The adjustment of medical insurance catalogue is coming soon: expansion or struggle?

Source: Medical observer 2015-02-12 introduction: in the five years since the implementation of the new medical reform, there has been a lot of ups and downs around "drugs" During this period, many things have happened, which can be called a medical reform drama The plot can be summarized in three words: "tighten (strengthen control) - disorderly - release" At present, drug prices have been liberalized, and there are different opinions on whether to continue to implement "centralized bidding" for drug procurement However, non essential drugs in primary medical institutions have been liberalized, and the once strictly prohibited "second price negotiation" has been quietly abolished These policy changes are also based on the "blood" as a lesson In this situation, the adjustment of the medical insurance catalogue is really concerned According to the practice, the medical insurance catalogue of our country is adjusted once every five years, focusing on the review of new drugs, local adjustment and addition of drugs and drugs recommended by review experts In 1999, China established the medical insurance system for urban employees, the next year formulated the first version of the medical insurance catalog, which was revised in 2004; in December 2009, the Ministry of human resources and social security released the 2009 version of the medical insurance catalog, which included all the therapeutic drugs in the basic drug catalog into the class a part of the medical insurance catalog, and added 260 new drugs It has been five years since 2009 Therefore, some insiders believe that the 2009 version of the medical insurance catalog can not meet the requirements of increasing medical coverage and medical consumption demand At the same time, the deepening of medical reform also puts forward internal requirements for the revision of the medical insurance catalog In fact, as early as the first half of 2014, an official of the Pharmaceutical Department of the consumer goods department of the Ministry of industry and information technology disclosed at the China Pharmaceutical Industry Development Summit Forum that "this year and next, we will start to modify the medical insurance catalog, and the catalog will be expanded" Moreover, although the Central Committee has only made a statement and has not yet made any real action, the local government is ready to make a move in this regard Even as early as March 2013, Xinjiang could not help but include nine varieties into the category B list of medical insurance reimbursement in the region, and added 13 varieties in January 2014 Beijing also announced in 2014 that 224 kinds of drugs used to treat common chronic and elderly diseases were included in the community drug insurance catalogue of Beijing, and the corresponding proportion of individual medical reimbursement in the community increased to 90% So far, the reimbursement range of community drugs in Beijing has increased from 1211 to 1435 In addition, relevant departments in Chongqing, Hubei, Tianjin, Hebei and other places are also enthusiastic about the adjustment of the medical insurance catalogue Xu Yucai, deputy director of Shanyang County Health Bureau of Shaanxi Province, said that in the five years since the implementation of the new medical reform, there have been a lot of things around "drugs" During this period, many things have happened, which can be called a medical reform drama The plot can be summarized in three words: "tighten (strengthen control) - disorderly - release" At present, drug prices have been liberalized, and there are different opinions on whether to continue to implement "centralized bidding" for drug procurement However, non essential drugs in primary medical institutions have been liberalized, and the once strictly prohibited "second price negotiation" has been quietly abolished These policy changes are also based on the "blood" as a lesson In this situation, the adjustment of the medical insurance catalogue is really concerned In general, the new round of medical insurance catalog adjustment should have the following two characteristics: first, expand the capacity, increase the varieties and specifications; second, integrate and link up with the basic drug catalog In fact, the current policy direction is not clear, so which pharmaceutical companies will benefit in the end remains to be discussed If the competent department is open-minded and guided by market determinism, then the price is not a problem, and the original patented drugs will naturally usher in a great opportunity; but if it is in accordance with Sanming's "medical insurance benchmark price" policy, these drugs are a dead end Although "everything is possible", the abuse of traditional Chinese medicine injections has become a major "public hazard" in terms of the existing problems in grass-roots drug use Whether there is "unjust enrichment" is self-evident If only from the perspective of clinical use, there are two major problems: first, whether the user is qualified to use, and second, whether to strictly follow the "clinical use principles of traditional Chinese medicine injection" Therefore, in the absence of "evidence-based medicine basis" background, open the cage to let a large number of Chinese patent medicine into the medical insurance, is the blessing or the disaster can only be left for future generations to comment There are three key factors that determine whether products can be squeezed into medical insurance: first, drug quality There should be no serious adverse drug reactions, especially the hot events concerned by the media, such as raw materials, process fraud, suspected drug kickbacks, etc.; second, drug prices The higher the price is, the less likely it is to enter the medical insurance catalog; third, the clinical efficacy We should try our best to ensure the safety and reliability of clinical efficacy At present, there is still a lack of independent and authoritative pharmacoeconomic evaluation institutions and evaluation index system in China, and there is no specific health technology evaluation method, standard and process for evidence-based medicine and pharmacoeconomic research evidence Therefore, there is still a long way to go to keep pace with the above countries [medical insurance catalog] - it's better to abandon the current situation than to adjust it It's of little significance to adjust the medical insurance catalog As we have been trying to do a lot of things, just at the cost of physical effort to do, but forget why we did it, that is, forget why we started So this time, let's look back and see why we made the Medicare catalog It's because of who In 1979, who put forward the formulation of the national essential drugs catalogue, which aims to protect people's basic right to health, mainly for developing countries Who has developed a guidance catalogue on which countries can make adjustments According to this, in the 1980s, China issued the catalogue of drugs for public labor insurance In 1999, the Interim Measures for the administration of the scope of drugs for medical insurance for urban employees was issued In 2000, the catalogue of drugs for national basic medical insurance, industrial injury insurance and maternity insurance was established Therefore, we can see clearly how the current medical insurance catalog of our country comes from But now, there are quite a lot of drug catalogues in China, which have caused inconvenience to medical institutions, medical insurance supervision, and patients, and also hindered the promotion of national online reimbursement of medical insurance Moreover, there are both national and provincial editions of these catalogues I can only say that the water is too deep And here, I want to say that since the basic drug catalog has several versions, can we no longer need the medical insurance catalog? The answer is "it's hard to give up" On the one hand, it may be because there are too many people's interests in it; on the other hand, it is because many of our current policies also mix the medical insurance catalog, such as the implementation of "three major catalogs" (disease catalog, diagnosis and treatment catalog, and drug catalog) management in basic medical insurance At this time, if there is no drug catalog, what should we do? People will be "at a loss" So, if we really want to abandon the medical insurance catalog, what should we do? My suggestion is that we should not select and develop the so-called medical insurance catalog, and all the drugs in the basic drug catalog should be included in the compliance expenses for reimbursement in proportion; for reimbursement of non basic drugs, as long as they are "reasonably used", all the drugs should be included in the compliance expenses for reimbursement in proportion after paying a certain proportion Of course, after the implementation of this policy, we also need to pay attention to the following points: first, to limit the use of certain special drugs for special diseases; second, after the reimbursement of basic medical insurance, the patients' out of pocket expenses exceed a certain proportion and directly enter the reimbursement of serious diseases insurance, without excluding any project expenses; The third is to abolish the centralized purchase of drugs, and let medical institutions choose which drugs to use and what price to purchase drugs; the fourth is to strengthen the control of sub average cost, and punish the medical institutions with poor cost control in accordance with the "agreement"; the fifth is to punish commercial bribery in accordance with the law; Sixth, actively explore the reform of "medical insurance payment price", improve the price of medical services, and mobilize the initiative of medical institutions to control fees.