New policies for medical insurance reform 2022

Expand the scope of centralized procurement of pharmaceutical consumables, adjust medical service prices, and further expand direct settlement of outpatient expenses across provinces... Recently, the General Office of the State Council issued the "Key Tasks for Deepening the Reform of the Medical and Health System in 2022", which once again clarified This year’s reform goals in the medical insurance field.

Focus 1: Expand the scope of centralized procurement of pharmaceutical consumables

The task is clear, continue to carry out centralized bulk procurement of pharmaceutical consumables, and expand the scope of procurement, striving to ensure national and local procurement of pharmaceuticals in every province The total number of common names exceeds 350. This means that centralized drug purchasing will continue to expand, further squeezing the space for gold sales of drugs and expanding the scope of benefits for the common people.

Over the past three years, centralized purchasing has entered a stage of normalization and institutionalization. The country has purchased 234 types of drugs in 6 batches of centralized purchasing, and the average number of centralized purchasing varieties in each province has reached 50. The National Medical Insurance Administration has also made it clear before that centralized drug purchasing will be carried out in all three sectors: chemical drugs, Chinese patent drugs, and biological drugs.

Centralized purchasing not only reduces the price of purchased drugs, but also creates a catfish effect on the drug market. Judging from the drug price monitoring data carried out by the National Medical Insurance Administration, the overall price level of drugs has continued to decline in the two years of 2019 and 2021, reaching an annual average of about 7%.

In terms of high-value medical consumables, a batch of high-value spinal medical consumables will be purchased at the national level in 2022. For pharmaceutical consumables with large usage and high purchase amounts outside the national organization procurement, the National Medical Insurance Administration and other departments will guide each province to implement or participate in alliance procurement to implement at least one centralized mass procurement.

Focus 2: Promote medical service price reform

Medical service price is an important livelihood price. The task is clear. All provinces will issue relevant documents on establishing a dynamic adjustment mechanism for medical service prices before the end of June 2022, and remove medical service prices from the cost supervision and price hearing catalog before the end of the year.

Previously, eight departments including the National Medical Insurance Administration jointly issued the "Pilot Plan for Deepening Medical Service Price Reform", which clearly stated that through a 3 to 5-year pilot, we will explore and form replicable and popularizable medical service price reform experience. Five cities, Ganzhou, Suzhou, Xiamen, Tangshan and Leshan, have become pilot cities.

In 2022, the National Medical Insurance Administration and other departments will guide local governments to scientifically set the starting conditions, triggering standards and constraints for medical service price adjustments. A price adjustment assessment will be carried out within the year, and prices will be adjusted in a timely manner if conditions are met.

The relevant person in charge of the National Medical Insurance Administration stated that while deepening the price reform of medical services, supporting measures will also be continuously improved to ensure the overall stability of the public's burden. This includes assessing the feasibility of price adjustments, coordinating medical service prices and payment policies, and incorporating price adjustments into the scope of medical insurance payment as required.

Focus 3: Promote a diversified and compound medical insurance payment method

In order to promote the high-quality development of medical insurance, the mission is clear and the diversified and compound medical insurance payment method, which is based on payment based on disease type, will be promoted. Carry out the reform of diagnosis-related group (DRG) payment or disease-based payment (DIP) payment in more than 40% of the coordinated areas across the country. The proportion of DRG payment or DIP payment medical insurance funds in all eligible hospitalization medical insurance fund expenditures reaches 30%.

The implementation of a diversified and comprehensive medical insurance payment method that focuses on payment based on disease type will improve the efficiency of the use of medical insurance funds and reduce the individual burden on patients. Since 2019, national pilots for DRG payment in 30 cities and national pilots for DIP payment in 71 cities have been launched, playing a positive role in slowing down the growth of medical expenses and standardizing medical behaviors.

According to reports, on the basis of national pilot projects, some provinces have also selected some cities with better basic conditions to carry out pilot projects. There have been more than 200 DRG and DIP pilot projects nationwide. According to the arrangement, relevant departments will evaluate the pilot cities that have entered the actual payment stage and improve payment policies based on the evaluation results.

Focus 4: Promote the development of a multi-level medical security system

At present, our country has basically established a system with basic medical insurance as the main body, medical assistance as the underpinning, and supplementary medical insurance. The development of multi-level medical security system. In 2022, commercial insurance institutions will continue to be supported in developing commercial health insurance products that are connected with basic medical insurance to better cover expenses not covered by basic medical insurance.

In addition, the level of basic medical insurance pooling has been steadily improved. Most provinces in my country have implemented municipal level pooling, and provinces such as Beijing, Tianjin, Shanghai, Chongqing, and Hainan have explored provincial level pooling. Next, provincial-level coordination of basic medical insurance will continue to advance.

In terms of direct settlement of medical expenses in different places across provinces, the direct settlement of outpatient expenses across provinces will be further expanded. At least one designated medical institution in each county can provide direct settlement services for medical expenses, including outpatient expenses, across provinces.

The National Medical Insurance Administration and other departments will also guide various localities to promote the co-ordination of general outpatient services for employee medical insurance, implement differentiated payment policies for medical treatment in primary medical and health institutions, and gradually include general outpatient expenses for frequently-occurring and common diseases into the co-ordination fund. Payment range.