Ningbo explores the use of medical insurance personal accounts to pay for dental implant projects to guide prices back to a reasonable space, which has attracted widespread attention
Is it possible for dental implants worth tens of thousands of yuan to be covered by medical insurance?
Professionals suggest that various methods should be used to squeeze out the "moisture" and reduce the price of dental implants
Our reporter Chen Xi
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Planting a tooth costs 10,000 yuan, and it is not included in medical insurance reimbursement, which puts pressure on many patients.
The functional positioning of medical insurance is to "guarantee basics."
Currently, medical insurance is mainly coordinated at the prefecture and city level.
Professionals believe that if the medical insurance fund is used to pay for the cost of dental implants, it may be unbearable in many areas. Compared with the medical insurance, lowering the price of dental implants is the key.
"Don't look at the teeth, the tooth hurts; after seeing the teeth, I feel distressed." Recently, Dalian, a post-85 white-collar worker, Shen Chen spent 17,000 yuan on planting a tooth, which is equivalent to her two-month salary. Moreover, she couldn't get her medical insurance card.
When it comes to implants, many people's first reaction is expensive.
During the National People’s Congress this year, Li Xiaoli, a representative of the National People’s Congress, proposed that the average treatment cost for a dental implant ranges from 6,000 yuan to 20,000 yuan.
She suggested that the cost of dental implants should be included in medical insurance as much as possible to meet the needs of the people for oral health.
In August of this year, the Ningbo Municipal Medical Insurance Bureau of Zhejiang Province issued the "Plan for Further Clarification of Medical Insurance Account Payment for Dental Implant Projects (Draft for Comment)", planning to adjust the overall medical insurance payment standard for dental implant projects, which made many netizens envy.
Recently, Sichuan and Ningxia have successively started to fill in the historical procurement data of dental medical consumables.
Analysts believe that these actions have released a signal that dental implants are expected to reduce the burden on patients through centralized procurement at the price of quantity.
Implants with a price of 10,000 yuan, nearly half of the cost is used to "shop the market"
Generally speaking, dental implants are implants (artificial tooth roots) made of pure titanium and implanted into the alveolar bone of the missing tooth. When the osseointegration is completed, a matching artificial tooth crown is placed on top of it.
Dental implants have always been the most expensive item in dentistry because they can obtain restoration effects that are very similar to the function, structure and shape of natural teeth.
Breaking down to the specific link, the Pacific Securities Research Report shows that implants, as the core material, cost between 3,500 yuan and 12,000 yuan, accounting for 50% of the overall cost; the total cost of surgery and anesthesia is between 3,000 yuan and 5,000 yuan, accounting for 25%; of the remaining costs, restorative materials and implant abutments each account for 10%, and dental crowns account for 5%.
It can be seen that dental implants are expensive, mainly in implants and medical service fees.
An analysis report pointed out that the implants on the market are mainly imported brands such as European and Korean brands, and the market share of domestic brands is still less than 10%.
Zhou Bingyuan, a doctor at a third-level dental hospital, told reporters that the price of many imported brand implants is three times that of domestic brands.
In contrast, domestic brands started late and are still in the technology-following stage. They lack sufficient clinical data to support them. Although the prices are low, doctors are reluctant to try and make mistakes, and the acceptance rate of patients is not high.
Some expenses are not publicly recognized, but they cannot be ignored.
Huang Liang, a manufacturer of restoration materials, revealed that due to the homogeneity of competition, businesses have invested a lot in marketing. '."
At the same time, the scarcity of domestic planting doctors has also pushed up prices.
Lin Ye, deputy dean of Peking University School of Stomatology, once said that to get a good tooth, good materials are not enough, and good clinical training is needed.
Generally speaking, a person can enter this professional field after at least 10 years of medical studies.
Highly demanding technical standards, the corresponding learning costs are very high, which will eventually be reflected in the treatment costs.
Zhou Bingyuan introduced that the dental implantation process is complicated, the technical barriers are high, and the auxiliary equipment is expensive. Patients need to see a doctor at least 4 to 5 times. The doctors serve for several months before and after, and the labor cost is not low.
Explore skip middlemen and reduce material prices
According to the current medical insurance policy, therapeutic dental items, such as tooth extractions, fillings, root canal treatments, etc., are reimbursed, while dental implants, orthodontics, and tooth whitening are included in the cosmetic restoration items and are not included in the medical insurance payment scope.
Wang Tianyu, associate professor of the Department of Social Security of the School of Labor and Human Resources of Renmin University of China, analyzed that the functional positioning of medical insurance is "basic protection". Dental implants are not the only option for restoration of missing teeth. They can be replaced by lower-priced movable dentures and fixed teeth. Most countries are self-funded projects.
However, with the development of economy and society, people desire a higher quality of life.
Although movable dentures and fixed teeth are relatively cheap, they have disadvantages such as strong foreign body sensation and need to wear natural teeth.
Therefore, more and more people choose dental implants.
Last year, the Jinan Political Consultative Conference proposed to "Expand the scope of reimbursement for oral medical care," suggesting that dental implant materials should be included in the payment scope of the overall fund, but it was not possible because of immature conditions.
Starting from the medical insurance account this time, Ningbo plans to establish a catalog of dental implant brands that can be paid by the account for the citizens. The payment standard is: domestic material fee of 1,000 yuan, imported material fee of 1,500 yuan, covering implants, abutments, crowns, and restorations. Cost of consumables such as accessories and supporting tools; medical service fee of 2,000 yuan, including oral CT and other related auxiliary examination costs, and medical service costs within six months after dental implantation.
Wang Tianyu explained that the medical insurance fund consists of a social pooling fund and personal accounts, and the "reimbursement" that the public usually calls is paid by the pooling fund.
The medical insurance account over the years refers to the fund balance in the personal account.
Ningbo's move means that patients can use the money in their medical insurance accounts to pay for dental implants. The significance is to further utilize personal accounts and make good use of medical reserves.
So, how to achieve price reduction?
The relevant person in charge of the Ningbo Medical Insurance Bureau said that he would skip middlemen and talk directly to the source manufacturer to reduce the price of materials.
Zhou Bingyuan believes that there is still room for discussion.
"It's not about planting the upper teeth for half a year without problems, but also including the costs of postoperative maintenance, periodic review, and restoration. The plan has not been considered for the time being."
Reducing the price of dental implants is the key
In September this year, the National Medical Insurance Bureau responded to Li Xiaoli’s proposal, saying that glasses, dentures, artificial eyes and other appliances are not included in the basic medical insurance payment. Ability to formulate reasonable payment standards.
In this case, is the Ningbo solution expected to be implemented and promoted?
Generally speaking, in areas with high per capita income, the funds in personal medical insurance accounts are relatively abundant.
Statistics show that in 2020, the per capita disposable income of urban and rural residents in Ningbo will reach 59,952 yuan, ranking first among cities in the country.
Some experts said that this is also the confidence of the Ningbo pilot.
According to the "Statistical Bulletin on the Development of National Medical Security Undertakings in 2020", in 2020, 344.55 million employees participated in medical insurance, with a total personal account balance of 1009.6 billion yuan.
In other words, the average balance per person is more than 2,900 yuan, which is not even enough to grow the cheapest tooth.
"Currently, medical insurance is mainly coordinated at the prefecture and city level. The age structure and economic development level of each region determine the endurance of local medical insurance funds and the demand for dental implants." Wang Tianyu said that Ningbo has not shaken off personal account payments this time. The affordability of the fund may be unbearable in many regions if it involves a pooled fund in the future.
He believes that lowering the price of dental implants is the key compared to including medical insurance.
Compared with centralized procurement of heart stents and artificial joints, many professionals believe that centralized procurement of dental consumables may face special challenges.
Wang Tianyu said that the private sector accounts for a large proportion of the dental market.
The logic of centralized procurement is to exchange price for quantity. If private hospitals are unwilling to join, the overall procurement volume will not increase, which will weaken the bargaining power.
Zhou Bingyuan is worried that the price cut will affect the income of doctors, and he does not rule out the possibility that dentists from public hospitals will flow to private institutions.
"Price reduction is an inevitable trend." Huang Liang felt that the high premium of dental consumables brands, and there is a lot of room for price reductions in centralized procurement, which will force companies to shift from re-marketing to re-development.
In the future, further talent training and technology promotion in the dental implant industry will help standardize medical service fees.