Chinanews.com client, Beijing, November 6th (Reporter Zhang Ni) "Internet +" medical insurance payment will adopt a consistent online and offline reimbursement policy. Online medical reimbursement starts with outpatient chronic diseases... Recently, the National Medical Insurance Administration A guiding opinion issued clarified the scope of "Internet +" medical insurance payment.
At the same time, many places have begun to actively test the water for online medical reimbursement.
In the opinion of industry experts, this means that "Internet +" medical insurance payment has entered the practical level.
Data map: A patient uses the face recognition system to make an appointment with an expert number under guidance.
Photo by Wang Guangzhao
"Internet +" medical insurance payment scope determined to welcome the "first year of outbreak" in Internet medical care?
This year, under the special background of the epidemic, the public's demand for Internet diagnosis and treatment has blown out. Some people call 2020 the "first year of the outbreak" of Internet medical treatment.
According to data disclosed by the National Health Commission in March this year, during the epidemic, Internet diagnosis and treatment in hospitals under the management of the National Health Commission increased 17 times compared with the same period last year.
At the same time, the volume of diagnosis and treatment consultation on some third-party Internet service platforms has increased by more than 20 times over the same period, and the number of prescriptions has increased by nearly 10 times.
On October 28 this year, at a press conference held by the Information Office of the State Council, the National Health Commission revealed a set of latest figures: Currently, there are 900 Internet hospitals in China, and the telemedicine collaboration network covers all prefecture-level cities 2.4 More than 10,000 medical institutions and more than 5,500 hospitals above the second level can provide online services.
As more and more medical institutions embrace the Internet, the "Internet +" medical supporting measures are also stepping up to keep up.
Since the second half of this year, many blockbuster documents related to Internet medical treatment have been published at the national level.
In July, 13 departments including the National Development and Reform Commission jointly issued the "Opinions on Supporting the Healthy Development of New Business Forms and New Models, Activating the Consumer Market and Driving Employment Expansion", proposing that eligible "Internet +" medical service fees should be included in the scope of medical insurance payment.
Since then, the General Office of the State Council has issued the "Implementation Opinions on Further Optimizing the Business Environment and Better Serving Market Entities", once again mentioning the issue of "unbinding" medical insurance policies.
Earlier this month, the National Medical Insurance Administration issued the "Guiding Opinions on Actively Promoting the Payment of "Internet +" Medical Services and Medical Insurance", clarifying that eligible Internet medical institutions can voluntarily "sign up" into the scope of medical insurance through the physical medical institutions they rely on. "Internet +" medical insurance payment will adopt a consistent online and offline reimbursement policy.
It is worth mentioning that the "Guiding Opinions" also included the relevant experience and practices of resolving patients with chronic diseases during the new coronary pneumonia epidemic into normalization work, and clarified the scope and method of "Internet +" medical insurance payment.
For example, the scope of payment for "Internet+" medical insurance covers outpatient chronic diseases and other follow-up renewal requirements. The insured person’s medical examination fees and drug fees incurred by the "Internet+" designated medical institutions in the overall planning area for follow-up visits and prescriptions can be based on local Medical insurance stipulates payment.
The medical insurance burden is directly settled by local medical insurance agencies, designated physical medical institutions and designated retail pharmacies.
Ma Guanglei, deputy secretary-general of the China Medical Commerce Association and general manager of Yi Fuxian, said in an interview that this new policy proposes that medical insurance should strengthen support for Internet diagnosis and treatment, and further clarifies the scope of reimbursement for this new type of medical behavior, including diagnosis and treatment. It is a very complete guidance document in terms of follow-up visits and drug purchases and extended prescriptions.
"It can be said that the'Internet +'medical insurance payment has entered the practical level, and it has great guiding significance for the reform of medical insurance payment." Ma Guanglei said.
Internet "Cloud Clinic" of Capital Institute of Pediatrics.
For picture
Trying the water in many places
While releasing positive policy signals at the national level, many places have already "tested the waters" in advance.
In April this year, the Qingdao Municipal Medical Insurance Bureau explored innovative services for medical insurance payment in physical hospital Internet hospitals.
Follow-up patients can use the WeChat public account "Qingdao Medical Insurance", choose the Internet hospital of municipal hospitals, and conduct online consultations with doctors through video or graphics.
After the online doctor verifies the patient’s re-examination identity, the re-examination prescription is issued, and the prescription is sent to the patient through the third-party prescription circulation service platform. The patient can choose the medical insurance designated pharmacy after receiving the text message. After the pharmacy receives the order, the medicine will be reimbursed together with the overall plan Settlement slips and pharmacy service orders are delivered to the door. After the patients receive the drugs, they can choose medical insurance to pay, which truly realizes the closed-loop one-stop diagnosis and treatment service that patients can consult, renew prescriptions, purchase drugs, and reimburse medical insurance payments without leaving home , To solve the problem of "seeking a doctor for medicine".
In Beijing, some hospitals’ "cloud consultation rooms" can also be registered for real-time medical insurance settlement.
In October of this year, the Capital Institute of Pediatrics passed the "Internet +" medical insurance qualification review and became the first pediatric hospital in Beijing that has real-time settlement of medical service fees and offline medical insurance settlement for drugs, inspections and inspections.
This time the Internet diagnosis and treatment system has been upgraded, and functions such as the application form for inspection and examination, the issuance of a hospital certificate, and online appointment and offline number source are also available.
According to data released by the Capital Institute of Pediatrics, as of October 23, the number of patients in the hospital who completed Internet diagnosis and treatment through the "Jingyitong" platform was 4022. The number of visits in September increased by 59.1% month-on-month, and patients from other places accounted for 73.1%. Local patients accounted for 26.9%. Among them, dermatology, gastroenterology, health care, and endocrinology received the highest number of consultations.
In Shanghai, the Internet hospitals in the Yangtze River Delta Eco-Green Integrated Development Demonstration Zone have opened remote online settlement of medical insurance. Insured persons in the three places in the demonstration zone can use the Internet hospitals to complete follow-up visits, dispensing and online payments using mobile phones.
With the launch of local pilot projects, medical insurance policies regarding Internet diagnosis and treatment have been continuously standardized and improved.
For example, starting this month, the "Tianjin City "Internet +" Medical Service Medical Insurance Payment Management Measures (Trial)" began to be formally implemented.
In accordance with the administrative measures, designated medical institutions shall provide Internet diagnosis and treatment services for insured patients within the scope of their offline physical medical institutions’ diagnosis and treatment subjects, and shall not exceed the scope of their Internet diagnosis and treatment subjects. They shall be limited to those common and chronic diseases that can be independently completed online. .
The Internet diagnosis and treatment services provided by designated medical institutions for insured patients are limited to the types of medical insurance payment. If the medical insurance meets the scope of medical insurance payment, the medical insurance fund shall be paid in accordance with regulations.
Data map: Medical staff are answering questions online. Photo by Fang Yongle
How to supervise Internet healthcare? Expert: Realize traceability of information
Officially released data show that from 2015 to 2019, the total number of visits in medical and health institutions nationwide increased from 7.69 billion to 8.72 billion, the average number of visits by residents increased from 5.6 to 6.2, and the number of hospital admissions increased from 21.53 million to 26,596. Million people.
The people's demand for high-quality medical resources is increasing day by day, and the problems of "difficult to see a doctor" and "overcrowding in large hospitals" also follow.
"Internet +" medical services will undoubtedly be a breakthrough to solve these problems.
Recently, the "Recommendations of the Central Committee of the Communist Party of China on Formulating the Fourteenth Five-Year Plan for National Economic and Social Development and Long-Term Goals for 2035" were formally announced, which also clearly stated "supporting society to run medical services and promoting telemedicine."
However, as a new thing, with the advancement of "Internet +" medical payment, will the regulatory pressure on medical insurance funds increase?
How to improve the efficiency of supervision?
What development path will different types of platforms face in the future?
These have become the most concerned issues of the outside world.
Ma Guanglei analyzed in the interview that the recent new medical insurance policies have repeatedly emphasized the importance of agreement management. Among them, in applying for the basic conditions of the "Internet +" medical service medical insurance supplementary agreement, it is clearly stated that the electronic medical record of the insured person should be retained during the diagnosis and treatment process. , Electronic prescriptions, drug purchase records, etc., to achieve the full traceability of diagnosis and treatment, prescriptions, dispensing, etc., which will prompt medical insurance, hospitals, prescription circulation platforms or pharmacies to jointly sign circulation agreements, which require each to perform their duties and multi-party joint supervision.
He emphasized that multi-party joint supervision first needs to realize the interconnection and real-time sharing of information.
It is necessary to break the information islands between medical care, medicine, and medical insurance, and establish a "three-medicine linkage" supervision mechanism. While ensuring the safety of patients' medication, the entire process of diagnosis and treatment, prescription, and dispensing must be traced to ensure the safe use of medical insurance funds.
Fu Hongqiao, an associate researcher at the School of Public Health of Peking University, analyzed that the new "Internet +" medical insurance regulations issued by the National Medical Insurance Bureau did not differentiate between hospitals and third-party platforms, and clarified the medical insurance payment of third-party Internet medical platforms that rely on physical medical institutions. Realize.
Fu Hongqiao said that this shows that as long as it is an Internet medical institution that meets the requirements, the medical insurance department will treat it equally, promote fair competition between online and offline, and further promote the development of the "Internet +" medical service industry.
"The entire industry is still in the initial stage, and many related policies are still being explored. The recognition of the people still needs to be cultivated. As time goes by, the shortcomings will be gradually made up." Fu Hongqiao said.
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