On January 12, the National Medical Security Work Conference was held in Beijing.
The meeting sorted out the achievements of the National Medical Insurance Administration (established in 2018 - reporter's note) in the past five years since its establishment.
During this period, a series of reform measures squeezed the inflated prices of pharmaceutical consumables, cracked down on fraudulent insurance fraud, recovered huge medical insurance funds, continued to promote information reform, and "put" the medical insurance bureau into the pockets of ordinary people.
The medical insurance fund is the life-saving money for ordinary people to see a doctor.
According to the report card released by the National Medical Insurance Bureau in the past five years, it can be seen that the money spent on medical treatment and life-saving is more reasonable and efficient.
"Soul bargaining" allows the masses to use life-saving medicine that they could not afford faster
In 2021, a video of negotiating medical insurance drugs became popular all over the Internet, and the "high-priced drug" Nocinogen Sodium, which was once 700,000 yuan per injection, dropped to 33,000 yuan.
Nosinagen Sodium is the world's first drug for the treatment of spinal muscular atrophy. When using this drug, patients need to inject 6 injections in the first year, and then 4 injections per year, and take the drug for life.
Wang Yan is a young man suffering from spinal muscular atrophy, who has been severely disabled by the disease.
People with spinal muscular atrophy experience muscle atrophy until they can no longer eat or breathe.
Before taking this medicine, Wang Yan's muscles had shrunk to the point where he couldn't even hold a bottle of mineral water, and he often choked on eating and drinking.
The incidence of spinal muscular atrophy is only 1/6000-1/10000, "every small group should not be given up", until the negotiation called "soul bargaining", about 40,000 spinal cord patients across the country Patients with muscular dystrophy finally have hope.
Looking back on the work of the past five years, the National Medical Security Work Conference pointed out that through negotiations to reduce the price of new drugs, the average price of 250 new drugs has been reduced by more than 50% and included in medical insurance reimbursement, so that people can use life-saving drugs that they could not afford before.
On January 13, Wang Yan told reporters from China Youth Daily and China Youth Daily that in 2022, he had already injected 5 injections of Nocinogen Sodium. After reimbursement by medical insurance, combined with multiple local welfare measures, the total price of 5 injections was less than 10,000 yuan. .
After injecting Nocinogen sodium into his body, Wang Yan's muscle atrophy process finally stopped, and the problem of choking and coughing while eating and drinking was basically gone.
Wang Yan was also infected with the new coronavirus, but his symptoms were not very serious. The dizziness and fever ended within a day.
Wang Yan could feel that after the injection of Nosinagen Sodium, his physical fitness was improving. He would catch a cold every time the seasons changed, but this situation will not happen again in 2022.
At the China Rare Diseases Conference held in November 2022, Huang Huabo, deputy director of the National Medical Insurance Administration, said that the successful negotiation of Nosinagen Sodium was a classic case of the National Medical Insurance Administration’s "quantity-for-price exchange". Entering the medical insurance has greatly reduced the burden of medication for patients, improved the accessibility of medication for patients, and reflected social responsibility.
In addition to Nosinagen Sodium, 73 new drugs will be included in the medical insurance list in 2021, and 67 exclusive drugs will have an average price reduction of 61.71%.
Centralized procurement effectively squeezes out the inflated prices of pharmaceutical consumables
The National Medical Security Work Conference pointed out that in the past five years, the national organization has collectively purchased 7 batches of 294 kinds of medicines with an average price reduction of more than 50%, and the average price reduction of 3 batches of 4 types of consumables has been reduced by more than 80%. Superimposed with local alliance centralized procurement, the cumulative cost of drug consumption has been reduced by more than 4,000 billion.
For a long time, the problem of inflated drug prices in my country has been serious, and the price of commonly used drugs is 2-3 times the average price of major international countries.
At the same time, sales expenses of mainstream pharmaceutical companies account for nearly 40% of sales revenue, which is significantly higher than other consumer goods industries. This not only increases the burden on the public and medical insurance funds, encourages unhealthy trends in the industry, but also restricts the high-quality development of the medical and health industry.
The relevant person in charge of the National Drug Joint Procurement Office stated that the original intention of carrying out the reform of centralized procurement with quantity is to squeeze out the water of inflated drug prices, promote the return of drug prices to a reasonable level, reduce the cost burden of the masses, and make drugs affordable to patients. .
It is understood that the price reduction space for centralized procurement of medicines mainly comes from three aspects, including direct supply to hospitals to reduce marketing costs, timely payment to reduce financial costs, and small profits but quick turnover to reduce production costs. Reasonable fees, not corporate production costs, do not affect drug quality.
In addition to the centralized procurement of medicines, the centralized procurement of high-value medical consumables has also brought tangible benefits to the common people.
The centralized procurement of high-value medical consumables began with coronary stents, and the price of the selected coronary stents dropped by 93%.
In January 2021, after the implementation of the centralized procurement of coronary stents, the burden on the masses has been significantly reduced.
According to calculations in Beijing, the average personal burden of patients receiving stent implantation has dropped by 10,000 yuan.
At the same time, many people who could not afford brackets or chrome alloy brackets have also used "high quality and low price" chrome alloy brackets.
After the coronary stents broke the ice, the centralized procurement of high-value medical consumables for artificial joints and orthopedics and spine also proceeded smoothly. The average price of relevant selected products dropped from tens of thousands of yuan to several thousand yuan, with an average price reduction of more than 80%.
Continue to crack down on fraud and insurance fraud, recovering 77.13 billion yuan in medical insurance funds
The safety of the use of medical insurance funds involves the vital interests of the general public and is related to the healthy and sustainable development of the medical security system.
On January 15, 2021, the "Regulations on the Supervision and Management of the Use of Medical Security Funds" was officially promulgated, which solved the problems of how to administer according to law and scientifically enforce the law in the previous fund supervision, as well as the lack of clear regulations on supervision and inspection procedures and measures, and the inconsistent standards in various regions. Issues such as greater discretion in punishment.
In the past five years, the National Medical Insurance Administration has continued to crack down on fraudulent insurance fraud. It has inspected 3.189 million medical institutions, dealt with 1.543 million times, recovered 77.13 billion yuan in medical insurance funds, exposed 245,000 typical cases, and assessed 184 pharmaceutical companies. and impose punishment.
In November 2022, the "Measures for Incentives for Reporting Illegal and Illegal Use of Medical Security Funds" was promulgated and will come into force on January 1, 2023.
The method raised the upper limit of the reward amount from 100,000 yuan to 200,000 yuan, and set a minimum reward amount of 200 yuan to give full play to the incentive effect of rewards and actively encourage and guide the masses to participate in social supervision.
Next, the National Medical Insurance Bureau will continue to increase fund supervision, carry out fund supervision safety and standardization year action and medical insurance anti-fraud big data supervision pilot, explore the supervision mechanism that adapts to new payment methods, and protect every penny of the people's medical treatment and life-saving money .
(Wang Yan is a pseudonym to protect patient privacy)
China Youth Daily·China Youth Daily reporter Liu Changrong Source: China Youth Daily