National Medical Insurance Bureau: Focus on the people and effectively protect patients' medical expenses
Since the outbreak of new crown pneumonia, the cost of treating patients has been a hot spot of concern for the people. What is the average cost of treating patients with new coronary pneumonia, and who pays for these medical costs? On these issues, we interviewed the responsible comrades of the Medical Service Management Department of the State Medical Insurance Bureau.
Q: What is the significance of "free treatment" for patients with new coronary pneumonia for epidemic prevention and control? What does the National Medical Insurance Administration do to protect the expenses of patients with new coronary pneumonia?
Xiong Xianjun (Director of the Department of Medical Service Management, National Medical Insurance Bureau): New crown pneumonia is highly contagious and threatens the life and health of all people. If the cost channel is not clear, patients will have concerns, which is not conducive to timely diagnosis and treatment and control of the source of infection.
Since the outbreak of the epidemic, the National Medical Insurance Bureau has seriously implemented the unified deployment of the Party Central Committee and the State Council, placing the protection of people's health as the first priority, and timely improving and adjusting the medical insurance policies during the epidemic. On January 22, our bureau together with the Ministry of Finance clearly put forward the "two guarantees" requirement of "ensuring that patients are not affected by medical expenses and ensuring that receiving medical institutions are not affected by payment policies." In order to alleviate the patient's worries and allow patients to come to the clinic with ease, the medical insurance department requires that all diagnosed and suspected patients be treated first and then settled. After basic medical insurance, critical illness insurance, medical assistance, etc. are paid in accordance with regulations, the personal burden will be subsidized by the finances. At the same time, in order to ensure that medical institutions are not worried about budget restrictions and can be assured of admission, the medical insurance department timely adjusted the total budget indicators of the designated medical institutions for treatment, and separately budgeted related medical expenses, without occupying the total budget indicators of the year.
In order to alleviate the pressure on medical institutions to advance funds, the medical insurance agency also prepaid special funds for patient treatment. As of March 19, medical insurance departments in various places have allocated a total of 19.3 billion yuan, of which 3.7 billion yuan in Hubei Province.
During the epidemic, the "two guarantees" policy played an important role in promoting "early detection, early reporting, early isolation, and early treatment" and was a major institutional innovation in responding to public health events.
Question: As of now, how much money has the medical insurance system settled and paid for patients with new coronary pneumonia nationwide? What is the average cost of treatment for patients admitted to the hospital?
Xiong Xianjun: As of March 15, 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps reported that the national new crown pneumonia diagnosis and suspected patients had medical insurance settlements 93,238 person-times (including multiple outpatient settlements), involving a total cost of 10.396 million Yuan, the medical insurance system paid a total of 67.734 million yuan.
The number of cleared patients in China was 44,189, involving a total cost of 750.48 million yuan and a per capita cost of 17,000 yuan, of which the medical insurance payment ratio was about 65% (the remaining part was subsidized by the finance).
Q: How does the medical insurance system adjust the scope of reimbursement for drugs and services that need to be used to treat patients with new coronary pneumonia and have not been listed in the medical insurance list?
Xiong Xianjun: Since new coronary pneumonia is a new disease, we fully consider patients and clinical needs, and treat medicines and services that fall within the scope of the new coronary pneumonia diagnosis and treatment plan formulated by the health and health department, regardless of whether they are in the medical insurance list or whether There are limited payment scopes, all of which are temporarily included in the medical insurance fund payment scope. At the same time, the scope of reimbursement is dynamically adjusted according to the changes in the diagnosis and treatment plan. For example, the extracorporeal membrane oxygenation (ECMO) in the diagnosis and treatment program has higher requirements for diagnosis and treatment, and the cost is more expensive. Many provinces have not been included in the scope of payment before, and medical insurance is also paid in the case of pneumonia.
Q: Who will bear the cost of new coronary pneumonia patients who seek medical treatment away? Who pays for the medical expenses incurred before the diagnosis of a confirmed patient?
Xiong Xianjun: In accordance with the "two guarantees" policy requirements just introduced, for the confirmed and suspected patients identified by the health and health department, whether they are local or non-local patients, first treatment and settlement will be implemented. After basic medical insurance, critical illness insurance, medical assistance, etc. are paid in accordance with the regulations, part of the personal burden will be subsidized by the financial institution for medical treatment, and medical expenses paid for medical insurance in other places will be paid in advance by the medical insurance department at the medical place. The local medical insurance department shall settle the settlement with the medical insurance department of the medical institution.
At the same time, special policies are implemented in special times to break the routine management model of medical insurance, and to focus on patients rather than on the process of diagnosis and treatment. For diagnosed and suspected patients, even the pre-diagnosis and suspected expenses are included in the scope of the "two guarantees" policy.
Q: During the fight against the epidemic, how to ensure the demand for medical insurance services for patients with chronic diseases? In addition, what health insurance policies has the National Health Insurance Bureau adjusted?
Xiong Xianjun: During the fight against the epidemic, due to the concentrated manpower and material resources of medical institutions for prevention and control, the normal medical treatment needs of patients with common diseases such as hypertension and diabetes were backlogged. Medical insurance departments at all levels cooperate with health and health departments to implement the long prescription policy to reduce the number of patients with chronic diseases going to the hospital. At the same time, eligible "Internet +" medical service fees are included in the scope of medical insurance payments in a timely manner, and designated medical institutions are encouraged to provide "in-person" drug purchase services. In response to the needs of patients with severe and chronic diseases in outpatient clinics, Wuhan has included more than 1,300 “Internet +” medical service fees paid by the medical insurance daily, and transferred more than 1,100 prescriptions to designated retail pharmacies.
At the same time, in order to reduce the risk of infection brought about by the gathering of people, medical insurance departments at all levels have vigorously optimized their work processes and methods. Establish a green channel for medical institutions that focus on treating patients with new coronary pneumonia to shorten the processing time; relax the time limit for processing medical insurance services and postpone the processing of non-emergency matters; use the non-contact methods such as the Internet, telephone, and post to promote medical insurance services to meet without meeting