These "good things in the hospital" are getting cheaper and cheaper, and most people don't know it

Many of the measures of health care reform have really affected our lives, and these reforms, if summed up in one word, are "affordable".

More and more people can enjoy high-quality medical services at lower prices, including drugs, medical equipment, and resources of large hospitals.

Do you know the benefits of these health care reforms?

In 2022, the new version of the National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalogue (2021) was officially implemented. The catalogue added 74 new drugs outside the catalogue, including 67 exclusive drugs transferred in the negotiation and 7 non-exclusive drugs directly transferred, of which the average price reduction of the exclusive drugs successfully negotiated was 61.71%[1].

The 74 drugs include many commonly used drugs for patients with chronic diseases such as cancer and hypertension, and some "sky-high drugs" have also been included.

After the adjustment of the catalogue, the total number of drugs in the national medical insurance drug catalogue is 2860, including 1486 kinds of Western medicines and 1374 kinds of proprietary Chinese medicines, and the number of Chinese medicine tablets in the catalog has not been adjusted, and it is still 892 kinds. (The specific directory can be viewed: the official website of the National Medical Insurance Bureau: http://www.nhsa.gov.cn/art/2021/12/3/art_37_7429.html)

Drugs are included in the medical insurance list, and for patients, the price of drugs is reduced, and there is medical insurance to reimburse.

On the one hand, before being included in the medical insurance directory, the medical insurance bureau will negotiate price reductions with pharmaceutical companies, and the prices of the drugs themselves will be reduced, and in 2021, the overall price reduction of the 74 drugs newly added to the list will reach 61.71%.

Taking the diabetes drug meglutide injection as an example, this drug is also included in the new version of the medical insurance directory. This is a long-acting hypoglycemic drug, which only needs to be used once a week, but the drug is expensive, and it costs about 170 to 750 yuan a week. (1.5 ml specification price 1120 yuan, the initial dose of 0.25 mg once a week, after which gradually increased to 1 mg, it is not recommended to do more than 1 mg per week)

In 2022, after entering the medical insurance directory, the price dropped to 478 yuan, and the drug cost could be reimbursed proportionally according to local policies, and the number of diabetic patients in China was the largest in the world, nearly 114 million [2], which allowed more patients to use the latest drugs at lower prices.

Most importantly, if you meet the local general outpatient or outpatient special drug reimbursement policy, medical insurance can be reimbursed when taking drugs.

Taking Beijing as an example, if you buy drugs in the medical insurance directory in the hospital when you see a doctor in an outpatient clinic, and have reached the outpatient reimbursement threshold of 1800 yuan, the incumbent only needs to pay 30% of the drug cost.

Beijing Outpatient Reimbursement Policy

The outpatient reimbursement threshold is 1800 yuan for in-service personnel and 1300 yuan for retirees. The reimbursement ratio is 70%-90% according to the type of personnel and the level of medical institutions seeking medical treatment, and the cap line is 20,000 yuan.

The minimum payment line for hospitalization reimbursement is 1300 yuan, and the reimbursement ratio varies according to the type of personnel and the segmentation of expenses, which can reach more than 85%, and the reimbursement cap line is 500,000 yuan.

There is a saying that there is only one disease in the world, the disease of poverty.

This is especially true in the field of oncology. Compared with traditional chemotherapy drugs, many new anti-tumor drugs — targeted drugs — have low toxicity, high selectivity, and good efficacy, but are expensive to treat without Medicare reimbursement [3].

Before 2018, the Medicare catalog lagged far behind clinical recommendations, with many oncology treatment guidelines recommending innovative drugs, but many of these drugs were not included in Medicare. Taking colorectal cancer treatment as an example, before the medicare drug list was dynamically adjusted, only cytotoxic drugs were in the catalog, and no targeted drugs were available [4].

In the past three years, anti-tumor drugs have been the highlight of the adjustment of the medical insurance catalog.

In 2021 alone, the adjustment of the national medical insurance catalogue will add 18 new anti-tumor drugs, accounting for 24% of the total number of new drugs, which is a life-saving drug for many tumor patients.

The four domestic PD-1/L1 are also all included in medical insurance, with a price reduction of more than 80%, and the price of PD-1 has been directly pulled from 300,000 yuan / year that is "unaffordable" to about 100,000 yuan / year.

Although this price is still high for many patients, it has been greatly reduced and may be lower in the future.

Taking the first-line treatment drug osimertinib for lung cancer as an example, in 2018, the National Medical Insurance Bureau organized special negotiations on anti-tumor drugs, and the monthly cost of osimtinib was directly reduced to 15,300 yuan. In 2020, the drug re-entered the medical insurance negotiations as a first-line drug, and the price was reduced to 5580 yuan per month [5].

There are also more and more drugs for rare diseases in the medical insurance list.

The 2020 edition of the medical insurance catalogue contains 45 drugs for rare diseases, covering 22 rare diseases; the 2009 edition of the medical insurance catalogue contains 22 drugs for rare diseases, covering 13 types of rare diseases.

The world's first SMA disease correction treatment drug, sodium northinalsen, was listed in China in 2019 and priced at 700,000 yuan a shot. The initial dose of nocinazine sodium injection is 4 injections within two months, and the subsequent maintenance dose is 1 injection every 4 months, which requires lifelong medication.

Even if only the starting dose is counted, 4 injections cost 2.8 million yuan, which is a real "sky-high drug".

In 2021, the National Medical Insurance Bureau announced a new version of the national medical insurance drug catalog, Nocinasine sodium after 8 rounds of price negotiations, the price of a needle dropped by more than 600,000 yuan, to about 33,000 yuan, patients can also enjoy medical insurance reimbursement, self-payment as low as about 1,000 yuan.

The dynamic adjustment mechanism of the medical and pharmaceutical catalogue has been initially established, and the adjustment period has been shortened from a maximum of 7 years to 1 year.

The dynamic adjustment of the medical insurance drug list will transfer drugs with low clinical value out of the catalog, and drugs with high clinical value and good economy will be transferred to the catalog.

The goal of centralized procurement of drugs is: to exchange the price for quantity, that is, to discount the amount of large amounts.

The Medical Insurance Bureau came out to bid, and pharmaceutical companies bid, exchanging quantities for prices to bring more benefits and benefits to patients.

At present, the centralized procurement of drugs is also a regular project. In 2021 alone, three batches of national drug centralized procurement were carried out.

Speaking of collection, I have to say that the "star medicine" metformin hydrochloride. This is a first-line hypoglycemic drug for the treatment of type 2 diabetes, and after collection, the average price of a single tablet of 0.5 g is only 6 cents, and the monthly drug cost for patients is only 6% of the past [6].

Not only medicines, but also the collection of surgical equipment.

The first batch of coronary stents selected in the national centralized procurement of the number of coronary stents landed on January 1, 2020, and the average price of 700 yuan of coronary stents benefited a large number of patients.

An analysis of the coronary stent surgery data of four medical institutions in Anyang City, Henan Province, found that the cost of stents in the four medical institutions after the price reduction was more than 80%, and the highest price reduction was 92.54%[7].

In September 2021, the second batch of national high-value medical consumables collected and targeted artificial joints, including artificial hip joints and artificial knee joints. After the collection, the average price of the proposed artificial hip joint dropped from 35,000 yuan to about 7,000 yuan, and the average price of artificial knee joint dropped from 32,000 yuan to about 5,000 yuan [8].

Personal account reform, the money in your health insurance card, less, but also more "mutually helpful".

Generally speaking, part of the money in the medical insurance account of urban employees is paid by themselves, and part of it is paid by the employer.

In the past, the money in the personal account of medical insurance was 30% of the total amount of individual medical insurance contributions and the unit medical insurance contributions.

In the reform of the medical insurance personal account, the unit payment is no longer included in the personal medical insurance account, and on the surface, the money in your personal medical insurance account will "shrink" by 50%.

However, it is also more "mutually exclusive".

The latest medical insurance reform policy has three main points:

1. Outpatient treatment has been improved - after the reform, the general outpatient medical expenses of multiple diseases and common diseases will gradually be included in the scope of payment of the pooled fund, and the payment ratio will start from 50%, before, outpatient clinics can only be paid through personal accounts, and after exceeding the quota, they need to be solved at their own expense.

2. The personal account benefits a wider range of people - the medical insurance personal account of the active employee can pay for the medical expenses of the spouse, parents and children of the employee.

Suppose you are Xiaoming, an employee of an enterprise, and after the reform of the personal medical insurance account of urban employees, it will have such an impact on you:

Suppose, your monthly salary is 10,000 yuan, and the original monthly medical insurance personal account will deposit 380 yuan.

After the reform, Xiaoming Medical Insurance personal account funds will be reduced by about 50%, that is to say, the personal account will only deposit 200 yuan per month, and the other 180 yuan will be included in the pooled fund, that is, the personal account will shrink by about 50%.

Don't worry, though, the money in your original personal account won't change. Outpatient mutual aid does not use the money that exists in the employee's account.

At the same time, the money in your personal account is more widely available. The personal account of medical insurance has been broadened from only individual payment to family members such as spouses, children, and parents, and from only being used for drug payment to medical consumables and medical devices.

In fact, the health care reform that began in 2009 is not only that, but there is much more.

All of these are headed for a big goal -

Let more people enjoy good medical services.

Review expert: Wu Jing

Professor and doctoral supervisor of School of Pharmaceutical Science and Technology, Tianjin University

bibliography

[1] Guangming Network.74 new drugs added to the medical insurance directory "Shangxin" to expand the beneficiaries.2021.12.05.https://m.gmw.cn/baijia/2021-12/05/1302706559.html

[2] Luo Z, Fabre G, Rodwin VG. Meeting the Challenge of Diabetes in China. Int J Health Policy Manag. 2020;9(2):47-52. Published 2020 Feb 1. doi:10.15171/ijhpm.2019.80

Tian Jingang,Wang Xuechen,Xie Mingming,Zhu Minglai. Feasibility study on the inclusion of tumor-targeted drugs in the scope of medical insurance payment[J].China Medical Insurance,2016,(03):39-42.

China Medical Insurance. After the adjustment of the drug list and the purchase of quantities, what new changes have taken place in the management of medical insurance drugs in mainland China? 2021-11-16

http://hsa.gd.gov.cn/zwdt/ywsd/content/post_3659063.html

[5]http://www.xinhuanet.com/politics/2021-04/06/c_1127295990.htm

[6]http://www.gov.cn/xinwen/2020-12/15/content_5569468.htm

Xing Jianguo,Wu Zhou. Analysis of hospitalization costs of patients before and after the price reduction of coronary stents in Anyang City[J].China Medical Insurance, 2021(08):68-70.

Beijing Youth Daily. Artificial joint collection the proposed price reduction of the selected products by 82%. September 15, 2021

http://epaper.ynet.com/html/2021-09/15/content_383327.htm?div=0

Author: Zhang Xiaoyi

Editors: Zhang Xiaoyi, Wu Jiaxiang, Zhang Jie

Proofreading: Wu Yihe | Typesetting: Li Yongmin

Operation: Han Ningning | Coordinator: Wu Wei