Recently, several rumors about medical insurance have spread on the Internet, such as "pharmacies have stopped co-ordinating quota payments" and "medical insurance outpatient co-ordination will not be reimbursed by the end of December". In this regard, the medical security bureaus in many places issued statements to refute rumors.
Inner Mongolia: "'Policy cancellation' is pure rumor, and 'zero at the end of the year' is a misunderstanding and misreading of the medical insurance policy!" Inner Mongolia Xilin Gol League Medical Security Bureau said that Xilin Gol League will implement the outpatient mutual aid security mechanism of basic medical insurance for employees from October 1, 2022, and the system stipulates that the outpatient co-ordination treatment standard is that within a natural year, the general outpatient medical expenses incurred by the insured personnel within the policy scope of the designated medical institutions shall be settled according to the policy. In 2024, the outpatient expenses of insured employees will be re-accumulated, and they will enjoy the outpatient co-ordination treatment according to the regulations after reaching the minimum payment standard. Therefore, there is no such thing as "zero reimbursement amount" and "policy cancellation".
Hunan: The relevant person in charge of the Hunan Provincial Medical Insurance Bureau said that the annual reimbursement amount of medical insurance is the maximum payment limit that the medical expenses incurred by the insured can be reimbursed by the medical insurance pooling fund in a natural year. In the new natural year, the annual reimbursement amount of the general outpatient clinic of the employee medical insurance will be updated according to the new statistical data to ensure that the insured receives continuous and adequate amount protection. In other words, after the end of 2023 and into 2024, the annual reimbursement amount of the insured person's outpatient co-ordination will be updated according to the new statistics in 2024 and calculated in the new natural year. Therefore, there is no such thing as "clearing", "waste", or "money refunded if it is not used up".
Jiangxi: Recently, there have been rumors on the Douyin account that "Jiangxi pharmacies have stopped coordinating quota payments". After verification, the rumor is a false rumor on the Internet. According to the preliminary investigation, some designated retail pharmacies have recently been driven by profits, misinterpreted the medical insurance outpatient co-ordination policy, wrongly advertised that "outpatient co-ordination is not used, and the quota will be cleared at the end of the year", and even issued prescriptions online through Internet hospitals to obtain outpatient co-ordination funds, causing major safety hazards to the implementation of outpatient co-ordination policies and the safety of medical insurance funds. At present, the local medical security department has verified the relevant Internet hospitals and designated retail pharmacies, and the relevant Internet hospitals and designated retail pharmacies are also being rectified as required.
China's medical insurance policy and catalogue adjustments
In recent years, the adjustment of the medical insurance catalogue has gradually become normalized, and the frequency of adjustment is once a year. On September 6, 2022, the National Health Insurance Administration issued the "2022 National Medical Insurance Drug List Adjustment Passed the Preliminary Form Review of Drugs and Information", and 344 varieties were shortlisted, involving 229 companies, and a total of 199 off-catalog varieties met the adjustment conditions.
In recent years, the mainland has actively built a framework for the medical security system with Chinese characteristics, and has unremittingly promoted major reforms to promote the smooth operation of medical security. The scale of the National Medical Insurance Fund continues to expand. In 2022, the revenue of China's basic medical security fund will reach 3.1 trillion yuan, and the expenditure will reach 2.4 trillion yuan. The number of people participating in basic medical insurance nationwide has reached 1.34 billion, and the participation rate has remained stable at more than 95%.
This year is the sixth consecutive year that the National Medical Insurance Drug Catalogue has been adjusted, and a total of 126 new drugs have been added to the adjustment, of which 121 drugs have entered the National Medical Insurance Drug Catalogue through negotiation or bidding, which is the most in the past years, with an average price reduction of 61.7%. Covering chronic diseases, rare diseases, children's drugs and other fields, a large number of new mechanisms and new target drugs have been included in the catalog.
Li Xuri, a negotiation expert of the 2023 National Medical Insurance Drug List Negotiation Group: "Some innovative drugs can enter clinical use in a timely manner through negotiation, and can quickly occupy the market after entering the medical insurance payment, encouraging pharmaceutical institutions to increase their efforts to develop innovative drugs, and more good drugs will appear on the market." ”
Prospective Economist APP Information Group
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