2021 Medical Insurance Statistical Express, Fund Income and Expenditure, Medical Insurance Catalogue Adjustment, Centralized Procurement, DRG/DIP...

On March 4, the National Medical Insurance Administration released the "2021 Statistical Express on the Development of Medical Insurance".
Through these statistical data, we can roughly understand the "big things" that medical insurance has done in that year and the results achieved
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As a rule, after the release of the Statistical Express, there will be a more detailed bulletin a few months later, and the data of the two will be fine-tuned
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We make a simple comment on the Express, and welcome readers and friends to give us suggestions
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2021 Statistical Bulletin of Medical Security Development In 2021, the National Medical Insurance Administration will adhere to the guidance of Xi Jinping/Jin/Pingxin Era Socialism with Chinese Characteristics Resolutely implement the decisions and arrangements of the Party Central Committee and the State Council, conscientiously carry out the study and education of Party history, continue to improve the medical insurance system with Chinese characteristics, promote the deepening of medical insurance reform, improve the quality and efficiency of management services, the overall stable operation of the medical insurance system, and the safety and sustainability of funds.
The treatment of the masses has been consolidated and improved, and the "14th Five-Year Plan" has achieved a good start
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1.
Basic medical insurance (1) Information on the insured persons
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By the end of 2021, the number of people insured by basic medical insurance has reached 1,364.
24 million[1], and the coverage of insurance has stabilized at more than 95%
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Among them, 354.
22 million people participated in the basic medical insurance for employees, an increase of 9.
67 million or 2.
8% over the end of 2020; among the people participating in the basic medical insurance for employees, 260.
99 million were active employees and 93.
23 million retired employees, an increase of 6.
70 million over the end of 2020.
million and 2.
97 million
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The number of people participating in basic medical insurance for urban and rural residents was 1,010.
02 million, a decrease of 6.
74 million or 0.
7% from the end of 2020
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Comments: The coverage rate of insurance has been stable at more than 95% in recent years.
Stability and wide coverage are the main features.
Doing your best and doing what you can is the basic principle.

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The number of urban and rural residents participating in medical insurance continued to decline (the data in 2020 was 8.
06 million less than in 2019, a decrease of 0.
8%), which corresponds to the continuous increase in the number of employees participating in medical insurance (an increase of 14.
98 million in 2020 compared with the same period in 2019) people, an increase of 4.
6%), is it the gradual increase in the number of rural people who migrate to cities to participate in employee medical insurance or something else? This phenomenon deserves attention
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(2) Fund income and expenditure
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In 2021, the total income and total expenditure of the basic medical insurance fund (including maternity insurance) will be 2,871.
028 billion yuan and 2,401.
109 billion yuan respectively, and the cumulative balance of basic medical insurance (including maternity insurance) at the end of the year will be 3,612.
154 billion yuan
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The annual employee basic medical insurance fund (including maternity insurance) income was 1,896.
803 billion yuan, a year-on-year increase of 20.
6%, mainly due to the phased reduction of employee medical insurance premiums in 2020, which was affected by a low year-on-year base; among which, the income from collection and payment (including maternity insurance) 1,777.
807 billion yuan
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Fund (including maternity insurance) expenditure was 1,486.
302 billion yuan, a year-on-year increase of 15.
5%, mainly due to the recovery of the number of medical visits after the normalization of epidemic prevention and control, and the increase in fund expenditure
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The employee basic medical insurance fund (including maternity insurance) had a cumulative balance of 2,940.
924 billion yuan at the end of the year, of which the cumulative balance of the co-ordination fund was 1,783.
382 billion yuan, and the cumulative balance of personal accounts was 1,157.
543 billion yuan
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The income of the basic medical insurance fund for urban and rural residents was 974.
225 billion yuan, a year-on-year increase of 6.
9%; the expenditure was 914.
807 billion yuan, a year-on-year increase of 12.
0%.
Affected by the recovery of medical treatment and the expenditure on the protection of new coronavirus vaccine and vaccination expenses, the expenditure of urban and rural residents' medical insurance fund in 2021 was year-on-year.
The growth rate is higher than the year-on-year growth rate of revenue
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The accumulated balance at the end of the year was 671.
230 billion yuan
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Comments: The total income and accumulated balance of basic medical insurance in 2021 will increase compared with 2020, which is not unrelated to the 8.
1% increase in GPD; and the total expenditure is slightly lower than the 2094.
926 billion yuan in 2020.
Does it mean that the centralized procurement of drugs and consumables Price reduction, DRG/DIP pilot operation and other medical insurance cost control have begun to show results? In addition, it is worth noting that the growth rate of urban and rural residents' medical insurance fund expenditure is higher than that of income.
Given the continuous decline in the number of insured members of this medical insurance, the premiums paid have also decreased year-on-year? (There is no data for this, and it is only judged by logic and common sense), will there be a deficit in the fund balance in the future? 2.
Maternity Insurance By the end of 2021, the number of maternity insurance participants was 238.
51 million, an increase of 2.
83 million or 1.
2% over the end of 2020
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The expenditure on maternity insurance benefits was 80.
486 billion yuan, a year-on-year decrease of 7.
4%
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3.
Epidemic prevention and control While maintaining a balance between the fund’s revenue and expenditure, solidly do a good job in the medical insurance for the treatment of COVID-19, as well as the protection of COVID-19 vaccines and vaccination costs.
By the end of 2021, a total of 2.
83 billion doses of the COVID-19 vaccine have been vaccinated nationwide
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The cost of nucleic acid testing has been reasonably reduced in various places.
The price per person for single-person testing has been reduced to no more than 40 yuan, and the price of each person for multi-person mixed testing has been reduced to no more than 10 yuan, effectively reducing the burden on the public and the government
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Comments: The outbreak of the new crown pneumonia epidemic has also increased the pressure on the medical insurance fund, so it is imperative to reduce the price of nucleic acid testing and vaccines
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The cost of nucleic acid testing has dropped from more than 100 yuan at the beginning of 2020 to less than 40 yuan at present, a drop of more than 60%, which is even greater than the average drop in the purchase of chemicals in bulk.
In extraordinary times, it is particularly important to maintain social stability
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In fact, the relevant manufacturers have already made a lot of money
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With the efforts of several major domestic vaccine manufacturers, vaccines have also achieved high production capacity and even exported to overseas markets
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Relevant new crown neutralizing antibodies and specific drugs have been approved for listing with conditions, and everything is developing for the better
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4.
Rural Revitalization In 2021, the 25 provinces that were originally responsible for poverty alleviation through medical insurance will subsidize a total of 85.
1972 million people to participate in basic medical insurance, with an expenditure of 17.
669 billion yuan and a per capita subsidy of 207.
40 yuan
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The triple system of basic medical insurance, critical illness insurance, and medical assistance has benefited 123 million rural low-income people seeking medical treatment, reducing the burden of medical expenses by 118.
963 billion yuan
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Comments: Socialism with Chinese characteristics carries out rural revitalization on the basis of poverty alleviation, and the medical insurance field is also upgraded to rural revitalization from "medical insurance poverty alleviation"
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We believe that this is the continuous evolution and improvement of the medical insurance system based on the original new rural cooperative medical system, urban and rural residents' medical insurance, as well as serious illness treatment and medical assistance, and it is also a manifestation of the principle of doing our best and doing what we can
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5.
Direct settlement of inter-provincial and non-local medical treatment As of the end of 2021, the number of designated medical institutions for inter-provincial direct settlement of hospitalization expenses will be 52,700
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In 2021, the national platform will directly settle 4.
4059 million person-times, involving a total medical cost of 107.
020 billion yuan and a medical insurance fund of 62.
463 billion yuan
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The pilot work of cross-provincial direct settlement of outpatient expenses has been steadily advanced.
45,600 networked designated medical institutions and 82,700 networked designated retail pharmacies have been opened.
The accumulative cross-provincial direct settlement of outpatient expenses has reached 12.
5144 million person-times, involving a total medical expenses of 3.
128 billion yuan, paid by the medical insurance fund.
1.
750 billion yuan
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Comments: At present, the largest payer in the pharmaceutical market is still basic medical insurance.
Inter-provincial settlement is an important part of opening up the payment elements of medical insurance.
Hospitalization, outpatient services, and retail pharmacies are interconnected in different regions, different settlement entities, different insured persons, and different types of insurance.
Interoperability, the pharmaceutical market can complete the flow of factors at the payment level, the separation of medicines will have breakthroughs, and the circulation of prescriptions, online medical treatment, online sales of prescription drugs and other formats will be truly formed.

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6.
Supervision of medical security funds In 2021, a total of 708,000 designated medical institutions will be inspected, and 414,000 institutions that violate laws and regulations will be dealt with, including 4,181 medical insurance service agreements, 7,088 administrative penalties, and 404 judicial organs; Among them, 6,472 people were suspended from medical insurance card settlement, and 1,789 people were handed over to judicial organs
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By the end of 2021, a total of 23.
418 billion yuan of medical insurance funds had been recovered
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Organized and carried out 30 groups of unannounced inspections, actually inspected 68 designated medical institutions and 30 medical insurance agencies in 29 provinces, and found 558 million yuan of suspected illegal and illegal funds
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Comments: Resolutely support the country's crackdown on insurance fraud and hedging violations of laws and regulations.
Medical insurance money is the life-saving money shared by everyone.
Only by guarding the life-saving money can it be possible to make good use of the life-saving money
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With the continuous improvement of supervision, some formats that regard medical insurance as a "profit model" will be damaged, and the market should have a clear understanding
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7.
Catalogue of medical insurance drugs In the 2021 catalogue adjustment, 74 new drugs will be added to the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalogue (2021)" (referred to as the "2021 Catalogue")
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The "2021 Catalogue" contains a total of 2,860 kinds of Western medicines and Chinese patent medicines
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Among them, there are 1486 kinds of Western medicines and 1374 kinds of Chinese patent medicines
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It also contains 892 kinds of Chinese herbal medicines
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Since the establishment of the National Medical Insurance Bureau in 2018, it has carried out 4 consecutive access negotiations on the medical insurance drug catalog, and a total of 250 drugs have been added to the catalog through negotiation, with an average price drop of more than 50%
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In 2021, 140 million people will be reimbursed for 221 negotiated drugs during the agreement period, with an average actual reimbursement ratio of 68.
7%
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Through negotiated price reduction and medical insurance reimbursement, the cumulative burden on patients was reduced by 149.
49 billion yuan during the year
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Comments: Since 2018, the medical insurance catalog has gradually formed an annual dynamic adjustment, and the access method has gradually formed and stabilized.
A large number of newly launched innovative drugs can be quickly entered into the catalog through negotiation and purchased online in various places, or through the dual-channel policy.
Out-of-hospital designated pharmacies sell and pay
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Combined with the acceleration of the review and approval of innovative drugs, the "soul bargaining" for access to the medical insurance catalogue has also shortened the life cycle of innovative drugs accordingly
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The competition of some "innovative drugs" with different generic names with the same target or similar mechanism of action has also intensified
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The average decline of Guotan drugs is similar to that of centralized procurement (more than 50%), but centralized procurement has guaranteed sales while Guotan does not.
Guotan varieties can only seize opportunities through more innovative marketing methods and take advantage of the dividends released by the dual-channel policy
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After all, to repeat: product life cycles are limited
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The waiting period and patience for capital assistance is also limited
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At the same time, the supplemented varieties in the previous provincial catalogues will also be digested after June 2022, finally realizing the unification of the national medical insurance drug catalogue
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Provinces only reserve the right to adjust the catalogue of Chinese herbal pieces and ethnic medicines
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The unification of the catalogue will be one of the preconditions for payment according to the unified medical insurance payment standard in the future
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8.
Reform of the payment method of medical insurance As of the end of December 2021, 30 national pilot cities for payment by disease diagnosis-related group (DRG) and 71 pilot cities for regional point method total budget and disease point value (DIP) payment have all come into practice.
payment stage
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Comments: With the introduction and implementation of the DRG/DIP three-year action plan, this payment model will become the most important payment method in the medical insurance multiple compound payment system in the next few years
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All public hospitals and medical insurance designated private medical institutions in the country will undergo fundamental changes in their business positioning, diagnosis and treatment methods, and drug use/consumption methods.

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For this change and its response, please refer to the DRG/DIP series of articles DRG/DIP Impact Analysis: Hospital drug intake, drug structure, centralized collection and reporting, diagnosis and treatment methods, prescription circulation, self-paid drugs IX.
The total value of online procurement orders on the provincial centralized pharmaceutical procurement platform was 957.
3 billion yuan, an increase of 26.
1 billion yuan over 2020
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Among them, western medicine (chemical drugs and biological products) was 767.
2 billion yuan, and Chinese patent medicine was 190.
1 billion yuan, an increase of 15.
1 billion yuan and 11 billion yuan respectively over 2020
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The amount of online procurement orders for drugs in the medical insurance catalogue was 767 billion yuan, accounting for 80.
1% of the total online procurement orders
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In the whole year, a total of 2 batches of chemical drugs were purchased in a centralized manner, covering 106 kinds of drugs, with an average price reduction of 54%, and 1 batch of insulin special procurement was carried out, covering 16 kinds of insulin, with an average price reduction of 48%
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Since 2018, a total of 6 batches of state-organized drug centralized purchases have been carried out, and a total of 234 kinds of drugs have been purchased.
The amount involved accounts for 30% of the total annual purchase of chemical drugs by public medical institutions.
Calculated based on the pre-purchased amount, the cumulative cost savings is 2,600 yuan.
billions or more
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In terms of centralized procurement of high-value medical consumables, the results of the selection of coronary stents have been implemented for one year, and the annual procurement volume of the selected products is 1.
69 million, which is nearly 1.
6 times the agreed procurement volume
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The average price of artificial joints is reduced by 82%
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Comments: DRG/DIP is the "exit" of access, while centralized procurement is the "entrance".
If the entrance and exit are firmly grasped, the medical insurance cost control can basically achieve effective results
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Judging from the 6 batches and 7 rounds of centralized procurement implemented by the state, the procurement rules have gradually stabilized (the finalists are eliminated + the price drop is ≥ 50% or the quotation is ≤ 1.
8 times the lowest price, or ≤ 0.
1 yuan), with an average decrease of about 52%.
Exceeded expectations (drugs were 2.
5 times the agreed volume, and coronary stents were nearly 1.
6 times), greatly saving medical expenses (saving 260 billion yuan)
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The national centralized procurement varieties account for 30% of the drug consumption in public hospitals, and the varieties included in the local centralized procurement projects are enough to leverage the structural changes in the overall drug stock.

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Provincial, inter-provincial and inter-city alliances are also fast, covering more than 1,300 varieties (accumulated nationwide)
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Among them, Guangdong and Guangdong Alliance have included 495 varieties in centralized collection, including conventional chemical drugs, Chinese patent medicines, blood products, basic infusions and biological drugs
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By the end of 2025, there is no suspense that the provinces will complete the task of completing the target of 500 centralized collection varieties required by the 14th Five-Year Plan
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X.
Pharmaceutical price and credit evaluation of recruitment and procurement In 2021, a total of 4 batches of pharmaceutical commercial bribery cases and 1 batch of monopoly control and sales cases were reported, involving 220 enterprises
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Guide all localities to conduct untrustworthy ratings of the enterprises involved.
By the end of 2021, 49 generally untrustworthy enterprises, 13 moderately untrustworthy enterprises, and 5 severely untrustworthy enterprises will be rated
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Comments: The recruitment credit evaluation system is playing a fundamental deterrent role
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In addition to the above-mentioned regulatory cases, national centralized procurement and local centralized procurement have included this into the enterprise application conditions or comprehensive score
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If there is moderate or serious dishonesty, many provincial procurements are either not eligible for registration, or are replaced by companies with no integrity problems under the same conditions, or points are deducted or even vetoed in the scoring stage, it can be seen that this system is in the specific recruitment process.
played a vital role in the mining project
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