The Health Insurance Bureau issued a document,
Direct settlement of medical insurance for centralized procurement of consumables!
On the evening of April 28, the Henan Provincial Medical Insurance Bureau issued the "Notice on Preparing for the Direct Settlement of the Payment of Selected Products in Centralized Procurement with Volume" (hereinafter referred to as the "Notice"), which announced:
Henan Province is scheduled to officially launch direct settlement on April 30, 2024. From May 1, pharmaceutical companies can initiate a direct settlement application for the payment of selected drugs in April through the direct settlement system.
The "Notice" also announced the specific implementation of direct settlement hospitals, including 18 hospitals from 17 prefecture-level cities in Henan Province, including 9 tertiary and 5 tertiary hospitals, as shown in the following figure:
It's not a big deal, but it's just the first step. As early as April 12, the "Implementation Plan for Direct Settlement between the Medical Insurance Fund and Pharmaceutical Enterprises for the Centralized Procurement of Drugs and Medical Consumables in Henan Province" was officially issued, which made it clear:
In the designated medical insurance medical institutions that provide inpatient services in the overall planning areas of Henan Province, all the drugs and medical consumables that participate in the centralized procurement at the national and provincial levels are included in the direct settlement of the medical insurance fund.
Starting from April 2024, starting with drugs, one tertiary medical institution and some pharmaceutical companies with wide coverage and strong distribution capacity will be selected in each region to carry out direct settlement pilots. Then the medical consumables will be included in it in a timely manner, and finally realize the direct settlement of the province-wide centralized procurement of drugs and medical consumables medical insurance.
There is no doubt that the direct settlement of medical insurance for centralized procurement of drugs and consumables in Henan Province will be fully implemented!
The Central Commission for Discipline Inspection exposed:
"Difficult to repay" breeds pharmaceutical corruption!
In fact, behind the current nationwide promotion of direct settlement of drugs and medical consumables and medical insurance, it is precisely because of the "difficulty in repayment" that the problem of pharmaceutical corruption is increasingly exposed.
Among the cases exposed by the anti-corruption of medicine, many of the cadres under investigation have come from the finance department. Among them, the corruption of the financial department of some hospitals is directly related to the collection of corporate payments. Some hospitals have been in arrears for a long time to pay for drugs in large quantities as working capital or to seek value-added benefits, which breeds power rent-seeking and corruption.
According to the article "Rectifying Medical Corruption and Stubborn Diseases" issued by the Central Commission for Discipline Inspection, in the Xiangshui County People's Hospital of Jiangsu Province, the supplier's invoice entry, reconciliation, and payment collection could not bypass Liu Mourong, the former head of the Finance Department. In order to get the "payment" and return the funds as soon as possible, the supplier often offers "sincerity". Between 2015 and 2021, he illegally accepted bribes from suppliers and others such as cash and shopping cards, totaling more than 480,000 yuan.
It is not difficult to find that at present, corruption in the field of drug consumption purchase and sales has penetrated into the financial department and is directly linked to the problem of payment collection, which is precisely because the problem of hospital arrears is serious.
For example, at the beginning of this month, the Guangxi Medical Insurance Bureau disclosed that it had received reports from enterprises that some medical institutions had been in arrears for a long time. After investigation, it was found that there were 22 medical institutions in the region that had not returned the payment for more than 6 months, with an amount of 6.0127 million yuan, of which 10 medical institutions had not returned for more than 1 year, with an amount of 5.1802 million yuan.
Many provinces have landed one after another!
Bypass the hospital to settle the payment for consumables
At the same time as the anti-corruption of medicine is comprehensively promoted, the direct settlement model of medical insurance, which solves the core problem of difficulty in repayment, has also been rapidly promoted across the country.
Tianjin
Tianjin Municipal Medical Insurance Bureau disclosed in January this year that since July 2020, it has taken the lead in implementing the direct settlement of selected drugs and consumables by the medical insurance fund, and by the end of 2023, 751 medical institutions have been included in the direct settlement, and 203 pharmaceutical companies have been paid a total of 2.333 billion yuan. The next step will be to optimize and improve the settlement method and gradually expand the scope of direct settlement.
Hunan
Since October last year, Hunan has implemented the province-wide centralized procurement of selected drugs and medical consumables, and the payment for the selected drugs and medical consumables is directly settled by the medical insurance fund.
Shandong
In 2021, four departments, including the Shandong Provincial Medical Insurance Bureau, issued the "Implementation Plan for Direct Settlement of Drugs and Medical Consumables Payments of Designated Public Medical Institutions for Medical Insurance Funds and Pharmaceutical Enterprises", making it clear that the direct settlement between medical insurance funds and pharmaceutical enterprises will be fully implemented in 2025, becoming the first province in the country to clearly and comprehensively promote direct settlement.
Fujian
In 2022, the "Fujian Provincial Interim Measures for the Administration of Settlement and Payment of Medical Security Drugs and Devices" was issued, and the settlement department will settle the payment for drugs and devices to the drug and device distribution (supply) enterprises on behalf of medical institutions, and the relevant expenses will be deducted from the medical insurance settlement payment, and the remaining part will be paid to the medical institution by the settlement department.
Not only that, with the advancement of consumables with volume procurement, more provinces have clearly included centralized procurement of consumables directly into the direct settlement of medical insurance:
Up to now, 25 provinces have launched the procurement subsystem nationwide, and 16 provinces have promoted the direct settlement of consumables for medical insurance. With the acceleration of the expansion of centralized procurement of consumables, the direct settlement of medical insurance relying on the procurement system has begun to be implemented nationwide.
Under this, the "triangular debt" problem between medical insurance, hospitals, and suppliers, which has been difficult to solve for many years, is expected to be completely solved from the source, and the number of distribution companies trapped in cash flow pressure will also be greatly reduced.
Source: Medical Device Distributors Alliance