With the gradual deepening of the reform of medical insurance accounts, the adjustment of medical insurance payment policies for retail pharmacies across the country is also accelerating.
Sentence | Yoshiko
Recently, the National Health Insurance Bureau issued an announcement on soliciting participants at the Symposium on the Reform of Medical Insurance Payment Methods to further deepen the reform of medical insurance payment methods.
01
All localities have gradually adjusted the payment of medical insurance for pharmacies
Since the implementation of the reform of employees' medical insurance personal accounts, all localities have actively implemented the new regulations on the basis of the state's top-level policies, and gradually adjusted the medical insurance payment policies of retail pharmacies.
During 2023, Shanghai further optimized the management of designated retail pharmacies. For the use of funds from medical insurance personal accounts to purchase over-the-counter drugs, restrictions on the types of medicines, the frequency of drug purchases, and the cost of drugs have been relaxed. At the same time, Shanghai has also expanded the scope of personal account payment, adding 32 kinds of equipment consumables commonly used by citizens, with high demand, good safety and strong applicability, and the insured can use personal account funds to purchase in designated pharmacies.
In addition, Shenzhen has also made policy adjustments, and the city has canceled the "threshold" for the purchase of over-the-counter drugs in designated retail pharmacies and the mutual aid use of family members in the medical insurance personal account, and the insured can use it within the scope stipulated by the state, Guangdong Province and the city as long as there is a balance in the medical insurance personal account.
In January this year, Jin Weijia, director of the Anhui Provincial Medical Insurance Bureau, said in a public interview that Anhui will expand the use of employees' medical insurance personal accounts, and in 2024, all remote networked designated pharmacies in the country can use their personal accounts to purchase drugs.
The adjustment of the medical insurance payment policy of retail pharmacies in various places has made it convenient for insured employees to purchase drugs in designated retail pharmacies, and at the same time, it has also allowed the chain to obtain further incremental opportunities. At the same time, the implementation of the policy of incorporating designated retail pharmacies into the overall management of outpatient clinics has further released the dividends of medical insurance reform, which is also a new opportunity for pharmacies.
Zhong Chongming, a researcher at the Medical Insurance Payment Research Center of the Medical Consortium of the China Medical and Health Culture Association, said that the reform of medical insurance payment methods has a positive impact on the operation and service of pharmacies. "First, in addition to the hospitalization payment method, some high-value drug consumption to achieve the expansion of the channel accessible to patients, pharmacies can cut a considerable proportion of it; second, the active or passive reduction of the number of days of hospitalization has a subtle impact on the patient's awareness of medical consumption, home treatment, pharmacy medicine and other consumption trends are gradually rising. ”
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The income of medical insurance accounts has shrunk significantly
Not long ago, the National Health Insurance Administration announced the data of the medical insurance fund in 2023, and the funds in the medical insurance account have decreased significantly.
By the end of 2023, the cumulative balance of the national basic medical insurance fund will be 4,775.556 billion yuan. Among them, the cumulative balance of the employee pooled fund, the personal account of employees and the medical insurance of urban and rural residents was 2,640.6 billion yuan, 1,386 billion yuan and 758.9 billion yuan respectively, accounting for 55%, 29% and 16% respectively.
Among them, the income of employees' medical insurance personal accounts in 2023 will be 624.5 billion yuan, and this data will be about 763.3 billion yuan in 2022, a decrease of 138.8 billion yuan in 2023 compared with 2022, a decrease of 18%. Affected by the reform of medical insurance personal accounts, the personal accounts of employees' medical insurance will shrink significantly in 2023.
The relevant person in charge of a pharmacy in Hebei told the "First Pharmacy Caizhi" that their pharmacy is very dependent on medical insurance reimbursement, and the proportion of medical insurance reimbursement in pharmacies before the personal account reform was 55%, and during this year, the proportion fell by 10%. "It's down to 45 percent now, and it's still falling. ”
In response to this phenomenon, he said frankly that pharmacies are now increasing the scope of non-drug business and expanding revenue, and also hopes that more business scope can be opened up in the policy to increase the profit margin of pharmacies.
Some people in charge of relevant pharmacies bluntly said that after the reform of personal accounts, the number of customers and customer orders in pharmacies has decreased significantly, which has had a greater impact on corporate revenue. "Although pharmacies have been included in the overall management of outpatient services, they have not yet saved the declining customer flow. ”
Industry insiders said that the personal account pool is expected to become smaller and smaller in the future, and in the fierce market competition, it will be a must for pharmacies to open outpatient co-ordination services.
Just like the previous policy, while the funds in personal accounts have decreased, many places have begun to relax the restrictions on the use of their categories, funds, and regions.
In this regard, Zhong Chongming put forward his views: First, pharmacies should actively do a good job in operating services on the premise of the current conditions of medical insurance operation. For example, if the contract of insulin procurement has just ended, capable pharmacies can cooperate with hospitals and clinics to do relevant policy education and product introduction in the store. Second, we must get rid of medical insurance fraud and operate legally. The medical insurance payment standard has not yet been completed, and pharmacies make good use of this window period to closely connect with the needs of the surrounding business environment with good medical insurance and high-quality services. The third is to be cautious about the blind expansion of the number of varieties and specifications of pharmacies, and try to coordinate with other business projects under the theme of highlighting the overall planning of medical insurance outpatient clinics and the use of individual accounts.
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Is de-medical insurance the way out for pharmacies?
There are many voices in the industry that in the future, pharmacies can be reimbursed for less and less personal account funds, gradually compress the retail market, and it is no longer realistic to only focus on medical insurance drainage, and pharmacies need to go to medical insurance and seek new incremental space.
In the view of Cang Chun, a practical expert in the pharmaceutical retail industry, de-medical insurance is a very important topic for pharmacies in the next five years, and the decline in customer flow is inevitable.
In this regard, Zhong Chongming bluntly said that during the reform of medical insurance, the strategy and tactics for pharmacies will become more and more open, and pharmacies should not be closed, locked and trapped. "All payers are upstream, pharmacies are downstream, but it's all the same river. Refusing water from upstream is a disaster for downstream. ”
Zhong Chongming further said that in the context of medical insurance reform, pharmacies, as a traditional old industry, are encountering an unprecedented new situation, and the competition of physical pharmacies has ushered in many new faces. Therefore, pharmacies should strive for price and profit margins for medical insurance and upstream supply chains, and strive for room for maneuver in operation. "For medical insurance, we must gradually stand at the same level of bargaining position as medical care and commercial insurance. Chains or single stores should plan the business growth curve, and improve the quality of operation and service perception as the moat. ”
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