to the hospital – will it also reduce health insurance expenditures?

After communicating with a number of experts, the health community found that if only a small account is calculated, Internet medical care has little to do with medical insurance; but if a large account is calculated, it will be found that the effective and standardized application of Internet medical care can reduce the cost of medical insurance as a whole.

Image source: Figureworm creative

Nothing to do with Medicare?

Peking University Cancer Hospital (hereinafter referred to as Peking University Cancer Hospital) has carried out the Internet diagnosis and treatment business with great success. From June to mid-November 2021, the online diagnosis and treatment volume of the hospital's Internet hospital exceeded 110,000 person-times, and the online cost accumulated nearly 150 million yuan, accounting for 12% of the total outpatient visits and 9% of the outpatient income in the same period, respectively.

As the vice president in charge of internet hospital business, Xing Mo told the health community that the hospital once made a simple calculation, if patients from other places come to Peking University Cancer Hospital for a visit, the cost of travel, accommodation, lost work and other expenses will add up to about 5,000 yuan, and through the Internet diagnosis and treatment, they can completely save this batch of money.

"Internet healthcare does have many benefits, saving patients and hospital operating costs." But Xing Mo's words turned sharply, "It is just a convenient way for patients to seek medical treatment, and it is not directly related to medical insurance expenditure." ”

Xing Mo's words are not unfounded.

On November 2, 2020, the National Medical Insurance Bureau issued the "Guiding Opinions on Actively Promoting the Payment of Medical Insurance for "Internet +" Medical Services", which requires designated medical institutions that provide "Internet +" medical services to be included in the unified management of designated medical institutions in entities.

That is to say, for medical institutions, online and offline costs are from a plate, and there is no problem of saving money.

What's more, the medical insurance pooling fund mainly pays for large and inpatient medical expenses, most places do not include outpatient costs in the scope of payment, and Internet medical care only moves part of the outpatient business from offline to online, which is still outpatient, so its cost is generally not included in medical insurance.

In addition, platform-based Internet hospitals are mainly self-funded, and access to medical insurance may affect their income, and the motivation is equally insufficient.

"If the Internet diagnosis and treatment is widely included in medical insurance and the reimbursement ratio is increased, it may increase medical insurance expenditure, because everyone will pay more and more attention to their own health in the future." Xing Mo said.

Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, also said that it is not yet possible to conclude that "Internet diagnosis and treatment is conducive to medical insurance cost control". Because it may also facilitate excessive medical treatment, Internet medical care needs to improve and land various supporting systems.

Ying Yazhen, vice president of the National Institute of Medical Security at Capital Medical University, holds the same view: it can only be evaluated through research, through data and case studies.

As for Internet nursing, Han Binbin, chief accountant of Henan Provincial Cancer Hospital, believes that those who really need long-term care may go to hospitals and health care institutions, and the proportion of home care will not be too large. Xing Mo also agreed: offline nursing is mostly self-funded, and the population base is limited.

If you only calculate a small account, no matter how you calculate, Internet medical care has nothing to do with medical insurance.

Make a big deal out of it

What if it's a big account?

Xing Mo gave another angle.

At present, the reason why hospitals are facing such great operational pressure is because many equipment and wards have to operate, and the salaries of many medical staff need to be paid, while the government financial subsidies are limited, and they can only obtain income through medical insurance payments with sufficient business volume.

Assuming that the level of Development of Internet Medical Care is high enough, many of the public's medical needs can be met online, and hospitals naturally do not have to build so many buildings and do not need to hire so many medical staff, and the overall operating costs will decline.

"Spending money on health insurance is not such a way to spend."

In other words, there is an internal logic to medical insurance expenditure and Internet diagnosis and treatment.

Yu Guangjun, president of Shanghai Children's Hospital, told the health community that "individuals do not agree with the statement that medical insurance costs are controlled, and it should be the rational use of medical insurance funds." He believes that the effective and standardized application of Internet medical care is conducive to promoting the rational use of medical insurance funds and forming a new model of medical services, which can reduce the overall medical costs and indirect costs of patients. In this sense, Internet medical care can reduce the cost of medical insurance as a whole.

The Guiding Opinions on Actively Promoting the Payment of Medical Insurance for "Internet +" Medical Services, while emphasizing the total budget, also points out that the calculation factors of the total budget should take into account the medical costs and drug costs incurred by the "Internet +" medical services. That is to say, the policy level has not blocked the opening to increase the total amount of medical insurance, which undoubtedly leaves room for medical insurance payments for Internet diagnosis and treatment.

One of the effective results of Sanming's medical reform is the realization of the balance of the medical insurance fund. The reason why this can be achieved is that there are two factors directly related: one is the formation of a close-knit county medical community, which integrates all county, township and village public medical institutions in the county into one, sharing benefits and sharing responsibilities; the other is the county medical insurance fund package payment.

In this way, the medical community disease prevention is done well, the masses see fewer doctors, and the medical insurance naturally has a surplus, which can be included in the medical income for salary distribution and health promotion, thus forming a benign closed loop.

In terms of disease prevention and health management, Internet medical care can undoubtedly play a huge role, thereby directly reducing medical insurance expenditure, which may be the greatest value it is worth looking forward to.

Source | The health community

The author | Xiao O