Chen Xin, deputy to the National People's Congress: It is recommended to increase the medical insurance reimbursement rate for children with congenital heart disease to 90%
This year’s national "two sessions", Chen Xin, representative of the National People’s Congress, deputy dean of Nanjing First Hospital, and director of cardiothoracic and vascular surgery, suggested that medical insurance reimbursement for children with congenital heart disease (hereinafter referred to as "congenital heart disease") should be implemented as soon as possible. The problem is that children with congenital heart disease operations can enjoy a higher reimbursement rate, and strive to increase from the current 50-60% to 80-90%.
Congenital heart disease is recognized as a disease with "higher therapeutic benefit"-95% of congenital heart disease can be cured, and the cost is relatively small. Simple congenital heart disease is about 30,000 yuan.
"Most children with congenital heart disease can grow up like normal people after timely treatment." Representative Chen Xin told The Paper (www.thepaper.cn).
However, in actual life, there is still a considerable number of patients who cannot receive effective treatment because they cannot afford the cost of surgery.
According to the "China Cardiovascular Health and Disease Report 2019", there are about 2 million patients with congenital heart disease in my country, and 90 to 150,000 children with congenital heart disease are newly added every year, but in fact only 80,000 congenital heart surgery operations are completed every year.
"In terms of treatment costs, medical insurance payments at all levels have played a decisive role, and various charitable aid funds have also played an active supplementary role. There are also tens of thousands of children with congenital heart disease who have not received timely treatment, mainly for economic reasons." Chen Xin Said that children with congenital heart disease who were born in poor families, remote rural areas or underdeveloped areas in the west, due to poor family economic conditions, failed to be treated in time, became poor due to illness, and returned to poverty due to illness, which has increased the difficulty of poverty alleviation.
As early as 2010, when the then Premier Wen Jiabao of the State Council made a government work report, he clearly pointed out: to carry out the pilot medical insurance for rural children with leukemia and congenital heart disease.
In June of the same year, the former Ministry of Health included children's congenital heart disease surgery in the scope of the trial. In principle, the compensation/reimbursement ratio of the new rural cooperative medical system should reach about 70% of the provincial limit.
In 2011, the then Minister of Health Chen Zhu announced: "Children with congenital heart disease and acute leukemia will be fully introduced for free treatment"-70% will actually be reimbursed by the New Rural Cooperative Medical Insurance, and then 20% will be compensated by the Critical Disease Relief Fund according to the family situation.
However, due to various factors, it is not easy to treat congenital heart disease free of charge in many areas of the country, especially in rural and underdeveloped areas.
For example, for poor patients with congenital heart disease in rural areas, after the new rural cooperative medical insurance system was integrated into the residents’ medical insurance in 2019, in some areas, the reimbursement rate for serious illnesses enjoyed by farmers remained the same as that of urban residents, which became 50%. Under the comprehensive treatment policy for major diseases, children with congenital heart disease and leukemia can be reimbursed for 70%-90%, which to a certain extent increases the burden of poor patients with congenital heart disease in rural areas.
For patients who need to be transferred to a higher-level hospital for treatment, the reimbursement rate decreases after inter-city and inter-province, and the rate of reimbursement for surgery in tertiary hospitals is only 50-60%.
For infants and young children, if they are not covered by medical insurance within three months of birth, they cannot be reimbursed; if they are covered by medical insurance within three months of birth, the medical expenses incurred by the child will be reimbursed at a certain percentage from the time of birth. About 70~85%; the drugs commonly used to treat pulmonary hypertension before and after surgery in children with severe congenital heart disease are not covered by the medical insurance reimbursement.
To this end, Representative Chen Xin suggested that the state introduce policies to increase the reimbursement rate for children with congenital heart disease operations from the current 50-60% to 80-90%.
Specifically, the National Health Commission and the National Medical Insurance Bureau jointly issued guidelines to guarantee the level of medical insurance for children with congenital heart disease surgery in rural areas, poverty-stricken areas, and underdeveloped areas in the western region, for each province, municipality, and autonomous region to implement it according to their own conditions.
For newborns with congenital heart disease, it is stipulated that they can enjoy the medical insurance reimbursement policy if they pay medical insurance in time.
Include pulmonary artery pressure-reducing drugs before and after surgery for children with congenital heart disease into the scope of medical insurance to reduce the financial burden of these families.
At the same time, strengthen policy propaganda, especially in rural and underdeveloped areas, promptly screen for detection and treatment of congenital heart disease.
The Paper Reporter Chen Zhuo