The opportunity for the national medical insurance bureau to issue a document on domestic equipment
Last Update: 2020-06-19
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Domestic equipment ushered in a large number of hospitals< br / > < br / > < br / > recently, the state health insurance bureau issued the Interim Measures for the management of medical consumables for basic medical insurance (Draft for comments) (hereinafter referred to as draft for comments), requiring the formulation of the directory of medical consumables for basic medical insurance to include the consumables in the directory into the payment scope of medical insurance fund< br / > except for the special provisions, the local medical insurance department will implement the national catalogue of medical consumables for basic medical insurance and shall not adjust it without authorization< br / > at the same time, the draft shows that for exclusive products, non exclusive products, products purchased with quantity and products purchased without quantity, corresponding payment standards for medical insurance will be formulated< br / > for medical insurance payment standard, many people understand it as medical insurance payment price, which is not the case< br / > the person in charge of the bidding business of a well-known domestic machinery enterprise said to saberland equipment that the medical insurance payment standard is the settlement fee standard for the medical insurance fund and the insured to pay the cost of consumable drugs to the consumable provider when the insured uses the medical insurance consumable catalog< br / > the China Social Security Research Center of the Central University of Finance and economics has published an article analysisThe medical insurance payment standard specifically includes price standard, quantity standard and quality standardDetermining the medical insurance payment price is only one of its functions< br / > for the specific payment form, the above listed the medical insurance payment method of medical consumables in a certain area: the medical consumables used in the diagnosis and treatment project are divided into class A and class B, class A is the medical consumables with a single cost less than 500 yuan, which can be paid according to the proportion specified in the basic medical insurance; class B is the medical consumables with a single cost greater than 500 yuan, the patient pays 30% first, and the remaining 70% is included in the reimbursement scope< br / > 500 yuan is a reflection of the medical insurance payment price< br / >< br / > the person in charge of the bidding business of domestic well-known machinery enterprises analyzes the cypress blue equipmentFor example, the price of a kind of consumables varies from 500 yuan to 1000 yuanIf the payment standard of medical insurance is 600 yuan, the part exceeding 600 yuan shall be paid by the patient< br / > due to the influence of comprehensive factors (consumption proportion, zero addition of consumables, payment by disease, etc.), in the future, hospitals and doctors may tend to use consumables that meet the demand of basic medical services and below the payment standard of medical insurance, or have the power to negotiate with the manufacturers and distribution enterprises of consumables, while the higher the price, the less the consumption of consumables< br / > part of the machinery enterprises are fighting for more market share The product price will be adjusted, so the medical insurance payment standard will not directly affect the price of consumable products, but it will indirectly adjust the price of products < br / > therefore, if the price standard of medical insurance payment is low, the consumption of domestic consumables with low price may increase significantly in hospitals < br / > China Social Security Journal has published articles to sort out that the calculation of the medical insurance payment price standard mainly includes the lowest price method, the highest price method, the median method, the quantile method and the analogy method, among which the lowest price method can effectively control the medical insurance fund expenditure < br / > however, some specific payment standards of medical consumables of basic medical insurance are determined according to the lowest price of consumables < br / > the draft shows that for non exclusive products, in principle, the payment standard is determined and adjusted through centralized purchase According to the results of relevant volume purchase, each provincial medical security administrative department determines the local medical insurance payment standard with the lowest median price of medical consumables with the same category and similar functions < br / > for medical consumables not included in the scope of belt purchase, the payment standard shall be determined by each region according to the calculation method of the payment standard in the catalog The rules for determining the medical consumables medical insurance payment standard shall be formulated separately < br / > < br / > < br / / > in addition to the payment standard of medical insurance, the draft also emphasizes that for products that enter the medical insurance catalog through fraud and other illegal means, in principle, they will be directly transferred out of the basic medical insurance payment range after being reviewed by experts < br / > it is understood that drugs can be sorted and supervised by using the common name, but the consumables are too complex and difficult to be supervised, and some of them are fraudulently listed in the medical insurance catalogue < br / > the relevant person in charge of the domestic well-known machinery enterprises told cypress blue that this kind of problem does exist in the industry, because medical consumables are very complex and can be used for multiple types of operations or multiple anatomical parts, some consumables only the internal staff of the company can fully understand the clinical applicable operations < br / > due to this industry attribute, some consumables enterprises have the opportunity to enter the medical insurance catalog by providing false materials and other means < br / > according to the draft, for medical consumables meeting the conditions of direct transfer out, in principle, the directory of medical consumables for basic medical insurance will be directly transferred out < br / > the draft also requires that consumables such as dentures, artificial eyes, artificial limbs, hearing aids and other non therapeutic rehabilitation appliances, which cannot be charged separately, have low clinical value and can be completely replaced, are not included in the list < br / > in fact, as early as June 30, 1999, the former Ministry of labor and social security and other departments jointly issued the opinions on the management of urban employees' basic medical insurance diagnosis and treatment project < br / > it is also required that medical insurance shall not be paid for non clinical diagnosis and treatment items with uncertain effect; medical insurance shall not be paid for rehabilitation appliances such as glasses, dentures, artificial eyes, artificial limbs, hearing aids, etc.
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