Universal health insurance does not give up every small group
On May 10, Li Mu received the fourth injection of Nosinagen Sodium Injection.
Although he has been "tortured" by spinal muscular atrophy (SMA) and has become severely disabled, he is still very fortunate that he took this once "high-priced drug" when he was still able to sit in a wheelchair.
Arrangement: Qi Zheng Drawing: Li Han
A few months ago, Li Mu reached for a bottle of mineral water on the table and felt that the bottle of water suddenly became heavier.
He used all his strength to get the bottle of water. After trying two or three times, the bottle could be moved, but he couldn't pick it up until the bottle of water fell to the ground and rolled to the side, and Li Mu, who was in a wheelchair, couldn't reach it.
Li Mu knew that his hand muscles had degenerated, and he couldn't even hold a bottle of mineral water from now on.
At that time, Li Mu looked at the mineral water that was rolling away. He thought about what he should do in the future because of muscle atrophy, difficulty in eating, and even breathing.
The fact is, there is no way, he can only accept the arrangement of fate.
Spinal muscular atrophy is a rare disease caused by genetic mutations.
Muscle weakness and progressive muscle atrophy are the main manifestations of this disease.
Spinal muscular atrophy is known as the "number one killer" of genetically fatal diseases in children under the age of 2.
Most of the children died from respiratory failure caused by weak breathing muscles.
Li Mu was diagnosed with spinal muscular atrophy when he was more than 1 year old. At that time, he staggered and walked a step or two before falling. The doctor who diagnosed Li Mu's parents told Li Mu's parents that there was no cure for this disease, and the child might not live. adult.
When Li Mu's mother heard this, she fainted on the spot.
Before the age of 12, Li Mu didn't think he was a disabled person, he was still a little fat at the time, he just knew that he couldn't run and jump.
After the age of 12, Li Mu began to have scoliosis.
Nine years later, Li Mu's spine has been bent into a big letter "C", and his back is so high that he can only sit diagonally in a wheelchair.
Due to muscle atrophy, Li Mu has only a handful of places in his body that he can move: his head, his upper body can move a little, the fingers of his left hand and his right hand.
The power of the right hand can only pick up a phone or a spoon.
For spinal muscular atrophy, Nosinagen Sodium Injection is the first precision targeted therapy drug on the market in my country.
This drug requires 6 injections in the first year of use, and 3 injections per year thereafter, for life.
Because it sells for 125,000 US dollars (about 850,000 yuan) per injection in the United States, it is also included in the "Ten Most Expensive Drugs in the World".
In 2019, the drug was launched in China at a price of about 700,000 yuan per injection.
Li Mu found out about the drug while chatting with his patients. When he learned that one injection was 700,000 yuan, their chat stopped abruptly.
Li Mu told a reporter from China Youth Daily and China Youth Daily: "I did the math at the time. It took seven years for our family to save enough money for one injection if we didn't eat or drink. After 7 years of frugality, one injection would be gone. Then I put the thought of this shot behind me."
Until December 2021, a piece of "soul bargaining" news spread all over the Internet, and Li Mu's hope was rekindled.
State-organized centralized procurement has saved more than 260 billion yuan
December 3, 2021 is Li Mu's 21st birthday.
On the same day, the National Medical Insurance Administration held a press conference to announce the newly adjusted 2021 National Medical Insurance Drug Catalogue, in which Nosinason Sodium Injection, which once cost 700,000 yuan per injection, was included!
Li Mu saw the news in the group and felt that God gave him the best birthday present.
Subsequently, the negotiation video of Nosinasheng Sodium Injection was released online. Zhang Jinni, a medical insurance negotiator and director of the Pharmaceutical Equipment Procurement Department of the Fujian Provincial Medical Insurance Bureau, moved countless netizens with the sentence "Every small group should not be given up".
The incidence of spinal muscular atrophy is only 1/6000-1/10000, and the patients with this disease are a veritable small group.
As a severely disabled person, Li Mu hardly ever goes out and lives in his own little world.
These small groups do not seem to be seen, but the national medical insurance policy for benefiting the people is giving them a sense of gain.
Going back four years ago, on May 31, 2018, the National Medical Insurance Bureau was established in Xicheng District, Beijing, and various major reforms in the field of medical insurance in my country kicked off.
Centralized drug procurement is a major reform measure started shortly after the establishment of the National Medical Insurance Administration.
The fifth meeting of the Central Comprehensive Deepening Reform Committee held on November 14, 2018 reviewed and approved the "National Organization for Centralized Drug Procurement Pilot Program".
In January 2019, the General Office of the State Council issued the "Notice on Printing and Distributing the Pilot Program for the Centralized Procurement and Use of Drugs Organized by the State", fully deploying the relevant work of the pilot.
Jiang Changsong, director of the Price Recruitment and Procurement Office of the National Medical Insurance Research Institute, explained that, as the largest payer of medical services, the National Medical Insurance Bureau, relying on the unified national market, gave full play to its strategic purchasing advantages, and creatively carried out centralized procurement with volume and access to the medical insurance drug catalog. Negotiation work.
The two tasks are a set of "combination punches". The National Medical Insurance Administration makes full use of the economic leverage of demand to guide supply, leads the supply-side reform in the field of pharmaceuticals, and effectively ensures that the people can afford high-quality and affordable "over-evaluated drugs" and innovative drugs.
As Zhang Jinni said in the negotiation, with China's population base and the determination of the Chinese government to serve patients, it may be difficult to find such a market in the world for Nosinason Sodium Injection.
This one-and-a-half-hour negotiation finally reduced the "high-priced medicine" of 700,000 yuan a shot to less than 33,000 yuan.
Li Mu said that he was deeply impressed by the video, and the words "every small group should not be abandoned" were deeply imprinted in his mind.
Li Mu only needs to pay more than 2,000 yuan per injection for this once "high-priced drug" after medical insurance reimbursement. "When I saw the amount after reimbursement, I was happy from the bottom of my heart." Li Mu said that his income from playing games will increase. In addition to various subsidies from the state, the more than 2,000 yuan can basically be paid by yourself.
For a severely disabled person who needs the help of his family to get dressed, go to the toilet, and even turn over in bed, it is more special to be able to pay for the treatment by himself, so that his fragile self-esteem can be comforted very well.
Li Mu injected Nosinagen Sodium Injection at the Medical Genetics Department/Rare Disease Diagnosis and Treatment Center (hereinafter referred to as the "Rare Disease Diagnosis and Treatment Center") of the Second Affiliated Hospital of Zhejiang University School of Medicine.
The Rare Disease Diagnosis and Treatment Center established by the hospital on November 1, 2021 is the only rare disease ward in China. Wu Zhiying, the head of the ward, told the China Youth Daily and China Youth Daily that before the Noxinagen Sodium Injection was included in the medical insurance, Only two patients in the ward have received this injection. In January this year, after the medical insurance was officially reimbursed, more than 20 patients have come to the ward to have the injection.
As of December 2021, more than 60 drugs for rare diseases have been approved for marketing in China, of which more than 40 drugs involving 25 rare diseases have been included in the National Medical Insurance List.
Wu Zhiying said: "This actually allows all rare disease patients to see the light of day, which will increase the confidence of patients. Otherwise, many patients feel that there is no medicine available or the medicine is too expensive and cannot be used, and they will give up on themselves. Of course, on the other hand It also allows patients to see the country's emphasis on rare diseases and the country's economic strength."
The use of drugs for rare disease patients is a microcosm of my country's pharmaceutical centralized procurement.
As of February this year, the state has organized 6 batches of centralized drug purchases, with a total of 234 kinds of drugs, with an average drop of 53% in drug prices.
The cumulative results of the three-year reform show that the state organized centralized procurement to save more than 260 billion yuan.
During this period, the overall drug price level showed a trend of stability with some decline. The drug price monitoring data carried out by the National Medical Insurance Administration showed that the overall drug price level continued to decline in 2019 and 2021, with an average annual decline of about 7%.
The centralized procurement work has continuously included good medicines in the national medical insurance drug catalogue, and the availability of high-quality medicines has been significantly improved.
The National Medical Insurance Bureau dynamically adjusts the list of medical insurance drugs every year. A total of 507 kinds of drugs were transferred in and 391 kinds of drugs were transferred out in 4 years. The number of drugs in the catalogue increased to 2,860 kinds, and designated retail pharmacies were expanded as new drug supply channels, so that life-saving new drugs can be obtained faster and at better prices. more convenient.
In addition to medicines, my country's centralized procurement has also extended to high-value medical consumables.
Among them, the average price of cardiac stents dropped by 93%, and the average price of artificial hip joints and knee joints dropped by 82%, which effectively squeezed the space for artificially high prices.
Centralized procurement directly hits the soft underbelly of artificially high drug prices, and realizes multiple effects such as reducing drug prices, improving drug quality, and promoting industrial upgrading.
More importantly, centralized procurement not only reduces the burden of medical insurance and increases efficiency, but also creates conditions for standardizing medical behavior and promoting the reform of public medical institutions.
"The times are the examiners, we are the answerers, and the people are the examiners." On April 16, an article published by the Party Group of the National Medical Security Administration of the Communist Party of China in the magazine "Seeking Truth" pointed out that since the 18th National Congress of the Communist Party of China, medical security has Business development has entered a new stage.
The Party Central Committee has made the correct decision to establish the National Medical Insurance Bureau, drawn up a blueprint for reform, and accelerated the development of medical insurance.
"We have established the world's largest universal basic medical insurance network in a relatively short period of time. At present, the number of insured people exceeds 1.36 billion, and the insured rate is stable at over 95%. The payment ratio of hospitalization expenses within the scope of employee medical insurance and resident medical insurance policies is 80%. % and 70%, the fund’s annual revenue and expenditure both exceed 2 trillion yuan, benefiting more than 4 billion people seeking medical treatment, which has played an important role in solving the problem of difficult and expensive medical treatment for the masses, supporting the development of medical and health services, maintaining social stability and promoting common prosperity. effect."
Two months after the establishment of the National Medical Insurance Bureau, in July 2018, "I am not a drug god" was released. The film restored the cruel reality that poor cancer patients could not afford life-saving drugs.
One month later, the National Medical Insurance Administration and the National Health and Medical Commission jointly issued the "Notice on Carrying out Provincial-level Special Centralized Procurement of Anticancer Drugs".
In the subsequent collection work, the anticancer drug imatinib in "I'm Not a God of Medicine" was also included in the medical insurance catalog.
The centralized collection work enables patients who need imatinib treatment to receive adequate medication protection.
A reporter from China Youth Daily and China Youth Daily told Li Mu that when the National Medical Insurance Bureau was established in 2018, he said in surprise, "It's less than 5 years since it was established!" Then he said, "Then we are very lucky. It's a good time."
Cross-provincial direct settlement of hospitalization expenses has covered the whole country
On August 24, 2018, less than three months after the establishment of the National Medical Insurance Bureau, the State Council Information Office held a briefing on the direct settlement of hospitalization expenses for inter-provincial medical treatment. The number of cross-province and out-of-place medical visits settled by the national platform reached 486,000 (including 35,000 of the new rural cooperative medical system), and the medical expenses were 11.83 billion yuan, and the fund paid 7 billion yuan.
Three years later, on December 10, 2021, the State Council Information Office held a briefing on the same theme, and Li Tao attended again.
She updated the set of data reported three years ago: as of October 2021, the number of inpatient and outpatient settlements across provinces and outpatients exceeded 10 million respectively, and the two combined exceeded 20 million.
Among them, from January to October 2021, 3.6368 million person-times of hospitalization expenses across the country were directly settled across provinces, involving 88.035 billion yuan of medical expenses and 51.034 billion yuan of fund payments; 7.0003 million person-times of national general outpatient expenses were directly settled across provinces, involving 1.752 billion medical expenses Yuan, the fund paid 962 million yuan.
The comparison of the two sets of data, separated by three years, strongly illustrates the achievements made in the settlement of hospitalization expenses across provinces and different places in my country.
Behind the changes in the past three years, the state's attention to the relatively disadvantaged migrant workers has played a significant role.
On August 22, 2018, at the executive meeting of the State Council, the issue of direct settlement for medical treatment in other places was studied again, and the focus of the next step was also clarified - all migrant workers and migrant employment and entrepreneurial personnel should be included in the scope of direct settlement.
In terms of the procedures for medical treatment across provinces and other places, the insured needs to first go through the filing registration at the medical insurance agency in the insured place, "submit a very simple filing form, the main purpose is to know the insured person according to the handling agency in the insured place. Which city to go to is convenient for us to settle the medical insurance settlement with the city where the insured person lives or works in the next step." Li Tao explained.
In order to facilitate migrant workers to seek medical treatment in other places, the National Medical Insurance Bureau will simplify the filing process before the end of October 2018, and cancel all requirements for certificates or seals provided by the handling agencies or designated medical institutions in the places where they need to seek medical treatment.
In addition, before going out to work, migrant workers may not know the next place of work and residence. In this case, the National Medical Insurance Bureau adopts the method of "supplementary certification", that is, these migrant workers can file for the record first, and wait until they work or In the city where you live, you can reapply after obtaining the relevant materials.
In addition to these immediate short-term measures, the National Medical Insurance Administration also focuses on the overall situation and promotes cross-provincial and remote medical treatment on a larger scale across the country.
What is gratifying is that at the regular briefing on the State Council policy on direct settlement of inter-provincial and non-local medical expenses on December 10, 2021, Li Tao said that as of now, the direct settlement service of inter-provincial and non-local medical expenses has covered all the countries in the country. Provinces, all coordinating regions, various types of insured persons and major out-of-towners have access to 52,900 networked designated medical institutions, basically achieving the goal of full coverage of designated hospitals and at least one networked designated hospital in each county.
At the same time, the work of outpatient cross-provincial and remote medical treatment has also been fully launched.
Li Tao said that at the beginning of 2021, on the basis of fully opening up the pilot projects in the five provinces of Beijing-Tianjin-Hebei, the Yangtze River Delta and the southwest, the National Medical Insurance Bureau and the Ministry of Finance have further expanded the scope of the pilot, adding 15 provinces including Shanxi as national The pilot provinces for outpatient clinics have further implemented outpatient services across provinces and different places, covering 97.6% of the overall planning areas and 120,000 designated medical institutions, and 91.7% of counties have more than one networked designated medical institutions.
Cross-province and remote medical settlements, and many trips to go through the formalities, are a major pain point for the common people.
In order to solve this problem, the National Medical Insurance Administration optimized the filing management, accelerated the construction of the information system, and provided the people with "medical insurance business halls in their pockets" and "medical insurance service points moved to their homes": National Medical Insurance Service App, remote medical treatment filing Small programs, the national medical insurance service network hall interconnected with the national integrated government service platform.
In the past, it was necessary to hold a physical social security card for cross-provincial medical settlement settlement.
Now there is a new medium - medical insurance electronic certificate, which means that in addition to the social security card, the insured can activate and use the personal medical insurance electronic certificate through the national medical insurance service platform App or Alipay, WeChat, mobile banking and other channels before seeking medical treatment.
In addition, you can also use the family account function of the National Medical Insurance Service Platform App to help your parents and children activate and use the medical insurance electronic certificate. After activation, the insured will display the medical insurance electronic certificate during the admission procedures, discharge settlement or settlement at the outpatient billing window. QR code, you can scan the code for direct settlement across provinces.
An article published by the Party Group of the National Medical Security Administration of the Communist Party of China in "Seeking Truth" concluded: "After a hundred years of struggle, our Party has led the people of the whole country to successfully build a medical security system with distinctive Chinese characteristics. 'Unexpected extravagance' has become a basic welfare enjoyed by everyone, providing effective protection for the people of the whole country with a medical insurance investment equivalent to about 2% of GDP, and the average life expectancy has increased from less than 40 years old before the founding of New China. At the current age of 77.3, the development and progress of China's medical security industry has been fully affirmed at home and abroad."
(At the request of the interviewee, Li Mu is a pseudonym)
China Youth Daily and China Youth Daily reporter Liu Changrong