[ad_1]
Original title: Uniform health insurance benefits will be issued and the National Health Insurance Office clarifies that these items will not be reimbursed.
One year and four months after requesting opinions on the list of health insurance benefits, you have now entered the final stage of your formal submission. This list will propose uniform national standards for health insurance benefits, including inpatient and outpatient deduction lines and reimbursement rates.
Since November, the National Health Insurance Office has responded intensively to a number of proposals that require non-health insurance elements to be included in health insurance reimbursement. The National Health Insurance Administration follows the principles of the previously announced “Health Safety Benefits List” (draft for comments) and has given clear negative responses to items that should be borne by public health funds or physical exams.
The list of medical safety benefits will define the limit of the government’s medical safety liability to achieve a fair and appropriate level of protection. By realizing the national medical security level integration, it will also guide the localities and the masses to achieve reasonable and stable expectations.
Formulating the list of national health insurance benefits has been an important task since the establishment of the National Health Insurance Administration, and it has been included in the programmatic document of China’s health insurance reform “Opinions of the CPC Central Committee and the Council of State on the deepening of the reform of the medical security system “. Previously affected by the epidemic, this reform has been shelved According to China Business News, the National Health Insurance Bureau is actively promoting the introduction of the health insurance benefits list.
The Council of State is also adding weight to this reform. The executive meeting of the State Council held on November 6 proposed that, based on the national list of basic public services, combined with the actual exploration and establishment of a livelihood expense list management system, projects pilot in the fields of education and health insurance and gradually expand the scope.
Items such as physical exam and early detection are not included in the health insurance reimbursement
The “List of Health Safety Benefits” (Draft for Comments) published in July last year listed seven items that the health insurance fund would not pay, including those that should be paid out of the workers’ compensation fund, those that should pay a third party and those that should be paid by the public Health burden, medical treatment abroad, sports fitness, consumption of medical care, medical check-ups, those that do not comply with the basic medical insurance drug catalog, the scope of the elements of diagnosis and treatment, and the scope of the elements specified in the standards for medical services facilities.
As in previous years, during the two sessions this year, many committee representatives still put forward a variety of proposals to include non-health insurance elements in health insurance reimbursement, such as including rural medical examinations and early detection of chronic diseases in The medical insurance.
The National Health Insurance Office responded negatively to these proposals. The main basis is that Article 30 of the “Social Insurance Law of the People’s Republic of China” clearly stipulates that medical expenses to be borne by public health are not included in the scope of payment of the basic medical insurance fund. . Issues such as physical exams must be resolved through public health services and other channels.
According to China’s current institutional arrangements, the public health service system is mainly used to gradually solve the problems of disease prevention and control, health education, and the basic medical insurance system to gradually improve the level of protection of treatment diseases and vigorously develop commercial insurance to meet the different health needs of different people.
For some local representatives proposed to include local characteristic Chinese medicines in the health insurance catalog, the National Health Insurance Bureau emphasized the importance of the national unification of the health insurance catalog. The notice issued in 2019 of the “National Catalog of Basic Medical Insurance Medicines, Work Accident Insurance and Maternity Insurance” stipulates that all localities must strictly implement the “Medicines Catalog”, and must not formulate their own catalogs or use alternative methods of adding drugs to catalogs, nor should they do it themselves. Adjust the limited payment scope for drugs in the catalog. For Class B drugs that were added as required in the original provincial drug catalog, they must be digested gradually within 3 years.
Cancer genetic testing, heavy ion therapy, and other items are difficult to include due to the limited capacity of the health insurance fund. According to the National Health Insurance Administration, the level of funding for basic health insurance, especially for urban and rural residents, is relatively low. In 2019, the funding per capita is only about 800 yuan. The current basic health insurance system is based primarily on providing protection for the treatment of basic illnesses.
Establish a unified national health insurance treatment standard
Today’s health preservation policy is decentralized and fragmented, and health insurance benefits vary widely from place to place, and it is difficult for the public to form a unified expectation of health insurance benefits. The proposals of the two sessions this year also reflect these problems. In response to the current situation, the “Opinions of the Central Committee of the Communist Party of China and the State Council on the deepening of the reform of the medical security system” clearly stated that the medical security benefit list system should be implemented. .
Liao Cangyi, a researcher at Tsinghua University Medical Services Governance Research Center, said in an interview with China Business News that the list of health insurance benefits refers to the national standards of down payment, payment ratios and the maximum payment limits for basic health insurance, critical illness insurance, and outpatient inpatient clinic care. , Proposal for a unified national standard.
In response to the proposal, the National Directorate of Medical Insurance revealed that it is studying the idea of promoting the management of the list of benefits of medical insurance. It is proposed to propose basic systems, basic policies and payment of funds, determining the content of the basic protection, clarifying the limit of the payment of benefits, clarifying the authority to adjust policies and standardizing the decision-making processes. Outreach, guide local governments to further standardize the unified institutional framework and policy configuration, and promote the long-term sustainable development of the system.
Liao Cangyi said that the advantage of establishing a list of health insurance benefits is that it defines the liability limit of government health insurance. On the one hand, it must be underinsured and, on the other, it must not be an excess of well-being. This reflects the responsibility of basic health insurance for basic health insurance, and the level of protection is fair and consistent. Properly correct the problems of excessive protection and insufficient protection.
At the same time, it also fosters the implementation of the policy integration of the national medical security system, promotes the standardization of management and top-down decision-making, and promotes the equalization of basic medical services. It is conducive to maintaining financing and payment policies in line with the level of economic development and achieving the sustainable development of China’s health insurance system.
China Business News also learned from people familiar with the matter that one of the purposes of issuing the list of health insurance benefits is to prevent localities from competing with each other. Now some economically developed areas will increase health insurance reimbursement as a political achievement or to attract talent, causing dissatisfaction in the surrounding areas. In soliciting opinions, some economically developed regions believed that the improvement of health insurance benefits through their own financial resources should not be restricted. It can be seen that how to coordinate national standards and local standards is an issue that must be carefully weighed in the process of formulating the list of health insurance benefits.
Massive information, accurate interpretation, all in the Sina Finance APP
Editor in Charge: Chen Xin
