"Puhuibao" flowers bloom!

The health insurance reform shifts gears to speed up again
.

On September 15, the executive meeting of the State Council reviewed and approved the "14th Five-Year Plan" universal medical security plan

Based on this, the innovation guarantee model has been given new connotations
.

In particular, the urban inclusive supplementary medical insurance (hereinafter referred to as "inclusive insurance"), as an innovative product of social and business integration, has been popular all over the country at the speed of starting a prairie fire in the past two years

Dynamic adjustment of the catalogue of multi-modal special medicines for benefiting patients

Dynamic adjustment of the catalogue of multi-modal special medicines for benefiting patients

The basic principles of national medical insurance are wide coverage, low level, and basic guarantee.
Therefore, it is difficult for many new drugs and new materials to be quickly included in the coverage
.

There is a contradiction between the people's higher medical needs and the current level of coverage .

During the "14th Five-Year Plan" period, there is basically an opportunity to save the most serious illnesses
.

Pratt & Whitney has attracted much attention due to its low threshold, high insurance coverage, and price benefits for providing compensation for patients suffering from major diseases and large medical expenses

For example, Beijing "Inclusive Protection" covers 100 kinds of high-priced special drugs, including 75 kinds of overseas special drugs, with a total coverage of 1 million yuan per year, a deductible of 20,000 yuan for healthy people, and a 60% payout ratio, and people with past illnesses are deductible.
The amount is 40,000 yuan, and the payout ratio is 30%; while the Shanghai "Huhuibao" hospital self-funded part of the minimum payment line is 20,000 yuan, 70% for people with non-previous illnesses, and 50% for people with previous illnesses; Zhuhai City launched "Love Without Borders" For 37 kinds of targeted drugs, immune preparations and other malignant tumors, 90% of the reimbursement will be reimbursed between 10,000 and 300,000.
If the insured person is insured, 60% will be reimbursed in the first year, and 90% will be reimbursed in the second year.

.

Through the design of deductible and compensation ratio, the “insurable and compensable” of the widest group of people has been realized

Cheng Zhitao, director of the Zhuhai Medical Insurance Bureau, said that misalignment and complementarity are the distinctive features of Inclusive Insurance
.

Taking Zhuhai as an example, “compensation for non-medical insurance costs + health management” is its innovative highlight

At present, the "insurance fee + insurance drug" type of inclusive insurance is the most popular, and it has also greatly improved the accessibility of innovative therapies to cancer patients
.

According to reports, the proportion of patients in Zhuhai who use immunotherapy is 5 to 6 times higher than that in neighboring cities

Provide new access channels to make innovative drugs more accessible

Provide new access channels to make innovative drugs more accessible

Official data show: On the one hand, national basic medical expenditures in 2020 will exceed 2 trillion yuan
.

In comparison, the commercial insurance compensation expenditure is 292.

The impact of this is the poor accessibility of innovative drugs
.
According to data from Minai.
com, the total sales of various new drugs in 2020 will account for less than 10% of the total sales of pharmaceutical terminals in public medical institutions
.
New drugs included in medical insurance account for less than 45%, and the actual reimbursement rate for new drugs in medical insurance is about 50%
.
It is a top priority to support innovative drugs through multiple payers to benefit patients more
.

The comprehensive promotion of Pratt & Whitney has received active support from government departments
.
The contradiction between the cost of non-medical insurance and preventing the return to poverty due to illness has been to be resolved.
Inclusive of Welfare provides another option
.
At the end of 2019, Guangzhou "Suisuikang" started the era of benefiting the people in a real sense
.
In the first half of 2021, Guangzhou paid 184 million yuan, and the odds of the case were about 92.
4%
.
The most single-drug compensation was for a patient with chordal muscular atrophy, and the rate of personal burden reduced by Suisuikang was 69.
3%
.

In this access channel, the elderly have benefited significantly
.
For example, Zhuhai City attaches great importance to the insurance issue of the elderly over 60 years old, and the current insurance rate of the elderly is 47.
5%
.
As of the end of June, the elderly’s payment accounted for 34% of the total project payment in Zhuhai in the first half of this year, fully reflecting the characteristics of public welfare
.
Cheng Zhitao said, “On the one hand, Pratt & Whitney will reduce the burden on policyholders, and on the other hand, it will promote the innovation and development of medicine and medical technology, so that policyholders can enjoy higher and more precise diagnosis and treatment services in a timely manner
.
The implementation of'Love Without Borders ' allows more policyholders It has raised health awareness and has a positive effect on the expansion of basic medical insurance
.
"

It is reported that "Great Love Without Borders" accurately solves the high medical cost burden of serious and critically ill patients
.
Statistics show that in 2020, in the case of high cost compensation exceeding one million, the burden reduction rate is between 22.
33% and 53.
20%.
After multi-level comprehensive protection, the personal burden rate is only 7.
87%
.
In 2020, 371 people in Zhuhai City will receive compensation for the "Great Love Without Borders" tumor self-financed drug project, with an amount of 25.
9 million yuan, with an average compensation of 70,000 yuan per capita, and an average burden reduction of 87.
65%
.

Take the first immunosuppressant Odivo® to land in China as an example.
It was included in the "Love Without Borders" project in March 2019.
In 2020, there will be a total of 70 people applying for Odivo® compensation through its oncology self-financed drug project, 439 The total number of person-times is 5.
198 million yuan, and the personal out-of-pocket rate is only 9.
83%.
This has greatly eased the cost burden of policyholders and provides new options for patients with lung cancer and gastric cancer
.
For example, if a 66-year-old policyholder is diagnosed with lung cancer, the use of Odivo® costs 304,400 yuan per year, and through the "Great Love Without Borders" project compensation, the individual only needs to pay 39,000 yuan per year
.
In addition, the patient assistance projects provided by social welfare institutions also help to further ease the financial pressure of patients and improve their ability to pay
.
It is understood that in Zhuhai, Guangzhou, Hangzhou, Nanjing, Dalian, Guilin, Xuzhou, Zibo, Neijiang, Meizhou and other cities, Odivo® has been included in the local supplementary commercial insurance
.

In response to this new type of protection model, the industry believes that commercial insurance needs to be more closely integrated with basic medical insurance
.
“Public Insurance needs to extend from claims services to disease management and health services
.
At the same time, it establishes a commercial insurance catalog management to misalign and complement each other under controllable risks, and simultaneously benefit the pharmaceutical industry chain
.
” Experts bluntly said that the threshold of inclusive insurance is low.
It is easy to bring about adverse selection, and there are hidden worries of loss and unsustainable business.
Therefore, it is necessary to fill in the legal gap of Inclusive Insurance and clear the obstacles for the construction of a multi-level guarantee system
.