On December 28, according to the National Medical Insurance Administration, from January to October 2022, the national basic medical insurance participation rate has stabilized at more than 95%, and the bottom line of people's livelihood security has been firmly secured.
It is noteworthy that in the face of the new crown epidemic, in order to ensure that patients will not be affected by cost issues and that the treatment of hospitals will not be affected by payment policies, the National Medical Insurance Bureau temporarily includes the drugs and diagnosis and treatment items in the diagnosis and treatment plan into the medical insurance catalog, and settles the treatment in a timely manner. cost.
With the implementation of the "Class B and B Control" for the new coronavirus infection, can the new crown drugs and hospitalization expenses that were previously included in the medical insurance be reimbursed?
In this regard, experts believe that with the implementation of "Class B and B tubes" for the new coronavirus infection, the reimbursement policy of medical insurance may also be adjusted, including tilting towards key groups, including new crown innovative drugs, specific drugs, and some medical devices such as ventilators, Blood oxygen machines, etc. are gradually included in the scope of medical insurance.
The new crown drug "dynamically" enters the medical insurance
In order to increase the treatment of patients who may develop into severe and critically ill patients after COVID-19 infection, recently, Naimatevir Tablets/Ritonavir Tablets have also been included in the reimbursement scope of Beijing's medical insurance drugs, and the reimbursement ratio for Beijing community hospitals is 90% .
This is not an isolated case.
In fact, at the beginning of the outbreak in 2020, the National Medical Insurance Administration issued the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)", and transferred ribavirin injection, Arbidol granules and other drugs into the catalog , So far, all the drugs listed in the latest version of the national diagnosis and treatment plan have been included in the national medical insurance catalog.
In March of this year, the National Medical Insurance Bureau issued the "Notice of the Office of the National Medical Security Administration on Effectively Doing a Good Job in the Current Epidemic Prevention and Control and Medical Security", which specifically includes two requirements. Temporarily included in the catalog of basic medical insurance medical service items in the province.
The relevant expenses incurred by the insured person in the designated grassroots medical institutions shall be paid according to the current regulations of the overall planning area, and the cost of purchasing testing reagents in designated retail pharmacies may be paid using their personal accounts; the second is to timely adjust the new crown treatment drugs included in the scope of medical insurance payment.
Half a year later, a total of 343 drugs, including the first domestically produced new crown oral drug Azivudine Tablets, officially passed the formal review and were included in the "List of Drugs Applied for the 2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment that Passed the Formal Review".
Taking Beijing as an example, in order to cope with the new situation of the epidemic, the Beijing Municipal Medical Insurance Bureau approved by the National Medical Insurance Bureau to distribute the compound acetaminophen Capsules, the compound acetaminophen oral liquid, the children's acetaminophen Huang Namin granules, Amka Huangmin Capsules, Chlorphene Huangmin Tablets, and Ambroterol Oral Solution are temporarily included in the scope of drug reimbursement for medical insurance and industrial injury insurance in this city, and the reimbursement ratio is implemented in accordance with Class A drugs.
It will be implemented from December 18, 2022 and will be valid until March 18, 2023.
In addition to Beijing, Xi'an has temporarily included 234 new crown drugs in the scope of medical insurance payment, and Qinzhou has also temporarily included 15 drugs such as Exogenous Fengsha Granules in medical insurance, and will be reimbursed as Class A drugs in medical insurance, valid until March 22, 2023.
Outpatient and hospitalization can be reimbursed
In the past three years, the state has adopted the method of "treatment first, settlement later" for people infected with the new crown. After the comprehensive guarantee of basic medical insurance, serious illness insurance, and medical assistance, the personal burden will be subsidized by the government.
"Inclusion in medical insurance has greatly reduced the burden of medical treatment for infected people, especially those with severe illnesses, increased the enthusiasm for medical treatment and treatment rates for infected people, effectively controlled the spread of the virus, and played a great role in prevention and treatment." Hainan Boao Medical Deng Zhidong, general manager of Technology Co., Ltd. analyzed.
With the development and changes of the epidemic situation, the proportion of reimbursement for outpatient visits and hospitalizations of patients infected with the new crown is also changing.
A reporter from Beijing Business Daily sorted out and found that on December 26, the Linyi County Medical Insurance Bureau of Shanxi Province issued a notice on the guarantee of medical treatment for patients infected with the new crown virus, stating that in order to effectively protect the medical treatment of patients with the new crown virus and effectively safeguard the lives and health of the people Health, medical expenses can be included in the scope of medical insurance reimbursement.
Specifically, when urban employees (including retirees) go to outpatient clinics in Class III designated medical institutions, Class II designated medical institutions, and Class I designated medical institutions, the minimum payment standards are 30 yuan/time, 50 yuan/time, and 80 yuan respectively. Each time, the medical insurance reimbursement ratios are 50%, 55%, and 60% respectively, and the reimbursement ratio of retirees from medical institutions of the same level is 5 percentage points higher than that of current employees.
In a natural year, the maximum annual reimbursement for outpatient services for active employees is 1,800 yuan, and the maximum annual reimbursement for retirees is 2,000 yuan.
For medical expenses incurred during hospitalization, urban and rural residents will be reimbursed 85% at the 100-yuan minimum payment line in township hospitals, 75% at the 400-yuan minimum payment line at secondary hospitals, and 70% at the 500-yuan minimum payment line at private medical institutions; 90% of the reimbursement line is 200 yuan in health centers, and 85% of the 400 yuan minimum payment line in secondary hospitals.
In addition, Jinjiang County, Fujian Province issued a notice on medical insurance reimbursement after being infected with the new crown: In terms of outpatient clinics, insured persons can enjoy ordinary outpatient treatment if they seek medical treatment in designated grassroots medical institutions designated by medical insurance.
For medical treatment in township health centers (community health service centers), the reimbursement rate is 70%, with a maximum payment limit of 420 yuan; for medical treatment at designated village-level medical institutions in the city, the reimbursement rate is 50%, with a maximum payment limit of 50 yuan (a single reimbursement limit of 10 Yuan).
In terms of hospitalization, the basic medical insurance reimburses 80% of the municipal reimbursement quota for medical expenses incurred in designated medical institutions outside the city, and 60% of the municipal reimbursement quota for medical expenses incurred in designated medical institutions outside the province.
Medical insurance policies may be adjusted
At present, the prevention and control of the new crown epidemic has entered a "transition" stage. According to the National Health and Medical Commission, the new type of coronavirus pneumonia has been renamed as a new type of coronavirus infection, and the new type of coronavirus has been adjusted from "Class B and A" to "Class B". The goal of prevention and control work should focus on "protecting health and preventing severe illness", implement hierarchical and classified admissions for patients infected with the new coronavirus, and adjust medical security policies in a timely manner.
In this regard, Deng Zhidong said, "Our country divides infectious diseases into three categories, A, B, and C, and the treatment of Class A infectious diseases is fully reimbursed. The reimbursement ratio may be adjusted, such as from full reimbursement to most of the reimbursement, and the reimbursement intensity is tilted towards key groups, such as the elderly and patients with chronic underlying diseases.”
In the view of Wang Peng, a researcher at the Beijing Academy of Social Sciences and a researcher at the Intelligent Social Governance Research Center of Renmin University of China, "In addition to tilting towards key groups, some new crown innovative drugs and special effects drugs also have some medical devices, such as ventilators and blood oxygen machines. It is also expected to be included in the scope of medical insurance reimbursement."
"Treatments that meet the current medical insurance coverage, including hospitalization and drugs included in the medical insurance coverage, can continue to enjoy medical insurance; drugs that are not covered by medical insurance may be included in medical insurance in some areas, but they can be covered nationwide. It is difficult to unify, after all, there are differences in the financial situation of various places." Meng Lilian, chief expert of Sichuan Tianfu Health Industry Research Institute, said in an interview with a reporter from Beijing Business Daily, "But in general, medical assistance will still happen. It is very important. effect."