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Chinanews customer, Beijing, Nov. 6 (Reporter Zhang Ni) “Internet +” health insurance payment will adopt a consistent online and offline refund policy. Online Medical Reimbursement Starts With Outpatient Chronic Diseases … Recently, the National Health Insurance Administration A guiding opinion issued clarifies the scope of payment for “Internet +” health insurance. At the same time, many places have started actively testing the water for medical reimbursement online.
In the opinion of industry experts, this means that the “Internet +” health insurance payment has entered the practical level.
Is the scope of the “Internet +” health insurance payment determined to welcome the “first year of outbreak” in Internet health care?
This year, in the special context of the epidemic, the public demand for diagnosis and treatment over the Internet has waned. Some people call 2020 the “first year of the outbreak” of online medical treatment.
According to data released by the National Health Commission in March this year, during the epidemic, online diagnosis and treatment in hospitals under the direction of the National Health Commission increased 17 times compared to the same period last year. At the same time, the volume of diagnostic and treatment consultations on some third-party Internet service platforms has increased by more than 20 times during the same period, and the number of prescriptions has increased by almost 10 times.
On October 28 this year, at a press conference held by the State Council Information Office, the National Health Commission revealed a more recent set of figures: Currently, there are 900 Internet hospitals in China, and the network telemedicine collaboration covers all cities at the prefecture level 2.4 More than 10,000 medical institutions and more than 5,500 hospitals above the second level can provide services online.
As more and more medical institutions embrace the Internet, “Internet +” healthcare support measures are also stepping up to keep up. Since the second half of this year, a number of highly successful documents related to medical treatment have been published nationwide on the Internet.
In July, 13 departments, including the National Development and Reform Commission, jointly issued “Opinions on supporting the healthy development of new business forms and new models, activating the consumer market and promoting the expansion of employment” and proposed that eligible “Internet +” medical service fees be included in the scope of health insurance payment.
Since then, the General Office of the State Council has issued the “Implementation Opinions on the further optimization of the business environment and the best service to market entities”, mentioning once again the issue of the “relaxation” of insurance policies. health insurance.
Earlier this month, the National Health Insurance Administration issued the “Guiding Opinions on the Active Promotion of Payment for Medical Services and” Internet + “Health Insurance, clarifying that eligible Internet medical institutions can voluntarily” enroll “in the scope health insurance through the physical medical institutions they depend on The payment of the health insurance “Internet +” will adopt a consistent reimbursement policy online and offline.
It is worth mentioning that the “Guiding Opinions” also included the relevant experience and practices of solving patients with chronic diseases during the new epidemic of coronary pneumonia in standardization work, and clarified the scope and form of payment of the “Internet +” health insurance.
For example, the “Internet +” health insurance payment scope covers outpatient chronic illness and other follow-up renewal requirements. The insured person’s medical examination fees and drug fees incurred by designated “Internet +” medical institutions in the general planning area for follow-up visits and prescriptions may be based on the medical insurance stipulates payment. The health insurance burden is settled directly by local health insurance agencies, designated physical medical institutions, and designated retail pharmacies.
Ma Guanglei, deputy secretary general of the China Pharmaceutical Trade Association and general manager of Yifudi, said in an interview that this new policy proposes that health insurance should strengthen support for Internet diagnosis and treatment, and further clarify the scope of the reimbursement for this new type of medical behavior, including diagnosis and treatment. It is a very comprehensive guidance document in terms of follow-up visits and drug purchases and extended prescriptions.
“It can be said that the ‘Internet +’ health insurance payment has entered the practical level and has great guiding importance for health insurance payment reform,” said Ma Guanglei.
Test the water in many places
While sending out positive political signals nationally, many places have already “tested the waters” beforehand.
In April this year, the Qingdao Municipal Health Insurance Bureau explored innovative services for paying physical hospital health insurance online.
Follow-up patients can use the public WeChat account “Qingdao Medical Insurance”, choose the municipal hospital Internet hospital, and consult doctors online through videos or graphics.
After the online physician verifies the identity of the patient for the reexamination, the reexamination prescription is issued and the prescription is sent to the patient through the third-party prescription circulation service platform. The patient can choose the pharmacy designated by the health insurance after receiving the text message. Once the pharmacy receives the order, the medication will be reimbursed along with the general plan. Clearance receipts and pharmacy service orders are delivered to the door. Once patients receive the medications, they can choose health insurance to pay for. The closed loop of one-stop-shop diagnostic and treatment services that patients can view, fill prescriptions, purchase medications, and reimburse health insurance payments without leaving home. , To solve the problem of “seeking a doctor for medicine”.
In Beijing, in some hospitals, “cloud consultation rooms” can also be registered for real-time health insurance settlement. In October this year, the Capital Institute of Pediatrics passed the “Internet +” health insurance rating review and became the first pediatric hospital in Beijing to have real-time settlement of medical service fees and health insurance settlement outside line for medicines, inspections and inspections. This time, the Internet diagnosis and treatment system has been updated, and functions such as the request form for inspection and examination, the issuance of a hospital certificate and the source of online appointments and offline numbers are also available.
According to data published by the Capital Institute of Pediatrics, as of October 23, the number of patients in the hospital who completed the diagnosis and treatment online through the platform “Jingyitong” was 4022. The number of visits in September increased by 59.1% month to month, and patients from other places accounted for 73.1%. Local patients represented 26.9%, among them dermatology, gastroenterology, health and endocrinology received the highest number of consultations.
In Shanghai, Yangtze River Delta Ecological Integrated Development Demonstration Zone Internet Hospitals have opened online health insurance settlement in different places. Policyholders at the three locations in the demonstration area can use the Internet hospitals for follow-up visits, dispensing and payments online via mobile phones.
With the launch of local pilot projects, health insurance policies related to online diagnosis and treatment are also constantly standardized and improved.
For example, starting this month, the “Internet +” Health Insurance Payment Management Measures for medical services in Tianjin (for trial implementation) began to be officially implemented.
In accordance with administrative measures, designated medical institutions will provide online diagnostic and treatment services for insured patients within the scope of diagnosis and treatment topics of their physical offline medical institutions, and will not exceed the scope of their topics of diagnosis and treatment from the Internet, and will be limited to common and chronic diseases that can be completed independently online. . Online diagnostic and treatment services provided by designated medical institutions for insured patients are limited to health insurance payment types. If the health insurance meets the scope of the health insurance payment, the health insurance fund will be paid in accordance with the regulations.
How to monitor medical care on the Internet Expert: realize the traceability of information
Officially released data shows that from 2015 to 2019, the total number of visits to medical and health institutions across the country increased from 7.69 billion to 8.72 billion, the average number of resident visits increased from 5 , 6 to 6.2 and the number of hospital admissions increased from 21.53 million to 26,596. One million people.
People’s demand for high-quality medical resources is increasing day by day, and the problems of “difficulty seeing a doctor” and “large overcrowded hospitals” also continue. The “Internet +” medical services will undoubtedly be a great advance in solving these problems.
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