The latest weight policy of health insurance! Treatment list system nine points!

Medical network reported on July 25 that the "opinions on the establishment of the management system of medical insurance treatment list (Draft for comments)", once published, was "Crazy" by the circle of medical friends This opinion was publicly solicited until August 6, and the author also paid close attention to it The introduction of this document first reflects the strength of the current medical insurance sector The opinion draft can be said to have been upgraded to the level of national policy I believe that relevant ministries and commissions will work together Secondly, the list of medical insurance benefits required to be established in the opinion draft can be regarded as a positive list and exclusive list In other words, other items not in the list cannot be implemented, which must be clear The list is detailed in the attachment, which means that some necessary emphasis is being made, especially the payment proportion, payment amount, payment base, etc After careful study, the author finds that there are at least the following aspects worth focusing on 1 The general principle of coverage remains unchanged It can be understood that the draft again emphasizes that the general principle of China's medical insurance is low-level and full coverage, including basic medical insurance, major illness relief and major illness insurance New rural cooperative medical insurance, urban employee medical insurance, resident medical insurance, in-depth development of the two in one and gradually promote the three in one and other practices have now been standardized In the past, these works were in the charge of several ministries and commissions, and now the implementation will be more unified after they are unified in the medical insurance bureau 2 it is known to all that the level of medical insurance financing in different regions is still different due to the different economic level in each region For example, in Shanghai, employees will be allowed to invest the balance of their personal accounts in medical insurance, which is not necessarily available in other places Therefore, due to the different payment standards, medical standards and patients' needs, each province and city can make some appropriate adjustments within the scope of national permission, which I think is quite reasonable For example, in the Yangtze River Delta, the Pearl River Delta and the Bohai rim, the payment of some projects should be different from that in the northwest and some underdeveloped areas, which should be considered comprehensively 3 Considering the contents of the detailed documents of special funds, we should also supervise and curb the fraud, abuse and misappropriation of medical insurance funds in some regions Medical insurance funds should be special funds It should also be taken into account that if the entire medical security system changes as a result of this document, it will undoubtedly have an impact on the entire drug supply chain and have a binding effect on all links, which will require the cooperation of all relevant ministries and commissions 4 Supplementary medical insurance In terms of supplementary medical insurance, I think the emphasis on the serious illness and hospitalization insurance of the insured in the document is to fully reflect the national policy of benefiting the people After the document is issued, it will also affect the further promotion speed of the developing medical association and medical community In particular, outpatient payment and extra chronic disease payment have been added in the opinion draft, which means that a convenient channel has been opened for the extension of patients' prescriptions and the implementation of large prescriptions for chronic diseases after hierarchical diagnosis and treatment 5 It is not advisable to expect provincial directory All regions must see that in the future, they must implement the national medical insurance directory more strictly In the past, each region was allowed to increase or decrease 15% of the category B Medical Insurance catalogue (i.e the proportion of varieties in and out was about 15%) This practice should be cancelled Setting a three-year transition period will certainly have an impact on local enterprises This reminds the relevant enterprises that if some enterprises hope to supplement the provincial catalog, this practice may not work, so we should take precautions and deal with it as early as possible Recently, there have been many opinions on this content in the media To sum up, innovation is the absolute principle for a strong variety and enterprise 6 Entering the national catalog is not once and for all, because this influence is inevitable, the importance of relevant varieties entering the national medical insurance catalog is self-evident, but if entering the national medical insurance catalog is different, the product sales will rise, because some drugs are also limited in clinical use For example, some varieties are indeed listed in the national medical insurance catalog, but for general diseases, medical insurance is not allowed to reimburse (except for work-related injuries) For example, thymus method is a drug in the medical insurance catalog, but it is an auxiliary drug in the anti-tumor treatment In the future, it will be at its own expense Unless it is an industrial injury drug, we must pay attention to the restrictions on the clinical use of each variety in the catalog and make a comprehensive analysis 7 The medical insurance bureau unifies standards, and all ministries and commissions cooperate Opinions on the establishment of the management system of medical insurance treatment list (Draft for comments) is an emphasis on some previous documents The medical insurance bureau is doing the work of "Three Guarantees in one" Before that, it was all parts of the country acting separately There are two guarantees in one, and three guarantees in one The practice is different Now the medical insurance bureau is responsible for it It can implement a highly centralized, unified standard and unified step 8 Consider the use of various categories of catalog The industry must also pay attention to that this list is out for comments before the finalization of the new version of the basic medical insurance catalog That must be a foreshadowing Do not expect to supplement the catalog everywhere In addition, if the list officially issued is different from the new version of the basic drug catalog and the catalog of encouraging imitated varieties previously issued by the health care Commission, then in terms of the use of specific varieties, the medical institutions need to consider If the total amount control factors of medical insurance drugs are taken into account, the use of medical insurance catalog varieties must be given priority; if the clinical treatment water needs to be improved The national health and Health Commission's catalogue may be more instructive My opinion is whether 11 varieties that have not yet entered the national basic medical insurance catalogue in the list of basic drugs issued by the health commission can be included as soon as possible according to the clinical use effect 9 Third party payment considerations: in addition to production enterprises and medical institutions, based on the above possible changes, the patient also needs to consider the issue of third party payment Do you pay for it all, or do you choose to be insured? Or other means of payment In a word, each department has the responsibility of each department How to coordinate is the most important We'll see what happens to the list.