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Original title: National Health Insurance Administration: clarifying a series of support measures to promote the stable landing of centralized coronary stents
On the 17th, the National Medical Safety Administration issued the “Opinions on National Organizations for Centralized Procurement and Use of Support Measures for Coronary Stents”, to link the procurement platform of selected coronary stents, the work of distribution, advance payment of health insurance fund, payment of health insurance, medical institutions Support measures such as incentives and restrictions are clearly stipulated.
The “Opinions” stipulate that the products selected in the centralized procurement of coronary stents are listed on the provincial-level medical centralized procurement platforms at the selected prices, and the medical institutions purchase at the selected prices, and patients use them at the selected prices. selected prices.
For coronary stents other than selected products, in accordance with the principle of performance and price matching, consider the reasonable price relationship with the selected products and guide and encourage related companies to adjust the price to a reasonable level. All provincial health insurance departments must strictly implement the requirements for selected companies to independently select selected product distribution companies. It is necessary to strengthen the coupling between the supply and demand parties to ensure that selected companies establish a distribution relationship with all contractual procurement medical institutions to ensure timely delivery and use.
The “Opinions” stipulate that the health insurance departments of each coordinating area will calculate the agreed purchase amount of each selected product based on the selected price of the selected product, the purchase product and the amount agreed by each medical institution and the company.
Based on the total budgetary management of the health insurance fund, an advance payment mechanism is established. After the medical institution signs a purchase agreement with the selected company, the medical insurance fund is paid in advance to the medical institution at a rate not less than 30% of the agreed annual purchase amount, and the medical institution must resolve the agreement with the company in a timely manner. The compensation time shall not exceed the end of the month following acceptance of the delivery.
Under the premise of meeting the primary responsibility of medical institutions for the payment of goods, health insurance agencies or purchasing agencies are encouraged to settle directly with companies. Provincial health insurance departments must monitor and supervise the implementation of prepayment policies and reimbursements of medical institutions.
The “Opinions” stipulate that the products selected in the centralized procurement of coronary stents will be paid based on the selected price, and the total amount will be included in the scope of the health insurance payment, and the health insurance fund will pay in accordance with the prescribed ratio.
If coronary stents other than the selected products fall within the scope of payment of the health insurance fund, localities can reasonably set the upper limit of the health insurance payment standard based on the actual transaction price. The patient uses the product whose price exceeds the upper limit of the health insurance payment standard and, in principle, the patient pays the excess part. All locations must take steps to gradually adjust the payment standard within two years so that it does not exceed the highest price selected.
Online pricing, the patient’s own-pay ratio, and the upper limit of the health insurance payment standard should be considered broadly to avoid an increase in burden for patients.
The “Rulings” stipulate that, in accordance with the relevant regulations on the retention of health insurance funds for the centralized procurement of drugs organized by the state, all provincial health insurance departments should guide the general planning area to implement management budget separate from health insurance funds for varieties within the scope of centralized coronary stent collection, and savings of health insurance funds have been evaluated. Medical institutions will maintain the balance for use by medical institutions at a rate not higher than the balance reserved for the centralized purchase of drugs organized by the state. In areas where payment by type of disease (disease group) and other methods are carried out, under the premise of ensuring that the party that pays the patient on his own fully enjoys the effect of centralized procurement and price reduction , the medical insurance payment standard for the corresponding illness (illness group) cannot be lowered in the first year, and then periodically adjusted according to the rules. Type of illness (group of illness) standard of payment of the medical insurance.
The “Opinions” stipulate that in the provinces where the proportion of patients outside the country who undergo coronary stent implantation surgery is large and the current price of related medical services is significantly lower than the national average price and the price of neighboring provinces, the coronary stent implant can be appropriately adjusted according to local conditions In the price of surgery. It is necessary to strengthen supervision and implementation to ensure that the medical institutions involved in the centralized procurement of coronary stents complete the agreed purchase volume of the selected products in accordance with the sales contract. After the agreed purchase volume is completed, the selected varieties will continue to be used first. (Zhang Ping, CCTV reporter)
