【Economic interface】
"The per capita financial subsidy standards for residents' medical insurance and basic public health services will be increased by 30 yuan and 5 yuan respectively" "Promoting the centralized procurement of medicines and high-value medical consumables to ensure production and supply" "Include more common diseases and other outpatient expenses into medical insurance In the scope of reimbursement, the cross-provincial direct settlement rate of hospitalization expenses has reached 60%." "Gradually improve the level of service guarantees for the prevention and treatment of cardiovascular and cerebrovascular diseases, cancers and other diseases, and strengthen the guarantee of drugs for rare diseases"... "People's livelihood" listed in the government work report In the list", good news in the field of medical insurance is frequently reported.
Where the people are concerned, and where the government is directed.
During the "14th Five-Year Plan" period, the "gold content" of my country's basic medical insurance system has been continuously improved, and the sense of gain of insured personnel has steadily improved.
One by one policy measures, we are further closely weaving the health safety net benefiting more than 1.4 billion people.
Adjusting the National Medical Insurance Drug Catalog——
"Sky-high-priced drugs" fly into the homes of ordinary patients
■Case
"After waiting for so long, our child is finally saved." The mother of a rare disease spinal muscular atrophy patient in Henan Province saw the officially announced 2021 National Medical Insurance Drug List and learned that the drug used to treat this rare disease The price of the drug, Nosinagen Sodium Injection, was greatly reduced after being included in the medical insurance, and I couldn't help crying with joy.
Nosinagen Sodium Injection is the first imported specific drug approved for the treatment of spinal muscular atrophy in China.
However, the price of this special drug is as high as 700,000 yuan per injection, and the patient's annual treatment cost is as high as millions of yuan.
The "astronomical" medical expenses have discouraged many patients' families.
As more and more medicines enter the medical insurance and the prices are greatly reduced, patients can use "life-saving medicines" and see the hope of life.
Looking back at the past year, through the national negotiation of medical insurance, many "high-priced drugs" have been reduced to "common people's prices", which have truly become "life-saving drugs" for patients.
Catalog access negotiation has become an important means to guide drug price cuts.
In December 2021, a video of "soul bargaining" by medical insurance negotiators and representatives of pharmaceutical companies was trending on Weibo and became the focus of public attention. Netizens "liked" the negotiators' wonderful speeches.
On January 1 this year, the price of Nosinasheng Sodium Injection, which suffered from "soul bargaining", was officially implemented, and the price was reduced from 700,000 yuan per injection to 33,000 yuan.
For a long time, the issue of medication security for patients with rare diseases has attracted much attention from the society.
Nosinagen Sodium Injection is the first drug for the treatment of high-value rare diseases in my country to be included in medical insurance.
On December 3, 2021, the National Medical Insurance Administration announced the adjustment results of the 2021 National Medical Insurance Drug List.
The data shows that in addition to Nosinagen Sodium Injection, in 2021, a total of 7 rare disease drugs in my country have been successfully negotiated and included in the medical insurance, including human coagulation factor IX for the treatment of hemophilia, and ertiban acetate for the treatment of hereditary angioedema. Special injections, etc., the average price dropped by 65%.
According to data from the National Medical Insurance Administration, a total of 117 drugs will be included in the scope of medical insurance negotiation in 2021, and 94 drugs have been successfully negotiated, with a success rate of 80.34%.
It is expected that in 2022, the cumulative burden on patients will be reduced by more than 30 billion yuan.
After the price reduction of these "high-priced drugs", coupled with medical insurance reimbursement, the burden level of the patient's family has dropped significantly, greatly reducing the risk of "being impoverished due to illness and returning to poverty due to illness".
During the adjustment, the National Medical Insurance Administration firmly adhered to the "bottom line" of medical insurance's bottom line, emphasizing that "giving help in the snow" is greater than "icing on the cake" to meet the basic drug needs of the majority of insureds.
At present, the number of patients with rare diseases in China is relatively small, but the cost of treatment is often high, and many families cannot afford it.
Cai Weiping, chief expert of the Infectious Disease Center of the Eighth Hospital Affiliated to Guangzhou Medical University, said that while improving the service guarantee level of common diseases, my country is increasingly taking into account the guarantee of rare diseases.
This year's government work report proposes to "strengthen the protection of drugs for rare diseases", which fully reflects the concept of people first and life first.
Carry out centralized procurement with volume——
"Squeeze out" price inflated "moisture"
■Data
It is understood that since 2018, the National Medical Insurance Bureau has been continuously promoting the reform of the procurement of drugs and high-value medical consumables by volume. So far, six batches of drugs have been purchased by volume, and a total of 234 kinds of drugs have been purchased, and the amount involved accounts for the annual drug procurement of public medical institutions. 30% of the total.
Judging from the cumulative results of the three-year reform, the state organized centralized procurement to save more than 260 billion yuan.
Insulin is an important drug for diabetic patients to control blood sugar and has an irreplaceable position in diabetes treatment.
Because insulin needs to be used for a long time, the inflated price brings a heavy burden to patients.
In November 2021, the bid opening of the centralized procurement of insulin will bring good news to the majority of diabetic patients.
According to the relevant person in charge of the National Medical Insurance Bureau, after the centralized collection of insulin, taking insulin glargine, which is commonly used in clinic, as an example, the price has dropped from an average of 180 yuan/piece to about 70 yuan/piece, and each patient can save about 4,000 yuan per year.
The special procurement of insulin carried out this time expands the centralized procurement from chemicals to biological drugs for the first time.
In December of the same year, Hubei led the 19-province alliance to open bids for the centralized procurement of Chinese patent medicines, and Chinese patent medicines officially joined the centralized procurement team.
Because of its particularity, the quality of proprietary Chinese medicines is difficult to evaluate and there are many exclusive products, it is quite difficult to carry out centralized procurement.
"The particularity of the industry is not a safe haven for artificially high drug prices." The person in charge of the Department of Drug Price and Bidding and Procurement of the National Medical Insurance Administration said that it is necessary to let the people enjoy lower drug prices, but also to purify the industry environment, so that drugs can return to cure diseases and save people. essential properties.
It is reported that the procurement scale of Chinese patent medicines is nearly 10 billion yuan, and the average price of the selected Chinese medicines has dropped by 42.27%, with the largest drop of 82.63%.
According to the calculation of the annual demand of the 19-province alliance, it is estimated that more than 2.6 billion yuan in drug costs can be saved every year.
In terms of the centralized procurement of high-value medical consumables, cardiology and orthopedics are two areas that people are more concerned about.
Due to the complex technical classification and combination of orthopedic consumables, it is difficult to compete directly, and it has long been a difficulty in centralized procurement. The price is obviously inflated and the burden on patients is heavy.
On September 14, 2021, the National Medical Insurance Bureau organized a centralized procurement of artificial joints. The average price of the hip joints to be selected will drop from 35,000 yuan to around 7,000 yuan, and the average price of knee joints will drop from 32,000 yuan to around 5,000 yuan.
Chen Jinfu, deputy director of the National Medical Insurance Administration, said that in the first six batches of centralized procurement of medicines, the average reduction of cardiac stents was 93%, and the average reduction of artificial hip joints and knee joints was 82%. The price level of medical consumables showed a steady and declining trend.
"The price of medicines and high-value medical consumables will return to a reasonable level, and the benefits will be more obvious for the masses." Chen Jinfu said
Chen Jinfu revealed that the National Medical Insurance Administration is currently planning to purchase the seventh batch of drugs in a centralized manner.
By the end of 2022, through the procurement of national organizations and provincial alliances, we will strive to achieve an average coverage of more than 350 varieties of medicines per province, and more than 5 varieties of high-value medical consumables.
Full coverage of inter-provincial direct settlement——
Off-site reimbursement is no longer "running and breaking legs"
■Story
"The policy that medical insurance expenses can be settled across provinces has really helped us families who need medical treatment in other places." Mr. Chen, who has settled in Tianjin in the 1980s, told reporters that he brought his retired father to Tianjin to live with him. .
My father is in poor health and needs to take medicine all the year round, but my father's medical insurance is in Hebei, and it is very troublesome to reimburse the cost of medical treatment and prescription in the hospital in Tianjin.
After the pilot program of cross-provincial direct settlement of outpatient outpatient expenses is rolled out, there is no need for special filing, and services have already been opened in the places of medical treatment and social security, and medical insurance cards can be swiped directly.
This year's government work report pointed out that "improve the direct settlement method for cross-provincial medical treatment in different places, and realize the basic uniformity of the national medical insurance drug coverage".
In recent years, the number of people living in different places, retiring in different places, and working in different places has increased greatly, especially the group of elderly people who move with their children is becoming more and more large, and there is a higher demand for direct settlement of medical treatment in other places.
It is difficult for outpatient reimbursement and settlement in different places.
Many people in the same situation as Mr. Chen's family have "broken their legs" and "worn their mouths" for reimbursement.
The "hard bone" of out-patient chronic and special disease bill settlement in different places is particularly difficult to chew.
Long Xuewen, head of the National Medical Insurance Administration's Medical Insurance Management Center, said that no matter how difficult it is, we cannot "take a detour".
The National Medical Insurance Bureau starts with outpatient chronic and special diseases that involve a large number of people and are generally carried out in local areas, unify the names of diseases, disease codes and settlement rules, and promote regional pilots to national pilots.
In 2021, the National Medical Insurance Bureau, together with the Ministry of Finance, will issue the "Notice on Launching the Pilot Program of Cross-provincial Direct Settlement of Outpatient Chronic and Special Disease-related Treatment Expenses", focusing on outpatient radiotherapy and chemotherapy for hypertension, diabetes, and malignant tumors, dialysis for uremia, and postoperative organ transplantation. A pilot program of cross-provincial direct settlement of outpatient chronic and special disease-related treatment costs, including anti-rejection therapy, was launched.
Subsequently, the pilot program of cross-provincial direct settlement of outpatient extra-chronic diseases was gradually rolled out across the country.
At present, it has achieved full coverage of cross-provincial direct settlement of general outpatient expenses in 31 provinces (autonomous regions and municipalities directly under the Central Government) and all coordinating areas of Xinjiang Production and Construction Corps; each province has at least one coordinating area to initiate outpatient chronic disease-related treatment costs across provinces Direct settlement pilot.
According to the data of the National Medical Insurance Bureau, as of the end of December 2021, the number of designated medical institutions for cross-provincial direct settlement of outpatient expenses nationwide was 45,600; the accumulative cross-provincial direct settlement of outpatient expenses nationwide was 12.5144 million person-times; the medical expenses involved 3.128 billion yuan, and the fund paid 17.50 million 100 million yuan, and the fund payment ratio is 56.0%; the overall settlement scale has quadrupled compared with the same period in 2020.
In addition, in terms of the settlement process, Li Tao, deputy director of the National Medical Insurance Bureau, introduced that the cross-provincial direct settlement process for outpatient expenses has changed from "filing first, selecting a point, and seeking medical treatment with a card" to "first filing, selecting a point, and using the card code to seek medical treatment." ".
The change in one word reflects the more optimized and convenient settlement process.
Some insured places can use the national medical insurance service platform App and the national remote medical treatment filing mini-program to realize cross-provincial handling of medical treatment in different places, and the insured does not need to go back to the insured place to open the filing.
(Reporter Dong Bei)