Medical insurance reform continues to move into the deep water area, bringing a stronger sense of security and gain

  [Hundred Years of Struggle, Set Sail, New Journey, Well-off Dreams] Use the health of the whole people to support a well-off society in an all-round way

  On the eve of July 1st, a retired worker from the west slope of Changbai Mountain in Jilin Province bought a big cake to celebrate the centenary of the founding of the party.

"Our party and country are so great. They have effectively controlled the epidemic and vaccinated everyone for free." The family took his simple blessing to the motherland into a video and posted it to social platforms, which received 413,000 likes.

  Health is the common expectation of the people. It is an important part of building a moderately prosperous society in an all-round way to have medical treatment for the sick and support for the weak.

At present, my country has built the world's largest basic medical insurance network.

The number of people participating in basic medical insurance in my country is 1.36 billion, and the participation rate has stabilized at over 95%, achieving full coverage of the basic medical insurance system.

  From free treatment of patients with new coronary pneumonia to free vaccination, from normalized procurement of medicines and high-value consumables to the realization of direct settlement of outpatient expenses across provinces, China's medical insurance reform is continuously moving into the deep water area, focusing on solving the "difficult to see a doctor". The problem of "expensive medical care" has brought people a stronger sense of security and gain.

  Prepaid funds to ensure free vaccination

  According to the National Health Commission, as of July 23, there have been more than 1.5 billion doses of new crown vaccination in the country.

  As early as the beginning of the new crown pneumonia epidemic, my country clearly implemented treatment after treatment for confirmed and suspected patients.

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.

  In the face of disease, the original intention of medical insurance to protect people's health has never changed.

After launching the new crown pneumonia vaccination work, my country has determined the principle of voluntary vaccination of new crown pneumonia by individuals and free of charge by the state.

  According to Shi Zihai, deputy director of the National Medical Insurance Administration, the cost of vaccines and vaccination will be borne by the medical insurance fund, and the government will provide appropriate subsidies to the medical insurance fund, and residents will receive free vaccination.

The medical insurance fund is mainly borne by using the balance of the past years, and does not affect the income and expenditure of the fund in the current period, "that is, it will not affect the current medical treatment of the people."

  Regarding whether the vaccination costs that people care about will cost a large amount of medical insurance funds and affect people’s future medical reimbursements, the "Statistical Bulletin on the Development of National Medical Security Undertakings in 2020" announced not long ago shows that the total income and total expenditures of basic medical insurance funds in 2020 They are 2,484.6 billion yuan and 21,32 billion yuan, respectively. At the end of 2020, the total balance of medical insurance funds is 3.15 trillion yuan.

  "At present, the overall operation of the fund is stable and the balance is relatively abundant. The use of the balance will not affect the current medical insurance treatment of the people." Shi Zihai said.

  In order to ensure that all regions do not affect vaccination due to costs, the medical insurance departments of all regions promptly allocate funds to vaccine procurement agencies.

Xiong Xianjun, director of the Medical Service Management Department of the National Medical Insurance Administration, previously stated that as of the end of March, more than 24 billion yuan had been prepaid to vaccination institutions, achieving "money and other vaccines."

  Medicine prices are lower and medical reimbursement is more convenient

  On January 1st this year, 76-year-old Xiang Dazhu suffered from acute inferior ST-segment elevation myocardial infarction. He received emergency coronary angiography, intracoronary thrombolysis and stent implantation at Xiangtan First People’s Hospital. The price of the bracket used in China dropped from 7,800 yuan to 798 yuan.

This is an earlier group of patients in my country who enjoy the benefits of centralized procurement of coronary stents organized by the state.

  The heart stent that used to cost tens of thousands of yuan was reduced to more than 700 yuan after the "soul bargaining" of the medical insurance department.

As the first variety of high-value medical consumables purchased by the state, coronary stents have dived from an average price of about 13,000 yuan to about 700 yuan.

  It's not just a heart stent.

Not long ago, the National Medical Insurance Administration and other eight departments issued the "Guiding Opinions on Procurement and Use of High-Value Medical Consumables in National Organizations", clearly expanding the coverage, promoting the return of high-value medical consumables to a reasonable level, and reducing the burden on patients .

  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 will no longer "public relations" for drug sales and reduce drug prices.

  On June 23, the fifth batch of nationally organized drugs for centralized procurement of drugs was opened in Shanghai.

The centralized procurement involved public hospitals with a purchase amount of 55 billion yuan, 61 varieties were selected, and 251 products were selected, which set a record high for centralized procurement. The average price of drugs to be selected was reduced by 56%.

  Currently, centralized drug procurement is becoming normal.

According to Wang Guodong, head of the Pharmaceutical Price and Bidding Purchasing Department of the National Medical Insurance Administration, the five batches of centralized procurement involve a total of 218 varieties. Counting the fifth centralized procurement, it is estimated that the annual drug cost can be saved by 92.6 billion yuan.

  At the same time, medical reimbursement has become more convenient and smoother.

In February this year, the National Medical Insurance Bureau added 15 provinces as pilot provinces for direct settlement of outpatient expenses across provinces.

So far, 27 provinces (autonomous regions and municipalities) across the country have carried out direct settlement of ordinary outpatient expenses across provinces.

  According to the plan, by the end of this year, more than 60% of the counties in all provinces will have at least one inter-provincial networked medical institution for general outpatient expenses, and each coordinated area will basically achieve direct settlement of ordinary outpatient expenses across provinces; for outpatients for hypertension, diabetes, and malignant tumors, There are five outpatient clinics for chronic disease, including chemotherapy, uremic dialysis, and anti-rejection treatment after organ transplantation, which are in high demand and are widely carried out in various regions. Each province has at least one coordinated area to achieve direct settlement of related treatment costs across provinces.

  Medical insurance to alleviate poverty, prevent and resolve the return of poverty due to illness

  He Xiujuan, born in Enluo Village, Yingpan Town, Lanping Bai and Pumi Autonomous County, Nujiang Lisu Autonomous Prefecture, Yunnan Province, suffered from bone tuberculosis at the age of 8, and a basketball-sized bulge grew on her waist, which made her hunch back and move around. She walked slowly, and was once called the "Snail Girl" by the children in the village.

Benefiting from the poverty alleviation policy of medical insurance, in September 2019, He Xiujuan used surgery to remove the "snail shell" she had been carrying for 14 years.

  As a poor household with a registered card, He Xiujuan enjoys basic medical insurance, critical illness insurance, and medical assistance.

He Xiujuan only needs to bear more than 6,000 yuan after reimbursing 168,000 yuan for medical expenses.

The local civil affairs bureau and the Red Cross also applied for a 3,000 yuan temporary living aid for her.

  The medical insurance system plays an important role in preventing poverty and reducing poverty.

The relevant person in charge of the National Medical Insurance Bureau said that through the basic medical insurance, critical illness insurance, medical assistance and other triple guarantee systems, the burden of cascading has been reduced.

  According to statistics, since 2018, the medical insurance poverty alleviation policy has funded 230 million people insured for poor people like He Xiujuan, reduced the burden of personal payment by 40.3 billion yuan, and benefited 500 million people from poor people seeking medical care.

Medical insurance helps the poor, so that poor people don’t have to "rely on the slightest illness and rely on the sky for serious illnesses" as in the past.

  At present, my country has established a unified urban and rural residents' basic medical insurance and critical illness insurance system, and is gradually forming a multi-level medical security system with basic medical insurance as the main body, medical assistance as the foundation, and other guarantee measures.

  "Consolidate and expand the achievements of poverty alleviation through medical security, and effectively link the strategy of rural revitalization." At the end of May this year, the National Medical Insurance Bureau and other three departments issued a notice to clearly establish a long-term mechanism for preventing and resolving poverty due to illness, and to take care of the high cost burden of patients. Monitoring the risk of returning to poverty and causing poverty, timely including qualified personnel into the scope of medical assistance, and implementing medical assistance policies.

  Li Danqing

Keywords: