Interview with Director Xiong Xianjun of the National Medical Insurance Bureau:
Explore the establishment of special groups and specific diseases medical fee exemption system
China News Weekly Reporter / Li Mingzi
Published on 2020.5.25, the 948th issue of China News Weekly
As of May 6, the medical insurance departments of various provinces (autonomous regions and municipalities) and the Xinjiang Production Corps have allocated 193.85 billion yuan of targeted funds for designated medical institutions in advance, including about 3.7 billion yuan in Hubei Province.
"In this epidemic prevention and control, on the basis of basic medical insurance, critical illness insurance, and medical assistance, the central and local governments will provide subsidies for the personal burden of medical expenses, and some places also implement policies such as first admission and financial support for patients who seek medical treatment in other places. , To ensure that patients are not delayed in treatment due to cost issues. "On February 14, General Secretary Xi Jinping pointed out at the twelfth meeting of the Central Committee for Comprehensive Deepening Reform.
As the new crown epidemic entered a trailing period, there were many rebounds in Heilongjiang, Hubei and Jilin. "As long as the epidemic does not end, our work will not end." Xiong Xianjun, director of the Medical Management Department of the National Medical Insurance Bureau, said that work has not stopped from the beginning of January to the present, but the research was discussed before the "medical insurance prepayment + financial subsidy" The busiest during the policy period. On May 11, he was interviewed by China News Weekly in the office of the National Medical Insurance Bureau.
China News Weekly: During the epidemic, the National Medical Security Administration required local medical insurance funds to be pre-allocated. So far, how is the actual advance payment and settlement work going?
Xiong Xianjun: In order to eliminate the concerns of medical institutions and ensure that patients do not delay treatment due to cost issues, the national medical insurance department adjusts the total budget indicators of relevant medical institutions in a timely manner. The handling agency pre-allocated special funds for medical treatment of new coronary pneumonia.
The principle of prepayment for medical insurance is "wide play". Two patients are reported as a whole, and the cost of 10 patients may be allocated. A total of 13.785 billion yuan was disbursed nationwide, and the final settlement is subject to actual payment. As of May 6, the number of confirmed cases of new coronary pneumonia and suspected patients in the country reached 118,200, the total medical cost was about 1.7 billion yuan, and the medical insurance payment was about 1.133 billion yuan, accounting for 66.6% of the total cost. The settlement of confirmed and suspected patients in Hubei Province reached 79 thousand person times, the total medical cost was about 1.33 billion yuan, and the medical insurance payment was about 922 million yuan, accounting for about 81% of the national new coronary pneumonia medical insurance payment.
In terms of controlling the epidemic situation, the medical insurance provides good financial support. The biggest role is to stabilize the people's hearts, let the people rest assured, take the initiative to see a doctor, and cooperate with the country's epidemic prevention policy of "receiving and curing". Delayed treatment due to cost issues, which in turn caused a wider spread.
At present, the actual medical expenses per capita is 22,800 yuan, which is higher than the 17,000 yuan counted at the end of March. This is because the settlement work has not yet been completed. As the proportion of critically ill patients in the later period increases, the average cost will also increase. The per capita treatment cost of severe patients exceeds 150,000 yuan, and the treatment cost of a few critically ill patients even exceeds one million yuan, which are reimbursed according to regulations. For the medical expenses of confirmed and suspected patients, after the basic medical insurance, serious medical insurance, and medical assistance are settled, the personal burden will be subsidized by the finance.
China News Weekly: The day before the closure of the city, the National Medical Insurance Bureau and the Ministry of Finance proposed the "two guarantees" policy. At that time, how did the National Medical Insurance Bureau respond and formulate relevant treatment policies and measures? What lessons can be learned from the SARS response in 2003?
Xiong Xianjun: During SARS in 2003, Beijing patients were treated intensively in Xiaotangshan. I was in the Ministry of Human Resources and Social Security at that time, and I was also in charge of this part of the work. SARS is also managed as Class B infectious diseases according to Class A. After payment by the medical insurance, financial subsidies. This practice currently draws on the experience of SARS.
The difference is that the medical insurance funds were put in place faster this time to fight the new crown epidemic. The first is the country ’s institutional advantages. One side has difficulties and eight parties support. The various ministries including the Ministry of Finance, the Medical Insurance Bureau, and the Health and Health Commission have accelerated their actions. In accordance with the instructions of the central government, the safety and health of the people are the first priority.
Second, after the establishment of the National Medical Insurance Bureau, the basic medical insurance, critical illness insurance and medical assistance were integrated to achieve urban and rural coordination and reduce communication costs. If it is the original pattern, there will be many more consultation links. For example, you will have to go to the Ministry of Health to ask for the views of the new rural cooperative medical system, and ask the Ministry of Civil Affairs how to complete the payment together. Now, the medical insurance bureau only needs to discuss the cost with the Ministry of Finance, and quickly reached an agreement. This is the dividend of institutional reform after the establishment of the National Medical Insurance Bureau.
On January 7, when the General Secretary of the CPC Central Committee and State President Xi Jinping presided over the meeting of the Standing Committee of the Political Bureau of the Central Committee, he put forward requirements for the prevention and control of the epidemic situation. The Medical Insurance Bureau resolutely implemented the important instructions of General Secretary Xi and the spirit of the meeting of the Standing Committee of the Political Bureau of the Central Committee. Under the unified leadership of the Central New Crown Pneumonia Leading Group and the Joint Prevention and Control Working Mechanism of the State Council, it immediately researched and deployed the epidemic prevention and control of the medical security system.
On January 20, the Health and Safety Commission announced that New Coronary Pneumonia was "Class B Infectious Diseases Managed by Class A." On the same day, the video and telephone conference hosted by the Health and Health Commission divided the work of various departments. The Medical Insurance Bureau mainly studied the medical security of confirmed cases. problem. At that time, we discussed with the Ministry of Finance and put forward the general tone of "two guarantees". On the 22nd, the Medical Insurance Bureau, together with the Ministry of Finance, issued the "Notice on Doing a Good Job in Medical Security for New Virus Infected Pneumonia", which proposed specific contents to ensure that patients do not affect medical treatment due to cost issues, and that admission hospitals do not affect treatment due to payment policies, that is, " Two sure ".
Regarding the medical insurance for suspected patients, it is explained in the "Supplementary Notice on Doing a Good Job in Medical Security for New Coronavirus Infected Pneumonia Outbreaks" issued by the Ministry of Finance and the National Health and Health Commission on January 27.
The two "Notices" determine the general requirements for the first diagnosis and treatment of suspected patients and subsequent settlement. After basic medical care, critical illness insurance, medical assistance, etc. are paid according to regulations, the personal burden will be subsidized by the finance.
At the same time, according to the diagnosis and treatment plan issued by the Health and Health Commission, the Medical Insurance Bureau promptly included the relevant drugs and medical service items into the medical insurance catalog. For example, Kelizhi, which was used clinically in the early days, was originally indicated for AIDS, and treatment of new coronary pneumonia during the outbreak can also be reimbursed. The actual expenses incurred, but the medical expenses outside the diagnosis and treatment plan, the medical insurance also paid, for example, the medical expenses incurred due to the underlying disease during the treatment of the new crown.
During the epidemic, the focus of medical insurance work was in Hubei Province and Wuhan City, and the medical institutions such as Vulcan Mountain, Raytheon Mountain, and 5 private hospitals were included in the fixed point as soon as possible to ensure the "collectable collection". The follow-up work of the Medical Insurance Bureau is still in progress. In order to improve the overall coordination of settlement and accurately grasp the new coronavirus infection information, on February 14, a notice was issued to unify the disease classification (ICD) codes related to the new coronavirus infection. On April 3, in conjunction with the Ministry of Foreign Affairs, the Ministry of Finance, and the National Health and Health Commission, the "Notice on Issues Related to the Payment of Medical Expenses for Foreign Coronary Pneumonia Patients" was issued. At present, some settlement work is still in progress, mainly for critically ill patients and off-site treatment.
China News Weekly: Will the cost of the new crown epidemic put some pressure on the medical insurance fund this year? What are the issues that need to be resolved for the smooth implementation of medical insurance settlement for patients with new coronary pneumonia who have been treated elsewhere?
Xiong Xianjun: The epidemic will not put pressure on the payment of medical insurance.
In general, affected by the epidemic, the number of visits and expenses of medical institutions from January to February this year showed a downward trend. The number of settlements decreased by 22.36% compared with the same period of last year. Medical expenses and corresponding medical insurance funds decreased by more than 26% compared with the same period of last year. .
The current national epidemic prevention and control situation is generally good. The daily diagnosis and treatment activities of the hospitals have begun to recover. It is expected that the medical insurance costs will rebound in the later period. However, although there are overcrowding in some top three hospitals, there are still quite a few people who are still reluctant to go to the hospital for treatment. The epidemic has squeezed the demand for other diseases. Our preliminary assessment shows that the annual medical insurance expenditure will be about 5% lower than last year.
Regarding off-site treatment, first of all, medical institutions must implement the requirements of "treatment first, then settlement"; second, the medical insurance department at the place of medical treatment will first settle with the hospital, and then the National Medical Insurance Bureau will organize a national liquidation, which is the responsibility of the medical insurance department. The liquidation process does not affect the treatment of patients. At present, the settlement work is still going on, and it is not yet possible to determine the proportion of patients who seek medical treatment in other places.
The biggest problem of medical treatment in other places is that the information of insured patients is not allowed to be filled in. The name, ID number, telephone number and other information are incorrect. It is impossible to confirm the identity of the insured person and the place for medical insurance co-ordination, but this is only a very rare phenomenon.
China News Weekly: Hu Jinglin, director of the Medical Insurance Bureau, published an article in Banner on April 22, "We must summarize the practice of medical security during the new coronary pneumonia epidemic and improve the medical insurance cost protection mechanism for major epidemics." The security mechanism should How to build? Are there any specific practices for this epidemic prevention worth summing up and learning from in the future?
Xiong Xianjun: On March 5, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", requesting the improvement of the medical cost protection mechanism for major epidemics, and ensuring that medical institutions first treat and charge later when emergencies occur. . What we are doing is this work, exploring the implementation of an exemption system for medical expenses for specific populations and specific diseases, and transforming the policy measures for the prevention and control of this epidemic into long-term institutional arrangements. This work also needs to be consulted with relevant departments such as finance.
"Internet + medical" played an active role in the fight against the epidemic. The medical insurance department included eligible "Internet + medical" service fees into the scope of medical insurance payment, and encouraged designated medical institutions to provide "unseen" drug purchase services to make up for the offline medical gap. In response to the needs of outpatients with severe chronic diseases, Wuhan has included more than 1,300 "Internet + Medical" service fees paid by medical insurance every day, and transferred more than 1,100 prescriptions to designated retail pharmacies.
The future "Internet + medical" medical insurance policy is still under study. In general, firstly, the hospital can do Internet medical treatment, such as the Internet medical treatment of the Sino-Japanese Friendship Hospital, the third platform and the physical hospital jointly create an Internet hospital, or they can be included in the designated medical insurance by signing a supplementary agreement; The cost of online follow-up visits and the cost of circulation of prescriptions in the medical insurance co-ordination area can be included in the payment of medical insurance; again, it is necessary to strengthen the supervision of Internet medical service behavior and promote the gradual standardization of Internet medical care. Medical insurance will not pay for non-standard medical services.
During the epidemic period, the “long prescription” medical insurance reimbursement support policy was also implemented, supporting the relaxation of prescription drug use to three months, which facilitated the timely use of drugs by patients with chronic diseases and reduced the risk of infection, but this made it more difficult to control medical insurance costs. We also need to determine whether the long prescription policy will continue after the epidemic on the basis of further evaluation of regulatory issues.
"China News Weekly" No. 18, 2020
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