[Inventory at the end of 2020] Medical insurance "answer sheet"
The past 2020 is a special year.
The unprepared new crown pneumonia epidemic has swept everyone into it, giving everyone a deeper understanding and more real needs for health.
The epidemic is like a big exam.
In the face of "bursting" examination papers, everyone is a candidate.
In order to prevent anyone from being left behind, the medical insurance department responded quickly after receiving the exam questions and built a solid "firewall" with the promise of free treatment, so that the "candidates" could walk into the examination room calmly and "don't panic in case of the epidemic."
In 2020, not only will it be a "stress test" for the epidemic, but before the major issue of "how to spend less money so that people can enjoy better medical services", reforms in the medical insurance field will be unprecedented.
At present, a "big test" concerning the safety of nearly 1.4 billion insured persons is still going on.
Standing at the starting point of the new year, people are looking forward to the "14th Five-Year" medical reform in the deep water area, and write a heart-warming "health answer sheet" with "innovative pen".
Hu Jinglin, Director of the National Medical Insurance Administration: During the epidemic, the "two guarantees" played an important role in the realization of "early detection, early reporting, early isolation, and early treatment", and they are a major institutional innovation in response to public health incidents.
During the epidemic, the "two guarantees" played an important role in promoting the realization of "early detection, early reporting, early isolation, and early treatment", and were a major institutional innovation in response to public health incidents.
——Hu Jinglin, Director of the National Medical Insurance Administration
During the epidemic, the "two guarantees" played an important role in promoting the realization of "early detection, early reporting, early isolation, and early treatment", and were a major institutional innovation in response to public health incidents.
——Hu Jinglin, Director of the National Medical Insurance Administration
Hu Shanlian, Professor of School of Public Health, Fudan University:
The collections covered by the three national organizations have reached hundreds of varieties, which have played a significant role in regulating the circulation of drugs in the future, establishing the payment standards for medical insurance drugs, improving the availability of drugs for patients, and reducing medical costs.
(According to Xinhua News Agency)
Zhang Tiejun, Director of the Joint Purchasing Office of High-Value Medical Consumables of the National Organization: We will work with the safety and quality supervision department to form a traceability chain for each coronary stent from production, circulation, and use, so that patients can use it with confidence.
(According to "Health News")
During the epidemic, the "two guarantees" played an important role in promoting the realization of "early detection, early reporting, early isolation, and early treatment", and were a major institutional innovation in response to public health incidents.
——Hu Jinglin, Director of the National Medical Insurance Administration
Xiong Xianjun, Director of the Medical Service Management Department of the National Medical Insurance Administration: The adjustment of the National Medical Insurance Catalogue must do everything possible to "guarantee basics."
With this adjustment, the medical insurance fund expenditure has not increased significantly, the medical expenses of the insured patients have been significantly reduced, and the medical insurance drug protection capacity and level have been improved.
During the epidemic, the "two guarantees" played an important role in promoting the realization of "early detection, early reporting, early isolation, and early treatment", and were a major institutional innovation in response to public health incidents.
——Hu Jinglin, Director of the National Medical Insurance Administration
Medical insurance payment, "pays" for the treatment of new coronary pneumonia
The new coronavirus is highly contagious. If the cost of treatment is not clear, it is not conducive to timely diagnosis and treatment and control of the source of infection.
On January 22, 2020, when the epidemic broke out, the National Medical Insurance Administration, together with the Ministry of Finance and the Health Commission, issued an emergency notice requesting "two guarantees": to ensure that patients will not be affected by cost issues, and that hospitals admitted to hospitals will not be affected by payment policies Cure.
It is the Spring Festival travel season and there is a large flow of people.
For confirmed patients, both local and remote patients are 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 government.
As the number of suspected patients far exceeds the number of confirmed patients, 5 days later, a supplementary notice was issued, clarifying that the medical expenses of the suspected patients are covered by medical insurance and finance.
How much does it cost to treat a patient with COVID-19?
The National Medical Insurance Bureau has given the answer: The average medical cost for each patient with new coronary pneumonia is 21,500 yuan, and the medical insurance payment ratio is about 66.7%, and the remaining part is subsidized by the government.
Due to the fluctuation of the number of confirmed cases, this number is also changing dynamically.
However, in the face of disease, the original intention of medical insurance to protect people's health has never changed.
From prepaid funds to reduce the pressure on hospitals to advance payments, to support the provision of "long prescriptions" for patients with chronic diseases, and to clarify that medical insurance premiums can be postponed, the National Medical Insurance Administration has launched a "package" of measures to respond to the epidemic, all with the goal of ensuring people's lives and health.
Not only does it go all-out to insure and treat, the medical insurance department also provides "real money" to support the resumption of work and production, and it is clear that the payment of employee medical insurance units can be levied by half, and the reduction period will not exceed 5 months, which will reduce the burden of enterprises by 150 billion yuan.
During the epidemic prevention and control period, nucleic acid testing has become an effective measure for epidemic prevention and control.
In order to support the realization of "due inspections and voluntary inspections", the National Medical Insurance Bureau requires items such as nucleic acid testing to be included in medical insurance and lower fees.
The epidemic has made it difficult for patients with common and chronic diseases to see a doctor and follow up.
Just when people turned to the Internet to seek medical services, the medical insurance department promoted the inclusion of Internet diagnosis and treatment in medical insurance reimbursement, and proposed that patients with common diseases and chronic diseases can be reimbursed by medical insurance for re-examination at Internet medical institutions.
As many places test the water to include Internet diagnosis and treatment into the scope of medical insurance payment, an "Internet revolution" in medical insurance is accelerating.
In 2021, we look forward to medical "mobile".
National "group purchase of drugs" discounts, entering the era of "a penny"
On the morning of August 20, 2020, the gate of the Neilongbai Yunting venue at No. 2419 Hongqiao Road, Shanghai was opened, crowded with people inside and outside the gate.
The third batch of countries organized the procurement of drugs in quantities to open bids as scheduled, and 189 pharmaceutical companies participated in the bidding of 56 drugs here.
At 10 o'clock, the exciting part of singing the standard came.
The declared prices of various companies appeared on the big screen one by one.
The quotations are lower than one, and the competition is almost "hand-to-hand".
Pharmaceutical companies are scrambling to squeeze into the door of volume procurement.
The so-called volume purchase can be understood as the "super group purchase" of drugs with the country as the unit. The government clarifies the purchase volume and allows the company to quote the specific drug volume, and the lower price wins the bid.
After two hours of intense competition, 55 drugs from 125 companies were successfully purchased.
This is the third batch of drug purchases organized by the state.
The first batch was a pilot program in 11 cities at the end of 2018, and 25 varieties were purchased.
After setting out a reproducible path, the pilot scope was expanded to the whole country in September 2019.
In 2020, mass procurement will be "non-stop". From the 32 drugs selected in the second batch at the beginning of the year, to the centralized procurement in August 2020, more and more types of drugs will be purchased.
A total of 112 drugs were selected for three batches of bulk purchases, with an average price reduction of 54%.
These drugs include drugs for chronic diseases and major diseases such as hypertension, cardiovascular disease, and tumors.
Even ibuprofen, amoxicillin, etc., which are available in the family, have been put on the "group buying" negotiation table.
From the second batch of bulk purchases, the antipyretic acetaminophen fell to 0.033 yuan per tablet, to the third batch of metformin hydrochloride tablets for the treatment of diabetes fell to 0.015 yuan per tablet. The lowest price was constantly refreshed, and people exclaimed that the drug had dropped "A penny era".
In the past, due to the "sale with gold", the price of a considerable part of the medicines was inflated for a long time.
The core of the national organization of centralized drug procurement is to commit to the procurement volume and ensure the use, so that pharmaceutical companies no longer have to "public relations" for drug sales and reduce drug prices.
At present, the national organization of drug procurement with volume has become normal.
In the future, two batches of drugs are expected to be purchased in quantities each year. As long as the relevant drugs meet the procurement conditions, the state will trigger the national organization to purchase in quantities.
This means that more medicines are on the way.
The heart stent was cut to the "cabbage price", diving to 700 yuan
Not only medicines, this year's "circle of friends" with volume procurement has expanded to the field of high-value medical consumables.
How much can a heart stent that used to cost tens of thousands of yuan be reduced after being "soul bargained" by the medical insurance department?
The answer was announced on November 5, 2020, 700 yuan!
In the morning of the same day, as the first variety of high-value medical consumables purchased by the state, the coronary stent offered a "cabbage price", diving from an average price of about 13,000 yuan to about 700 yuan.
Netizens joked that this is an unprecedented "Double 11 Giant Benefit".
For a long time, high-value medical consumables such as coronary stents, artificial joints, and ophthalmic intraocular lenses, which are used in the human body and used in large quantities, have been widely criticized for their high prices and excessive use.
In order to reduce the "false fire", the state has been planning for a long time, and the "first shot" of reform has been aimed at coronary stents with high unit prices and large quantities.
Cardiovascular disease is the first cause of death among Chinese residents.
Currently, more than 2,400 medical institutions use approximately 1.5 million coronary stents each year.
The actual needs of patients are greater than 1.5 million.
The main reason why the demand is not met is that it is expensive and cannot be used.
The cost is five to six hundred yuan, the ex-factory price is two to three thousand yuan, and the price of coronary stents that enter the hospital and placed in front of patients exceeds 10,000 yuan.
The price difference is so large, mainly because too many "middlemen make the difference."
This time, pharmaceutical companies coincided with their price cuts by 93%.
The reason why they are willing to offer such a low price lies in the "charm of the market."
In the first year of this purchase, the intended purchases accounted for 65% of the coronary stent purchases in 2019.
Low price does not mean poor quality.
The National Medical Insurance Bureau said that after cost calculations, the quotation was within a reasonable range.
In this purchase, mainstream products commonly used by hospitals were basically selected.
This shows that the selected stent is a mature product that has been used clinically for a long time, and it also ensures that doctors feel the same as in the past.
From 2021, patients can already use reduced-price coronary stents.
To "squeeze water" for high-value medical consumables, coronary stents are just the beginning.
According to the official deployment, a big move to reduce the price of more high-value medical consumables has been laid.
Good medicine and new medicine are included in medical insurance, spending money on the blade
Affected by the epidemic, the new version of the medical insurance drug catalog was adjusted later than in previous years, and it will be the finale at the end of 2020.
At 19:00 on December 16, 2020, with the completion of the last drug negotiation for the treatment of melanoma, the three-day 2020 national medical insurance drug catalog adjustment work completed the most tense negotiation link.
The adjustment of the medical insurance drug catalogue is closely related to ordinary people's medical treatment and medical insurance reimbursement, and is an important basis for which drugs the medical insurance fund needs to "pay".
On December 28, 2020, a new version of the medical insurance drug catalog was released.
This version of the catalogue includes 119 new drugs, including 96 exclusive drugs imported through negotiation and 23 non-exclusive drugs imported directly. The average price of negotiated drugs is reduced by 50.64%.
After the news was sent, it quickly rushed to the "hot search".
Compared with previous years, this round of negotiations has the largest number of drugs and benefits the widest range of treatment fields.
Chronic obstructive pulmonary medications, lupus erythematosus medications, tumor immunotherapy medications, children's medications... the new drugs involved 31 clinical groups, accounting for 86% of all clinical groups.
Patients benefit more extensively.
In the past, the medical insurance catalogue was adjusted, and the threshold for drug access was generally as of the end of the previous year.
For the first time, this round of adjustment extended the time to the day when the adjustment work plan was announced.
In the end, 16 new drugs launched in 2020 were included in the catalog, allowing patients to benefit from drug development as soon as possible.
At the same time, this adjustment is the first attempt to negotiate a price reduction for the "old varieties" in the catalog.
After negotiation, 14 drugs with annual sales of more than 1 billion yuan were successfully negotiated and kept in the catalog, with an average price reduction of 43.46%.
"For a long time, safe and ineffective'magic medicines' in the medical insurance drug catalogue have prevailed.'Only in but not out', it affects the people's access to quality medicine services." Hu Jinglin, director of the National Medical Insurance Administration, pointed out that a large number of "magic medicines" were removed from the catalog. At the same time, many good drugs have been included in the medical insurance, and the structure has been optimized.
In the future, the list of medical insurance drugs will establish a complete dynamic adjustment mechanism, which in principle will be adjusted once a year.
This means that more good medicines that save lives are expected to be included in medical insurance in time, and people's medication protection and sense of medical treatment will continue to increase.
What are our new expectations for medical insurance in 2021?
News from our newspaper (Reporter Dou Feitao, intern Yu Qianqianbai Zhijie) At the end of 2020, the "famous scene" of the soul bargaining of medical insurance negotiations reappeared.
119 new drugs were included in the medical insurance, a drop of more than half, which attracted repeated praise from netizens.
In order to understand what people expect from medical insurance in the new year, a reporter from the Workers’ Daily recently interviewed dozens of insured persons randomly on the streets of Beijing.
In recent years, the coverage of my country's basic medical insurance has continued to expand, with more than 1.35 billion people participating.
"Paying for the treatment of patients with new coronary pneumonia", and drastically reducing the prices of medicines and coronary stents...In 2020, many people-benefiting policies in the medical insurance field have accelerated, making outstanding contributions to fighting the epidemic and protecting people's lives and health.
During the interview, most of the interviewees stated that they participated in medical insurance.
Among them, young people see fewer doctors and use medical insurance less frequently, and some elderly people say that they often enjoy medical insurance reimbursement when they see a doctor.
Currently, Zhang Honglong, a practitioner in the financial industry, is most concerned about the news of new coronary pneumonia treatment.
He was particularly excited to learn that all the drugs used for new coronary pneumonia were included in the medical insurance reimbursement: "This has greatly reduced the financial burden of patients."
"The elderly in the family have chronic diseases and have to go to the hospital to prescribe medication every month. The reimbursement ratio is quite high." Ms. Qiao, who works in the real estate industry, usually pays more attention to the news about medical reimbursement.
"In 2020, there are many policies to benefit the people with medical insurance. For example, the average price of coronary stents has dropped from 13,000 yuan to about 700 yuan, and the price reduction is still quite large." She said.
In 2020, institutional innovations such as the dynamic adjustment of the medical insurance drug catalog and the normalization of the procurement of drugs and consumables have enabled many patients to enjoy the tangible "benefits" of the medical reform.
Affected by the epidemic, many places will implement online appointment registration in 2020, which will reduce the risk of the spread of the epidemic and cause inconvenience to some elderly people in seeking medical treatment.
Grandma Li, who has retired for many years, said that for people her age, it is not convenient to make an appointment online. "Can you simplify it in the future?"
"If young people are strong and healthy, the medical insurance reimbursement ratio can be lower. In this way, young people can also be encouraged to exercise more and strengthen their physical fitness. However, after retirement, the income of the elderly decreases and their physical functions are also declining, so the reimbursement ratio can be relatively higher. "Zhang Honglong suggested.
When she catches a cold and has a fever, Ms. Qiao and her family often go to the community hospital near her home to see a doctor.
But she found that compared with large hospitals, community hospitals purchase limited types of medicines.
She looked forward to: "In the new year, more common and chronic diseases will be prescribed in community hospitals."
Reporter Li Danqing