Sino-Singapore Jingwei, May 27 (Wang Yuling) On the 26th, in response to the new coronavirus nucleic acid testing costs and other issues that have attracted more public opinion recently, the person in charge of the relevant department of the National Medical Insurance Administration introduced that in accordance with the "State Council's Joint Prevention and Control of Novel Coronavirus Infection Pneumonia Epidemic" The Guiding Opinions of the Control Mechanism on Doing a Good Job in the Normalized Prevention and Control of the New Coronary Pneumonia Epidemic" and "Implementation Opinions on Accelerating the Promotion of New Coronary Virus Nucleic Acid Testing", and the required costs shall be borne by the local governments.
Therefore, at present, financial departments in various places have provided financial support for normalized nucleic acid testing.
The National Medical Insurance Bureau's statement this time clearly denied the "medical insurance payment theory" that had been circulating on the Internet for normalized nucleic acid testing.
However, it is worth asking, what part of the nucleic acid testing cost has been borne by medical insurance before, and how much has it been spent?
What is the current pressure on medical insurance?
Why can't medical insurance pay for normalized nucleic acid?
As for who is the buyer, there are already rules.
According to the "Guiding Opinions of the State Council's Joint Prevention and Control Mechanism for the New Coronary Virus Infection Pneumonia Epidemic Prevention and Control on Doing a Good Job in the Normalized Prevention and Control of the New Coronary Pneumonia Epidemic" issued in May 2020, the cost of "exhaustive inspection" shall be borne by local governments. The cost of "willing to inspect and inspect" shall be borne by enterprises, institutions or individuals.
What needs to be asked is, does normalized nucleic acid belong to "exhaustive inspection" or "exhaustive inspection"?
Previously, the "exhaustive inspection" population was defined as including close contact, overseas inbound personnel, fever outpatients, inpatients and accompanying personnel, medical institution staff, port quarantine and border inspection personnel, prison staff, social welfare and pension institutions. staff etc.
The people who are "willing to do all the tests" are citizens who want to do nucleic acid testing other than those who "should do all the tests".
Sino-Singapore Jingwei noticed that some provincial and municipal medical security bureaus will pay for "exhaustive inspections".
According to a document issued by the Shenzhen Municipal Medical Security Bureau, if the insured person belongs to the group of "exhaustive examination" and accepts the new coronavirus nucleic acid test in Shenzhen according to regulations, the cost will be paid proportionally by the medical insurance coordinating fund and financial funds, and the individual does not need to bear it Fees, medical insurance personal accounts will not be debited.
However, the population of normalized nucleic acid is obviously far more than the original "should be tested and tested", but it is inappropriate to define normalized nucleic acid as "willing to be tested and tested".
From a legal perspective, Tang Jun, a researcher at the Social Policy Research Center of the Chinese Academy of Social Sciences, responded to Sino-Singapore Jingwei, saying that Article 28 of Chapter 3 "Basic Medical Insurance" of the "Social Insurance Law" stipulates that "in line with the basic medical insurance drug catalog, diagnosis and treatment items" , the standard of medical service facilities, as well as the medical expenses for emergency and rescue, shall be paid from the basic medical insurance fund in accordance with the state regulations.” The third paragraph of Article 30 also stipulates that “what should be borne by public health”, “is not included in the basic medical insurance fund”. Medical Insurance Fund Payment Scope”.
The above provisions of the "Social Insurance Law" point out the scope of payment of medical insurance funds, and "large-scale population nucleic acid testing" is obviously not among them.
In fact, "large-scale population nucleic acid testing" falls within the scope of public health.
The reason why the "Social Insurance Law" makes such a provision is, in theory, because public health and medical services are two completely different concepts.
"Medical insurance is different from endowment insurance. According to the "Social Insurance Law", endowment insurance is funded by contributions from employees and employers and government financial subsidies, while medical insurance is funded only by contributions from employees and employers. Medical insurance lacks the government's commitment to support. In the use of medical insurance funds, we must be extremely cautious. According to the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System", it is mentioned that the overall planning of the medical security fund and public health Use of service funds, increase the proportion of payment to primary medical institutions, and achieve effective connection between public health services and medical services. However, such 'coordination' and 'connection' should be limited, mainly for the 'payment ratio of primary medical institutions', not Call it at will." Tang Jun said.
How much nucleic acid testing cost does medical insurance bear?
Does medical insurance cover part of the cost of nucleic acid testing?
The answer is yes.
In June 2020, the National Medical Insurance Administration issued the "Notice on Cooperating and Doing a Good Job in Further Improving the New Coronavirus Detection Capability", which stated that factors such as the needs of the new coronavirus pneumonia prevention and control work and the payment ability of the medical insurance fund in the region should be comprehensively considered. On the basis of , according to the procedures, nucleic acid and antibody testing items and related consumables for the new coronavirus will be included in the provincial medical insurance diagnosis and treatment item catalog, and payment conditions will be determined simultaneously.
Since then, many places have responded to the National Medical Insurance Bureau and followed up.
According to the document issued by the Shanghai Municipal Medical Security Bureau, medical insurance’s support for nucleic acid testing mainly includes two parts: first, to promote the procurement channels for new coronavirus detection reagents; Nucleic acid testing or antibody testing fees shall be paid in accordance with medical insurance regulations.
How is "diagnosis and treatment need" defined?
Sino-Singapore Jingwei noticed that different regions have different reimbursement methods and ratios for nucleic acid testing medical insurance.
According to the Heilongjiang Provincial Medical Security Bureau, the new coronavirus nucleic acid detection project has been included in the medical insurance diagnosis and treatment project catalog, and it is managed as a Category B project. All insured personnel enjoy medical insurance reimbursement due to medical needs.
According to the Zhejiang Provincial Medical Security Bureau, according to the "Zhejiang Provincial Medical Security Bureau's Notice on Further Reducing the Price of Novel Coronavirus Nucleic Acid Testing Items", starting from April 4, 2022, the new coronavirus nucleic acid testing price will be adjusted to 28 yuan per time.
The price of the new coronavirus nucleic acid hybrid test is adjusted to 8 yuan per sample.
The scope of medical insurance payment is limited to fever clinics or patients with imaging features of new coronary pneumonia, and is paid according to Category A.
On the whole, medical insurance and finance jointly bear the cost of nucleic acid testing for residents to carry out "exhaustive inspections" in designated medical institutions and to go to local medical institutions for hospitalization or fever clinics.
So how much did health insurance cost in the process?
Previously, some data had been released around the country.
The Linyi Municipal Medical Security Bureau previously pointed out at the working meeting that in 2021, through three rounds of price adjustments, the price of nucleic acid testing will be greatly reduced.
The medical insurance fund paid more than 68 million yuan for nucleic acid testing for "exhaustive testing".
The Zhaoqing Municipal Medical Security Bureau of Guangdong Province issued a document stating that as of December 30, 2021, a total of 3.1943 million local insured persons for nucleic acid testing were settled throughout the year, and the total medical expenses were 124 million yuan, of which the medical insurance payment amount was 95.15 million yuan, and the payment ratio was 95.15 million yuan. Up to 76.9%, the insured person paid more than 1 million yuan for medical insurance for nucleic acid testing in different places.
According to the Shanghai Medical Insurance Bureau, as of the end of August 2021, Shanghai Medical Insurance has paid more than 15 million nucleic acid and antibody tests for the new coronavirus, and nearly 1.2 billion yuan.
Health insurance funds are under pressure
In fact, even if you do not pay for the normalized nucleic acid testing, the medical insurance funds in many places are already under certain pressure.
According to media reports, from January to October 2021, the basic medical insurance (including maternity insurance) fund income was 2,214.191 billion yuan, of which the employee basic medical insurance (including maternity insurance) fund income was 1,493.065 billion yuan, and the basic medical insurance fund income for urban and rural residents was 721.127 billion yuan. The basic medical insurance (including maternity insurance) fund expenditure was 1,901.313 billion yuan, of which the employee basic medical insurance (including maternity insurance) fund expenditure was 1,179.556 billion yuan, and the urban and rural residents' basic medical insurance fund expenditure was 721.757 billion yuan.
That is to say, the basic medical insurance fund for urban and rural residents is "not enough", and the balance from January to October 2021 is negative (-630 million yuan).
Tang Jun said that previous relevant research reports pointed out that in 2029, the basic medical insurance fund for urban employees will not be able to pay for the current period.
In recent years, through the efforts of the central to local medical insurance departments at all levels, the above situation has improved.
From the current point of view, the re-emergence of "not covering expenses" is worthy of vigilance.
From the perspective of medical insurance's support for epidemic prevention and control, combined with the published data, as of July 19, 2020, there were 135,500 medical insurance settlements for confirmed and suspected patients with new coronary pneumonia nationwide, involving 1.847 billion medical expenses and 1.232 billion medical insurance payments. Yuan, the payment ratio reaches 67%, and the remaining part is provided by financial subsidies.
In line with the principle of "treatment first, settlement later", the National Medical Insurance Bureau has clarified that the medical expenses of patients with new coronary pneumonia do not occupy the total budget index of the year.
In 2021, the Party Central Committee and the State Council made a decision that the medical insurance fund will cover the cost of the new coronavirus vaccine and vaccination, with financial subsidies and free vaccination for residents. The medical insurance fund is mainly borne by the balance of the past years, and does not affect the current fund's income and expenditure.
Earlier, the person in charge of the National Medical Insurance Bureau said that at present, my country has vaccinated 3.2 billion doses of vaccines, and the cost of vaccines is more than 120 billion yuan, which is shared by the medical insurance fund and finance.
However, according to the "Statistical Express on the Development of Medical Insurance in 2021", the phenomenon of "not covering expenses" of medical insurance funds has improved.
In 2021, the total income and total expenditure of the basic medical insurance fund (including maternity insurance) will be 2,871.028 billion yuan and 2,401.109 billion yuan respectively, and the cumulative balance of basic medical insurance (including maternity insurance) at the end of the year will be 3,612.154 billion yuan.
However, it also stated that the income of the basic medical insurance fund for urban and rural residents was 974.225 billion yuan, a year-on-year increase of 6.9%; the expenditure was 914.807 billion yuan, a year-on-year increase of 12.0%. The year-on-year growth rate of resident medical insurance fund expenditure was higher than the year-on-year growth rate of income.
Normalized nucleic acid frequency reduction?
It is worth noting that in the past two days, some places have announced to reduce the frequency of normalized nucleic acid testing.
On May 26, Hangzhou, which was the first to announce the normalization of nucleic acid testing, announced that it would reduce the frequency of normalized nucleic acid testing, and adjust the inspection every two days to every three days.
According to the announcement from the Office of the Leading Group for the Prevention and Control of the Novel Coronavirus Pneumonia in Hangzhou, from 0:00 on May 27, the frequency of normalized nucleic acid testing in Hangzhou has been extended from 48 hours to 72 hours.
Residents and other personnel in Hangzhou within the city's jurisdiction should consciously complete nucleic acid sampling every 72 hours.
The frequency of nucleic acid testing for staff in high-risk positions and employees in the public service industry shall be carried out in accordance with relevant regulations.
Those who come to Hangzhou and return to Hangzhou from non-epidemic key areas outside the city should provide a negative nucleic acid test certificate within 48 hours before arriving in Hangzhou.
On May 25, according to The Paper, following the adjustment of the frequency of nucleic acid testing in Xinyu, Jiangxi, the normalized nucleic acid testing in Fuzhou also announced a reduction in frequency.
According to the WeChat public account "Fuzhou Release", employees in key places in Fuzhou will be inspected once a day, workers with high-risk exposure will be inspected once in three days, and non-key positions, non-special industries, and non-public places except for first- and second-class personnel. And the general population (including public officials) in non-exposed service industries, as well as students living with parents, etc., will be checked every 7 days.
The Fuzhou Epidemic Prevention and Control Headquarters stated that the nucleic acid screening policy will be dynamically adjusted according to the requirements of the Provincial Epidemic Prevention and Control Headquarters and changes in the epidemic prevention and control situation.
Previously, employees in key places in Fuzhou implemented 1 inspection per day, and high-risk exposure groups implemented 1 inspection every 2 days. Personnel), carry out 1 inspection every 3 days.
In addition to the reduction in the frequency of testing in some areas, the price of normalized nucleic acids is also falling further.
On May 22, the Office of the National Medical Insurance Administration and the Medical Rescue Team of the Joint Prevention and Control Mechanism of the New Coronavirus Pneumonia Epidemic of the State Council issued the latest notice, requiring all localities to reduce the single-person nucleic acid test for the new coronavirus to no more than every one before June 10. 16 yuan per person, and multi-person mixed inspection is reduced to no more than 5 yuan per person.
In the case of large-scale screening and normalized testing organized by the government, testing institutions are required to provide services based on a multi-person mixed test of no more than 3.5 yuan per person.
(Sino-Singapore Jingwei APP)
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