People's Daily health client Xu Tingting Qiu Yue
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"I have been paying attention to the reactions of all parties to the government work report, and the deputies and netizens have said that they are both connected to the antenna and grounded. Some said that they had come up with really effective hard measures, and also introduced a lot of policy packages. It can be said that it is a truth-seeking and pragmatic report that urges people to forge ahead. Xiang Dong, deputy director of the State Council Research Office, pointed out at a briefing by the State Council Information Office on March 5.
The People's Daily health client reporter paid attention to the fact that in the "Good News of People's Livelihood in the Government Work Report" released by the Chinese government website, the first three of them are related to medical security, including: improving the direct settlement method for medical treatment in different places across provinces, realizing the basic unification of the scope of medical insurance use in the country, promoting the centralized procurement of drugs and high-value medical consumables, and strengthening the protection of drugs for rare diseases.
With the amount of procurement information open to the scene, enterprise representatives to inquire. Image courtesy of Xu Huidong of Zhongan Online
The direct settlement of medical treatment in different provinces has covered the whole country, and the scope of medical insurance use in the country will be basically unified by the end of the year
He Gong (pseudonym) from Jiangxi is a retired teacher who has stood on the podium for more than 30 years. In October 2021, binocular cataracts could no longer live normally. Because their families all work in Beijing, they have to cross 1,500 kilometers to Beijing for treatment.
He Gong, who originally thought that he could not use medical insurance in a different place, directly swiped his medical insurance card to achieve off-site reimbursement on the same day after successfully receiving surgery. "Thanks for giving me another light," Grandpa He said happily at the moment he walked out of the hospital.
According to data revealed by Long Xuewen, head of the Medical Insurance Business Management Center of the National Medical Insurance Bureau, in an exclusive interview with Xinhua News Agency on March 8, at present, the direct settlement of hospitalization expenses across provinces has covered all provinces, all co-ordination areas, all kinds of insured personnel and major outgoing personnel. The cumulative settlement of outpatient expenses has exceeded 10 million.
The staff of the off-site service department of the Nanchang Municipal Medical Insurance Bureau in Jiangxi Province told reporters that for citizens who settle in other places after retirement, as long as they go through the procedures for relocation, they can use medical insurance cards in newly settled cities to treat normally in networked hospitals, and the reimbursement ratio refers to the local reimbursement policies of newly settled cities. "At present, many top three hospitals and community hospitals in first-tier cities such as Beijing, Shanghai, and Guangzhou can achieve off-site medical treatment and settlement."
Wang An (pseudonym), 57, is in Nanchang, Jiangxi Province, going through the formalities of medical insurance relocation. Wang An also raised a concern, "I heard that the medical insurance directory is not exactly the same everywhere, and I don't know if it will affect my prescription reimbursement in the future." ”
The relevant staff of the Nanchang Municipal Medical Insurance Bureau told the People's Daily health client reporter, "At present, the vast majority of patients use drugs in the national medical insurance directory, this directory is unified throughout the country, but in the past few years due to the different incidence of different diseases in various regions, so the local medical insurance directory has also been formulated, and the whole country is currently retiring the directory, and the future will gradually realize the basic unification of the national medical insurance directory, which does take time." ”
According to the requirements of the "14th Five-Year Plan" for National Medical Security, the scope of basic medical insurance in the country will be basically unified by 2022. At present, the provinces are gradually transferring or digesting the medical insurance catalogue. For example, the notice issued by the Qinghai Provincial Medical Insurance Bureau on printing and distributing the supplementary drug digestion catalogue in Qinghai Province clearly states that the remaining 98 varieties will be transferred in 2022, and the payment of medical insurance and work injury insurance will be stopped from January 1, 2023.
On March 3, the Anhui Provincial Medical Insurance Bureau issued the "Anhui Province Former Provincial Supplementary Class B Drugs 2022 Digestion Varieties Announcement", which shows that it is proposed to transfer 83 drugs such as lysine aspirin, shiitake polysaccharide, and pinotoxine out of the medical insurance directory.
"The key is to open up the national medical treatment system and the medical insurance system and realize the national networking, so as to truly smooth the settlement of different places." At present, the provincial medical insurance system has just been connected to the national medical insurance system, and there is still a lot of work to be done in the future. Nanchang Medical Insurance Bureau staff said.
"In view of the problems of decentralized inter-provincial settlement policies and large differences in management and service areas, the management measures for the direct settlement of basic medical insurance in different places will be introduced." Long Xuewen said that further unify the rules and procedures for direct settlement of inpatient and outpatient expenses across provinces, and basically achieve the unification of the scope of medical insurance drugs nationwide by the end of 2022.
Collection and mining save 260 billion yuan! Promote centralized procurement of drugs and high-value medical consumables
Li Xiaoli, a deputy to the National People's Congress, a model worker in Anhui Province, and a dispatcher of Hefei Fenghua Auto Parts Co., Ltd., released a message in the circle of friends, and the tone was difficult to hide excitement: During the two sessions in 2021, the "Proposal on Regulating the Collection of Dental Implant Materials and Including the Cost of Treatment and Service Costs into Medical Insurance as much as Possible" was responded by the National Medical Security Bureau.
Li Xiaoli, who made this suggestion, has a personal feeling. In January 2021, she went to the hospital for a toothache and was diagnosed with a recommendation that she implant 3 teeth, but the cost of up to 70,000 yuan was prohibitive for her. Subsequently, Li Xiaoli began to investigate the hospital and dental clinic, and after the investigation, it was found that the oral treatment clinic received an average of about 30 patients per day, and the average cost of a dental implant treatment was between 6,000 yuan and 25,000 yuan.
The cost of dental implants, which makes Li Xiaoli feel doubly worried, has also been put on the agenda by the National Medical Insurance Bureau. In its reply to Li Xiaoli, the National Medical Insurance Bureau pointed out that the opinions of clinical, enterprise and local governments have been extensively listened to, and the implant collection program has basically matured, and will strive to land in some areas in the first half of this year.
The inclusion of dental implants in the collection is one of the signals to promote the acceleration and expansion of collection and collection. According to the data released by the National Medical Insurance Bureau on February 11, from the cumulative results of the three years of reform, the national organization has saved more than 260 billion yuan in costs. Today, gathering is accelerating its expansion. Chen Jinfu, deputy director of the National Medical Insurance Bureau, revealed at a regular briefing of the State Council that by the end of 2022, through the procurement of national organizations and provincial alliances, an average of more than 350 drug varieties and more than 5 varieties of high-value medical consumables will be achieved in each province.
"It must be a good thing!" When talking about drug collection, Fang Laiying, member of the National Committee of the Chinese People's Political Consultative Conference and vice president of the China Hospital Association, told reporters. He gave an example to reporters that from the perspective of the medical insurance fund, the original 100 yuan can only pay two boxes of medical insurance funds, and after the price adjustment, it can pay three boxes or four boxes, and the saved funds can gradually cover more drugs.
At the same time, in the process of promoting the collection, it is still exploring ways to further improve the relevant supporting mechanisms. "In the future, the collection is more important than the rules, the characteristics of different bidding targets are very complex, need to meet the requirements of product quality, but also meet the clinical needs, but also to effectively allow enterprises and patients to share the fruits of reform." Chen Jinfu said.
Wu Ming, member of the National Committee of the Chinese People's Political Consultative Conference and director of the Department of Health Policy and Management of the School of Public Health of Peking University, told reporters that the key is to have sufficient returns, which determines the driving force of pharmaceutical innovation, involving multiple links such as research and development, registration and approval, patent protection, pricing, medical insurance access and payment, procurement, hospital access and use, and any problem in any link will affect innovation.
Lu Hongbing, member of the National Committee of the Chinese People's Political Consultative Conference and vice president of the All-China Lawyers Association, told reporters that there are "ten years and one billion US dollars" in the international community to develop an innovative drug, and innovative drug investment has the risk of "nine deaths and one life". If innovative drugs are faced with high investment and high returns brought by high risks as soon as they are listed, it will greatly dampen the enthusiasm for venture capital and the passion for scientific and technological innovation.
Lü Hongbing suggested that a more detailed policy rule for the "collection and procurement" of independent innovation drugs in the mainland should be formulated, and that enterprises that conform to cutting-edge innovative technologies should independently develop new drugs, especially biomedicine, be given a longer tolerance period, and enterprises should decide whether to enter the centralized procurement directory and enter the centralized procurement directory price discount space to encourage more market players to invest in the development of innovative drugs.
More than 40 kinds of drugs for rare diseases have been included in medical insurance to strengthen the protection of drugs for rare diseases
2022 is the fifteenth consecutive year that Ding Jie, a member of the National Committee of the Chinese People's Political Consultative Conference and a professor of pediatrics at Peking University First Hospital, has paid attention to rare diseases.
This year, there are two pieces of good news that have doubled her confidence: First, strengthening the protection of drugs for rare diseases has been mentioned again in the 2022 government work report after it was written into the government work report in 2019. Second, rare disease drugs have entered the medical insurance directory through the national medical insurance negotiations.
The first day of 2022 is also a significant day for a 5-year-old child with spinal muscular atrophy (SMA) Xiaoxi (pseudonym). 5 ml of Nocinasine sodium injection was injected into her body at the price reimbursed by Medicare.
Xiaoxi's mother, Faye Wong (pseudonym), told reporters that since she was diagnosed in April 2018, she did not start injecting Norcinasum sodium injection until July 2020. "It took 1.4 million yuan to buy two injections, plus the company's gift of medicine, and a total of 7 injections have been given so far." The amount of reimbursement for the commercial insurance we purchased, the part of our own expense this year and a half is about 260,000 yuan. It's like a mountain for our average working family, overwhelming us."
Lu Junlan, chief physician of the Department of Neurology at Beijing Children's Hospital, told reporters, "When Nosinassin sodium was not yet on the market two years ago, I could only say to all parents of children diagnosed with SMA that there was no rule of law for this disease. As a doctor, I can only watch my patients slowly wither, and that feeling is very weak. Now, we can finally answer the parents of the children: not only is there medicine now, but after the Sodium Injection enters the medical insurance, the patient's out-of-pocket expenses in the first year are about 40,000, and from the second year onwards, they can pay about 20,000 per year."
According to the National Medical Insurance Bureau's response to the proposal of the CPPCC National Committee in September, more than 40 drugs for rare diseases have been included in medical insurance.
At the same time, in response to the call for rare disease treatment drugs to be included in medical insurance, Fang Laiying suggested that relying on national medical insurance alone may not be realistic, and when thinking about how to let patients get these services earlier, we can mobilize the power of society to consider the overall design of national medical insurance, commercial insurance, various charitable funds, public welfare organizations, etc., from different angles to supplement, so that the latest scientific research results can benefit ordinary patients as quickly as possible, which requires new policy design.
Recently, the inclusive health commercial insurance "Huimin Insurance" established in many places. The reporter's incomplete statistics show that in 2020, a total of 111 products were launched in 179 prefectures and cities in 82 regions in 23 provinces, with a total of more than 40 million people insured and a premium income of 5 billion yuan. As of May 2021, a total of 140 products have been launched, covering 26 provinces, of which 64 contain rare disease drugs, of which 12 contain high-value rare disease drugs from the National Essential Medicines List.
Ding Jie suggested that high-value drugs for rare diseases should be included in local inclusive commercial health insurance. As a measure of inclusive people's livelihood protection, Huimin Bao is positioned as a supplementary payment for serious and exceptionally serious diseases outside the mainland's basic medical insurance catalogue, and at present, in the case of high-value rare disease drugs failing to enter the medical insurance drug list, we should actively explore high-value rare disease drugs to enter the inclusive commercial health insurance of various places.
Professor Mao Zongfu, a deputy to the National People's Congress and director of the Global Health Research Center of Wuhan University, suggested that attention should be paid to the top-level design of macro policy guidance, such as the establishment of an inter-ministerial joint meeting on inclusive insurance at the national level to comprehensively guide local pilot work; at the same time, encourage local orderly first trials, and explore diversified financing methods in combination with actual conditions. In the operation mode of rare disease protection, it should ensure that all stakeholders can continue to participate, ensure that each subject performs its own duties, gives full play to subjective initiative and enthusiasm, and improves the quality of life and the level of protection of rare disease patients.