Basic medical security is related to people's access to medical treatment and the development of medical and health services. What is the current situation of basic medical insurance participation in China? How to include more new and good drugs in medical insurance? How to protect the "life-saving money" of the people?
In response to the hot topics of public concern, the relevant officials of the National Medical Insurance Bureau responded at the "Authoritative Departmental Discussion Opening" series of themed press conferences held by the National Development and Reform Office on May 18th.
The national population participation rate remains stable at around 95%, and the world's largest basic medical security network is established
Over the past five years, we have continuously improved the world's largest basic medical security network. "Hu Jinglin, Director of the National Medical Insurance Bureau, introduced at a press conference that from 2018 to 2022, the national population participation rate remained stable at around 95%, and the reimbursement rates for hospitalization expenses within the scope of employee medical insurance and urban and rural resident medical insurance policies reached around 80% and 70%, respectively.
Universal participation in medical insurance is a fundamental and comprehensive task for the development of the medical insurance industry. Shi Zihai, Deputy Director of the National Medical Insurance Bureau, stated that the bureau will continue to promote the expansion and improvement of insurance coverage from four aspects:
Improve the accuracy of insurance coverage through data comparison, and improve the insurance database that covers the entire population; Improve the targeted coverage of insurance through departmental linkage, and further increase the coverage rate of college students, newborns, migrant workers, and migrant workers; By optimizing services to improve the convenience of insurance coverage, strengthening collaboration with tax departments, and providing "one-stop" services for insured personnel.
In order to steadily achieve basic medical security for low-income rural populations, we must firmly adhere to the bottom line of preventing large-scale poverty reduction due to illness. The National Medical Insurance Administration will continue to make efforts in promoting the establishment of a diversified medical assistance system, improving a unified and standardized medical assistance system, and improving the comprehensive assistance mechanism for patients with high cost burden.
Incorporate more new and good drugs into medical insurance to continuously improve the level of medication security for insured individuals
In recent years, the National Medical Insurance Administration has taken various measures such as medical insurance negotiations, centralized procurement, and reform of residents' chronic disease protection methods to continuously reduce the burden of medical treatment on the public.
Li Tao, deputy director of the National Health Insurance Bureau, said that over the past five years, 618 drugs had been added to the National Health Insurance Catalogue, covering clinical treatment fields such as COVID-19 infection, tumors, cardiovascular and cerebrovascular diseases, rare diseases, and children's medicine.
In order to improve the accessibility of drugs, the National Medical Insurance Administration, in collaboration with the National Health Commission, has introduced policies such as negotiating "dual channels" for drugs, supporting the implementation of the directory. As of the end of December 2022, there have been 209000 designated hospitals and pharmacies nationwide equipped with catalog negotiation drugs.
It is reported that the national organization's centralized procurement of 333 drugs has an average price reduction of over 50%, and the centralized procurement of 8 high-value medical consumables such as heart stents and artificial joints has an average price reduction of over 80%. Together with local alliance procurement, the cumulative burden has been reduced by about 500 billion yuan.
Next, the National Medical Insurance Administration will continue to promote the expansion and improvement of centralized and volume procurement of pharmaceuticals:
From the national level, the eighth batch of centralized procurement of drugs has been carried out in 2023, and the fourth batch of high-value medical consumables will be carried out next, mainly for ophthalmic intraocular lens and orthopedic sports medicine consumables, and new batch of centralized procurement of drugs will be carried out in due time.
At the local level, it will focus on the procurement of inter provincial alliances for chemicals, traditional Chinese patent medicines and simple preparations, interferon, neurosurgery consumables, in vitro diagnostic reagents, etc. that are not collected by national organizations.
Protecting the People's "Lifesaving Money" and Promoting the Implementation of More Convenient Measures
Hu Jinglin introduced that over the past five years, a high-pressure situation in the supervision of medical insurance funds has been promoted through means such as flight inspections, special governance, and daily supervision. In the next step, the National Health Insurance Bureau will continue to increase the intensity of flight inspection, carry out in-depth special rectification against fraud and insurance fraud, strengthen big data supervision, build a social supervision defense line, and improve the total fund budget, the retention of the balance of centralized purchase of drugs and other policies.
In order to solve the problem of inconvenient reimbursement for medical treatment in different regions, the National Medical Insurance Bureau has vigorously promoted cross provincial and cross regional direct settlement. Currently, there are 68800, 382100, and 24600 cross provincial networked designated medical institutions for inpatient expenses, general outpatient expenses, and chronic and special diseases in China.
Hu Jinglin introduced that the National Medical Insurance Bureau will continue to expand its coverage, promote more designated medical institutions to be included in the scope of remote medical networking settlement, and continue to optimize the filing process, encourage more regions to carry out self-service filing, and facilitate people's remote medical treatment.
With the deepening of population aging and the increasing number of disabled elderly people, the issue of long-term care security has gradually become a social focus. As of the end of 2022, the number of long-term care insurance participants reached 169 million, with a cumulative benefit of 1.95 million people.
Hu Jinglin stated that the National Medical Insurance Administration will continue to deepen and improve the existing pilot projects, including the multi-party financing mechanism and fair and moderate treatment guarantee mechanism that have been formed in the early pilot projects. At the same time, we will promote the sound implementation of national level assessment standards for disability levels in local areas.
Assist in the coordinated development of the "three medical systems" and actively promote the development of commercial medical insurance
Li Tao introduced that since the establishment of the National Medical Insurance Bureau, it has focused on playing a fundamental role in the "three medical" linkage reform, promoting the benign interaction and coordinated reform of medical security, medical service system, and drug supply guarantee system, promoting the reduction of the burden of medical treatment on the public, promoting high-quality development of medical institutions, and supporting and encouraging pharmaceutical technology innovation.
Next, the National Medical Insurance Administration will institutionalize and normalize centralized and volume procurement, improve the pricing mechanism for medical services, and deepen the supply side reform of medical services; Support the deepening of public hospital reform guided by public welfare, and coordinate the expansion of high-quality medical resources and regional balanced layout; Promote the mutual promotion of medical insurance reform and medical innovation.
Huang Huabo, Deputy Director of the National Medical Insurance Bureau, introduced that on the basis of clarifying the responsibility boundaries between basic medical insurance and commercial medical insurance, the medical insurance department has taken measures to promote information sharing, support collaboration in handling, and improve fund efficiency, to help the development of commercial medical insurance.
Next, we will actively explore suitable paths and effective models for the coordinated development, complementarity and mutual promotion of basic medical insurance and commercial medical insurance with relevant departments, in order to better meet the multi-level medical security needs of the people, "Huang Huabo said. (Reporter Peng Yunjia and Gu Tiancheng)