Some have relaxed the scope of online medical insurance payment for follow-up visits, and some are trying to open up the online medical insurance interface, but the reporter found that the actual promotion effect of Internet hospital medical insurance payment is still very limited——
["Inquiry" Internet Hospital ②] Where is the "card" for online medical insurance payment
Our reporter Liu Youting, Dou Feitao, Liu Xu
reading tips
For patients, in addition to the quality of diagnosis and treatment, the connection between Internet hospital services and medical insurance is crucial.
Relevant policies encourage Internet hospitals to implement medical insurance payment, but the actual promotion effect is limited, and medical insurance payment is still a "blocking point" that many Internet hospitals need to get through.
The rise of Internet hospitals has made it easier for patients to seek medical treatment and medicine. Especially under the new crown pneumonia epidemic, offline consultation has become difficult. Internet hospitals provide patients with services such as appointment registration, specialist consultation, online follow-up, online prescription refill, and drug delivery. Provide solutions to medical problems.
Guo Yue, a citizen of Shenyang, Liaoning, suffers from hypothyroidism. Two years ago, she began to try to follow up through the Internet hospital.
"Online medical treatment is safe and convenient. Every time I go to the physical hospital to check the three items of thyroid function, I can leave without waiting for the results. The medicine is also issued directly in the hospital pharmacy, which is safe and reliable." Guo Yue said.
"The only regret for online medical treatment is that medical insurance cannot be reimbursed." Guo Yue told a reporter from "Workers Daily".
The reporter further interviewed and found that the inability to realize medical insurance payment is a major "blocking point" for many Internet hospitals, and it is also an important reason why patients "do not pay" and Internet hospitals are "built and not used".
Medical insurance payment is the key to the development of Internet hospitals
Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, said in an interview with Workers Daily that whether or not to obtain medical insurance payment is a key issue for the development of Internet hospitals.
In October 2020, the National Medical Security Administration issued the "Guiding Opinions on Actively Promoting "Internet +" Medical Services and Medical Insurance Payments", which clarified that the insured will return to the designated medical institutions for "Internet +" medical services in the overall planning area and issue prescriptions. The medical treatment fees and drug fees of the total can be paid in accordance with the medical insurance regulations of the overall planning area.
The opinion also proposes that all localities can start from outpatient chronic diseases and gradually expand the scope of medical insurance payment for "Internet +" medical services for common diseases and chronic diseases.
In addition, relevant departments have also formulated the "Guiding Opinions on Improving "Internet +" Medical Service Prices and Medical Insurance Payment Policies" and "Guiding Opinions on Promoting the Development of "Internet +" Medical Insurance Services During the Prevention and Control of the New Coronary Pneumonia Epidemic", etc. Project management, pricing range, pricing mechanism, etc.
But more than a year later, Chen Qiulin said bluntly that the promotion effect of medical insurance payment is still very limited.
At present, it is mainly some online medical services provided by hospitals that can really get medical insurance payment.
"Many Internet hospitals cannot carry out medical insurance reimbursement. The main reason is that my country's Internet hospital service standard and standard system has not yet been established, and the medical insurance department has no way to set prices, nor can it be included in the reimbursement catalog to determine the reimbursement ratio. Therefore, the medical insurance department can really implement the Not much." Chen Qiulin analyzed.
Xu Xuedong, director of the medical department of Peking University Third Hospital and director of the Internet Hospital Office, believes that for patients, in addition to the quality of diagnosis and treatment, the connection between Internet hospital services and medical insurance is very important. Open the medical insurance interface.”
The scope of medical insurance payment, benefits and guarantees are consistent online and offline
In order to promote the payment of medical insurance for "Internet +" medical services, in March 2020, Shenzhen issued the "Notice on Measures to Support Internet Medical Institutions in Carrying out Outpatient Chronic Diseases and Specific Diseases Follow-up", which clarified 19 kinds of chronic diseases that can be paid by medical insurance for online follow-up visits. disease range.
On April 18 this year, the Shenzhen Municipal Medical Insurance Bureau and the Municipal Health Commission issued the "Notice on Clarifying the Scope of Medical Insurance Payment Online Re-examination Diseases". Expand the scope of medical insurance payment for online follow-up consultations to meet the requirements of chronic diseases, common diseases, etc.
The notice also clarifies that the scope of medical insurance payment, treatment guarantees and other content are consistent online and offline.
Zhang Ningbo, director of the Medical Department of Peking University Shenzhen Hospital, told reporters that this shows that government departments will no longer “circle circles” on chronic diseases and common diseases that are reviewed online. Diseases suitable for online follow-up.
"The purpose of this is to increase the utilization rate of resources in the hospital, and at the same time to facilitate the insured people to obtain medical drugs." The staff of the Shenzhen Municipal Medical Insurance Bureau said that after the medical insurance agency of the designated Internet medical institution signs a supplementary agreement, the insured patients will conduct online follow-up visits for renewal. All parties can use the medical insurance electronic certificate to settle directly online.
According to reports, in addition to opening up the medical insurance payment channels of Internet hospitals, Shenzhen has also broadened the supply channels of prescription drugs for online follow-up consultations, and encourages designated retail pharmacies that have completed data docking and other information technology requirements to integrate into the "Internet +" online follow-up medical treatment chain. Promote the supply of drugs for chronic diseases and common diseases in designated medical institutions, so as to facilitate the insured people to use medical drugs, and create a complete "non-face" chain of online follow-up medical insurance payment.
In addition, Shenzhen has also improved the settlement of online medical expenses for follow-up visits, and made it clear that online billing expenses incurred by designated Internet medical institutions are included in offline expenses, and settled according to the city's medical insurance payment policy to prevent online expenses from "running away".
"Today, patients with chronic diseases and common diseases can realize the whole process of consultation, electronic prescription issuance, drug circulation, medical insurance payment and other full-process diagnosis and treatment in the Internet hospital, and routine specialties will be added in the later stage." Zhang Ningbo said.
You can start with the diseases with high incidence and large proportion
Xu Xuedong introduced to the reporter of "Worker Daily" that at present, the interface transformation of the Internet hospital diagnosis and treatment service of the Third Hospital of Peking University and medical insurance has been completed. After the acceptance is passed, the Internet follow-up consultation service will be included in the medical insurance, of which the Internet follow-up medical service fee can be settled in real time. .
The reporter also learned during field interviews in Liaoning that with the orderly progress of the construction of Internet hospitals in the local area, the use of online medical insurance has been officially launched.
In August 2021, the Second Affiliated Hospital of Dalian Medical University, the Second People's Hospital of Dalian, Wafangdian North Hospital Co., Ltd. and their affiliated medical insurance agencies signed the "Internet +" Medical Insurance Service Supplement for Dalian Medical Insurance Designated Medical Institutions. Agreement" to become a designated Internet hospital for medical insurance.
A staff member of the Shenzhen Municipal Medical Insurance Bureau told reporters that the issue of medical insurance payment for the diagnosis and treatment of chronic diseases and specific diseases in Internet hospitals should be carried out step by step according to the actual situation. It may also be unsupportable, and we can start with diseases with high incidence and large proportions.”
Chen Qiulin believes that the continuous advancement of the standardization and standardization of Internet hospital services has also created more favorable conditions for the intervention of medical insurance payment.