Health

Adjust the medical insurance policy in time

2023-01-06   

Recently, it was reported by the media that, with the approval of the National Medical Security Bureau, six drugs, including compound paracetamol and amantadine capsules and compound paracetamol and methylephedrine oral liquid, will be temporarily included in the reimbursement scope of Beijing medical insurance and industrial injury insurance drugs, and the reimbursement proportion will be implemented according to Class A drugs, and the epidemic prevention and control drugs, such as nematevir tablets/ritonavir tablets, have also been temporarily included in the payment scope of Beijing medical insurance fund. In addition, in response to the new situation of the epidemic, many places have also introduced COVID-19 related medical insurance policies: Anhui has made it clear that the reimbursement ratio of COVID-19 infection outpatient expenses is 70%; Sanhe, Hebei Province, issued the Understanding Paper of Medical Insurance Reimbursement Policy for COVID-19 Infected Persons to clarify the different reimbursement proportion and amount for different groups of people; The outpatient service and inpatient service in Jinjiang, Fujian can be reimbursed, with the proportion ranging from 50% to 80%; Shandong included online consultation of COVID-19 symptoms into medical insurance; Hubei has temporarily included 36 kinds of COVID-19 drugs into the medical insurance... The latest news is that on January 5, the on-site negotiations on the adjustment of the national medical insurance drug catalog officially began. The drugs in this negotiation involve hundreds of clinical drugs, such as tumor, rare disease, COVID-19 infection treatment. According to past experience, the average price drop of drugs included in medical insurance through negotiation is more than 50%, which will effectively reduce the burden of patients. In the past three years, China has taken the approach of "first treatment, then settlement" to strongly support and guarantee the treatment costs of diagnosed and suspected patients. After the basic medical insurance, serious illness medical insurance, and medical assistance, the part borne by individuals will be subsidized by the financial department. Such a policy reflects the institutional advantage of our country in mobilizing resources from all sides to jointly respond to public health events. However, such free treatment is a kind of medical security measure under emergency state. During 2020, there were data statistics that the per capita treatment cost of severe patients exceeded 150000 yuan, and the treatment cost of a few critically ill patients even exceeded one million yuan. Such expenditure has its particularity, but it is difficult to be sustainable. In fact, the diagnosis, treatment and reimbursement related to COVID-19 infection have been adjusted appropriately according to the situation, in order to meet the interests of more people. In March 2022, the National Medical Insurance Bureau made it clear that the relevant expenses incurred by the insured in the designated grassroots medical institutions should be paid according to the current regulations of the overall planning area, and the expenses for purchasing test reagents in the designated retail pharmacy can be paid using personal accounts. From January 8 this year, COVID-19 infection will be adjusted from "Class B, Class A" to "Class B, Class B". As a result, it is an urgent task to implement graded and classified treatment for people infected with the virus, and adjust the medical insurance policy at the same time. With the change of epidemic situation, medical insurance reimbursement also needs to return to normal management and be implemented within the framework of normal medical insurance reimbursement and management policies. The goal of "including medical insurance" is to reduce the burden of patients, so that more patients with COVID-19 infection can be assured of diagnosis, treatment and reimbursement in medical institutions, so as to truly enhance the people's sense of security and access. (Outlook New Times)

Edit:qihang Responsible editor:xinglan

Source:https://epaper.gmw.cn/gmrb/html/2023-01/06/nw.D110000gmrb_20230106_4-04.htm

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