"Life-saving medicine" brought out the catalog, why does inclusive insurance become commercial insurance?

  Feng Haining

  Yueyue in Suzhou, Jiangsu Province suffers from a rare disease called "Mucosaccharidosis Type (MPSⅡ, also known as Hunter Syndrome)". The specific drug for this disease is Haris. It was approved in China in September 2020. It was listed and was included in the Suhuibao protection catalog in March 2021.

Just as the patient’s family thought they saw hope, they discovered that the 2022 version of Su Huibao, which went on sale in October this year, had brought Hai Ruisi out of the catalog, "like a roller coaster ride."

  Suhuibao is a kind of inclusive supplementary commercial medical insurance (referred to as inclusive insurance). The name is slightly different in different places. It is called "Jinghuibao" in Beijing and "Sui Suikang" in Guangzhou.

Due to the advantages of low insurance threshold, low price, high reimbursement ratio, unlimited age, unlimited household registration, unlimited medical history, etc., inclusive insurance has been favored by the public once it was launched.

However, Su Huibao was questioned because he brought out the list of "life-saving medicine" for patients with rare diseases.

  In response, the local medical insurance hotline responded that Su Huibao is a commercial insurance, which is subject to the policy of the insurance company. The adjustment of the drug catalogue is a company action.

The insurer said that there is little hope of including Hi-Res in the 2022 Suhui Insurance.

It is possible that not many people use this medicine, or it has been replaced by other medicines.

According to incomplete statistics, only 4 people in Suzhou suffer from MPSⅡ.

  Due to the limited coverage of inclusive insurance and the limited types of drugs included in the catalog, it is not surprising that HiRes, which has few users, was removed from the protection catalog.

If not, it may affect the entry of drugs with a large amount of use into the catalog, thereby affecting the universality of the insurance.

At the same time, the insurance has commercial attributes, and drugs with fewer users occupy the catalog, which will affect the performance of the underwriting company.

From the perspectives of inclusiveness and commerciality, it is understandable that the drug has been brought out of the catalog.

  However, looking at it from another angle, there is something wrong with insurance companies bringing out "life-saving drugs" from the catalog.

First of all, the catalog adjustment has not been fully considered.

It is necessary to fully investigate and demonstrate before transferring, and appropriate buffering is required before transferring, so that the patient cannot be overjoyed and unable to adapt.

Secondly, as universal insurance is undoubtedly different from pure commercial insurance, insurance companies cannot be profiteering.

Moreover, one of the characteristics of insurance is mutual assistance, and it is impossible for every policy to make money.

  If inclusive insurance underwriters only value commercial returns, then inclusive insurance will tend to "commercial insurance."

Of course, when we discuss this kind of universal insurance, we also need to see how strong the local government supports universal insurance.

If the local government only provides guidance, without taxation, financial support, etc., the insurer will have complete autonomous decision-making power.

But if the government provides tangible support, the insurer cannot decide whether to enter or exit drugs at will.

  Although many patients with rare diseases belong to a niche group, they are "very few" in terms of numbers relative to patients with common diseases, but they should also receive corresponding welfare guarantees.

On the one hand, we must strive to include more specific drugs for the treatment of rare diseases into medical insurance.

In recent years, more and more drugs for rare diseases have been included in medical insurance, which is a welcome progress, but we must continue to work hard.

On the other hand, inclusive insurance in various regions should also be used as a benefit for patients with rare diseases to reduce their burden on the basis of medical insurance.

  In the next step, whether localities can use pragmatic policy support measures to encourage insurers to include more rare-disease drugs in the general insurance coverage list and ensure the continuity of certain specific drugs is worthy of discussion.

Once government support increases, it is clear that the right to speak for inclusive insurance will increase.

In addition, can a special policy be issued for the protection of drugs for patients with rare diseases?

It is estimated that there are about 20 million people affected by rare diseases in my country, and this group should receive corresponding attention and care.

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