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    Home > Medical News > Latest Medical News > The policy trend of employee medical insurance personal account reform gradually becomes clear that pharmaceutical retail channels are facing challenges!

    The policy trend of employee medical insurance personal account reform gradually becomes clear that pharmaceutical retail channels are facing challenges!

    • Last Update: 2019-08-28
    • Source: Internet
    • Author: User
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    With the cancellation of individual medical insurance accounts for urban and rural residents, the reform of individual medical insurance accounts for employees will become the focus of the next reform Recently, the state health insurance bureau published on its official website the reply of the state health insurance bureau to the second session of the 13th National People's Congress No Overall planning of the two work, the specific measures include: improving the method of personal account, standardizing the use scope of personal account, enhancing the function of outpatient mutual financial security, and improving the supervision of outpatient medical services and costs " From the above principles, the individual account of employee medical insurance will not be cancelled in the short and medium term, which helps to dispel market concerns However, through the reform of individual accounts and the strengthening of outpatient coordination, the total plate and scope of application of individual accounts of employee medical insurance will be changed, which will have a great impact on the drug retail outside the hospital and the medical service and drug use inside the hospital First of all, improving the method of individual account accounting means that the capital injection of individual account will be reduced and the total scale of individual account will be reduced At present, the balance of individual accounts of employee medical insurance is small on average, but the total scale has reached 700 billion The idle account funds are not conducive to the mutual aid function of medical insurance, which makes the medical insurance funds not effectively used, and even causes the problem of cash out abuse in some areas In order to improve the efficiency and mutual benefit of medical insurance funds, the main way to reduce the individual account funds in the future is to gradually reduce the employer's payment part until it is cancelled Whether the individual payment part will be gradually incorporated into the overall planning needs further observation of the policy trend At present, the individual accounts of most regions will inject about 20% - 30% of the employer's payment into the individual accounts of employees, and the rest will be integrated If the employer's contribution is gradually reduced and injected into individual accounts until it is fully integrated into the overall planning, the fund scale of individual accounts in the current year will be reduced to the original 50% - 70% Considering that individual accounts are mainly used in medical institutions, this will continue to increase the proportion of outpatient co-ordination in medical institutions Drug retail channels will continue to be compressed According to the 2018 statistical bulletin issued by the state health insurance bureau, in 2018, the total medical expenses of employees' medical insurance participants were 1214 billion yuan, an increase of 26.9% over the previous year, including 1049.5 billion yuan incurred by medical institutions and 164.5 billion yuan spent by individual accounts in pharmacies In 2018, the drug sales of retail drugstores reached 286.9 billion yuan, which means that 57% of the drug sales revenue of retail channels comes from medical insurance Once the individual account of medical insurance is reduced, the medium and long-term drug revenue of retail drugstores will face a decline Of course, in the future, it is also possible to open the overall access of outpatient drugs to pharmacies, but a prescription circulation and regulatory system need to be established More importantly, the economic power of doctors must no longer be affected by drugs, otherwise the outflow of prescriptions is still difficult Even if pharmacies can obtain the outpatient medical insurance quota, the prescriptions, especially those from primary medical institutions, will not flow out, which is still a certain negative for pharmacies Secondly, the standardized use scope will reduce the original use scope of individual accounts Previously, in some areas with abundant accounts, the individual accounts of employee medical insurance can purchase sports fitness card, physical examination card or health care products With the implementation of the medical insurance treatment list management system, some non-conforming individual account use patterns will not be able to carry out, especially the health care products will be difficult to be included in the medical insurance in the future From the perspective of a series of policies since the establishment of the state health insurance bureau, the future development direction of individual medical insurance accounts for employees will focus on deepening medical security Therefore, similar to using individual account to purchase commercial health insurance will be the applicable direction of using individual account in the future Thirdly, promoting outpatient co-ordination will benefit medical institutions Due to the reduction of individual account amount, more individuals will enter medical institutions in the future From the current trend of development, although drugs have achieved double-digit growth in primary medical institutions, it is mainly due to the consistency of primary drug catalog and three levels, rather than the real primary medical institutions' market share has been greatly increased According to the 2018 statistical yearbook of the health care Commission, the proportion of primary medical institutions in outpatient visits continued to shrink, 61% in 2013 and 56% in 2017 The third level hospitals are the fastest growing hospitals in all levels, accounting for 18% in 2013 and 22% in 2017 Therefore, although the grass-roots level is still the highest proportion of visits, the grass-roots level receives the impact of the medical insurance quota, and most of the drugs issued are low-cost drugs The third level hospitals will gain more market share from the medical insurance outpatient service Finally, strengthening supervision means strengthening management in both outpatient and non-medical institutions The difficulty of cost management of outpatient co-ordination is much higher than that of hospitalization Because outpatient costs are frequent, more accessible and more likely to be abused, it is necessary to strengthen supervision Because of the weak technical ability of the whole grass-roots level in China, the outpatients regard it more as a means of prescribing medicine, which leads to serious waste and loss of medical insurance Although the supervision of high-level hospitals is being strengthened, there are still further measures to be taken on the overall supervision of outpatient services On the other hand, the supervision of drugstores and Internet channels needs to be strengthened Due to the strong impulse of individual account arbitrage, the previous individual account fraud and hedging events occur from time to time With the strengthening of health insurance fund supervision, it will be more and more difficult to carry out hedging in retail channels in the future, which will lead to a certain impact on drug revenue in retail channels In a word, the reform of individual accounts of employee medical insurance will be gradually promoted and improved The reduction and standardization of individual accounts will be the main goal in the short term The overall development and supervision of outpatient service is the medium and long-term goal It also needs to wait for the improvement of the fine management ability of medical insurance in outpatient service This article is reprinted by yaozhi.com The copyright belongs to the original author The purpose of reprint is to transmit more information, which does not represent the view of this platform If the content of the work, copyright and other issues are involved, please contact our website message, we will delete the content in the first time.
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