One year and four months after soliciting opinions on the medical insurance benefit list, it has now entered the final stage of its formal introduction.
This list will propose national uniform standards for medical insurance benefits including inpatient and outpatient deduction lines and reimbursement rates.
Since November, the National Medical Insurance Bureau has intensively responded to a number of proposals requiring non-medical insurance items to be included in medical insurance reimbursement.
The National Medical Insurance Bureau follows the principles in the previously announced "Medical Security Benefit List" (draft for comments), and gives clear negative answers to items that should be borne by public health funds or fitness physical examinations.
The medical security benefit list will define the responsibility boundary of government medical security to achieve a fair and appropriate level of protection.
While realizing the integration of the national medical security level, it will also guide the localities and the masses to achieve reasonable and stable expectations.
The formulation of the national medical insurance benefit list has been an important task since the establishment of the National Medical Insurance Administration, and it has been included in the programmatic document of my country's medical insurance reform "Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical Security System".
Previously affected by the epidemic, this reform has been shelved. According to China Business News, the National Medical Insurance Bureau is currently intensively promoting the introduction of the medical insurance benefit list.
The State Council is also adding weight to this reform.
The executive meeting of the State Council held on November 6 proposed that on the basis of the national basic public service list, combined with actual exploration and establishment of a livelihood expenditure list management system, pilot projects in the fields of education and medical insurance and gradually expand the scope.
Items such as physical examination and early screening are not included in medical insurance reimbursement
The "List of Medical Security Benefits" (draft for comments) published in July last year listed seven items that the medical insurance fund would not pay, including those that should be paid from the work-related injury insurance fund, those that should be paid by a third party, and those that should be paid by the public Health burdens, medical treatment abroad, sports fitness, health care consumption, health checkups, those that do not meet the basic medical insurance drug catalog, the scope of diagnosis and treatment items, and the scope of items specified in the standards for medical service facilities, etc.
As in previous years, during the two sessions this year, many representatives of the committees still proposed a variety of proposals to include non-medical insurance items in medical insurance reimbursement, such as including rural medical examinations and early screening for chronic diseases into medical insurance.
The National Medical Insurance Bureau gave negative answers to these proposals. The main basis is that Article 30 of the "Social Insurance Law of the People's Republic of China" clearly stipulates that medical expenses that should be borne by public health are not included in the scope of payment by the basic medical insurance fund. Items such as physical examinations should be resolved through public health services and other channels.
According to my country's current institutional arrangements, the public health service system is mainly used to gradually solve the problems of disease prevention and control, health education, and the basic medical insurance system to gradually improve the level of disease treatment protection and to vigorously develop commercial insurance to meet the different health needs of different groups of people.
For some local representatives proposed to include local characteristic Chinese medicines in the medical insurance catalog, the National Medical Insurance Bureau emphasized the importance of national unification of the medical insurance catalog.
In the notice issued in 2019 of the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog", it is stipulated that all regions should strictly implement the "Drug Catalog". Adjust the limited payment scope for drugs in the catalog.
For Class B drugs that were added in the original provincial drug catalogue as required, they should be gradually digested within 3 years.
Cancer genetic testing, heavy ion therapy and other items are difficult to include due to the limited capacity of the medical insurance fund.
According to the National Medical Insurance Administration, the level of financing for basic medical insurance, especially for urban and rural residents, is relatively low. In 2019, the per capita financing is only about 800 yuan.
The current basic medical insurance system is mainly based on providing protection for the treatment of basic diseases.
Establish a unified national medical insurance treatment standard
The current medical preservation policy is decentralized and fragmented, and medical insurance benefits vary widely from place to place, and it is difficult for the public to form a unified medical insurance benefit expectation. The proposals of the two sessions this year also reflect these problems.
In response to the current situation, 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" clearly stated that the medical security benefit list system should be implemented.
Liao Cangyi, a researcher at the Medical Service Governance Research Center of Tsinghua University, said in an interview with China Business News that the list of medical insurance benefits refers to the national top-down payment standards, payment ratios, and maximum payment limits for basic medical insurance, critical illness insurance and medical assistance in inpatient outpatient clinics. , Proposed a unified national standard.
In response to the proposal, the National Medical Insurance Bureau revealed that it is studying the idea of promoting the management of the medical insurance benefit list. It intends to propose basic systems, basic policies, and fund payment by determining the content of basic protection, clarifying the boundary of benefit payment, clarifying policy adjustment authority, and standardizing decision-making processes. Scope, guide local governments to further standardize the unified institutional framework and policy settings, and promote the long-term sustainable development of the system.
Liao Cangyi said that the advantage of establishing the medical insurance benefit list is that it defines the responsibility boundary of government medical insurance. On the one hand, it must be under-insured, and on the other hand, it must not be over-welfare. It reflects the basic medical insurance’s responsibility for basic medical insurance, and the level of protection is fair and consistent. Appropriately, correct the problems of excessive protection and insufficient protection.
At the same time, it is also conducive to the realization of the policy integration of the national medical security system, promotes the country's top-down decision-making and management standardization, and promotes the equalization of basic medical services.
It is conducive to keeping financing and payment policies in line with the level of economic development, and realizing the sustainable development of my country's medical insurance system.
China Business News also learned from people familiar with the matter that one of the purposes of issuing the medical insurance benefit list is to prevent localities from competing with each other.
Now some economically developed areas will increase medical insurance reimbursement as a political achievement or to attract talents, causing dissatisfaction in surrounding areas.
In soliciting opinions, some economically developed regions believed that improving medical insurance benefits through their own financial resources should not be restricted.
It can be seen that how to coordinate national standards and local standards is an issue that must be carefully weighed in the process of formulating the medical insurance benefit list.
Author: Guo Jinhui