The two sessions’ proposal focuses on medical insurance reform: a consensus is reached on improving the multi-level medical security system

On March 1, the new version of the medical insurance catalog was launched nationwide.

Medical security is an important part of people's livelihood security.

On the eve of the two sessions this year, various democratic parties and representative members have made suggestions on the reform of the medical insurance system.

In addition, in response to the rare disease protection model, the Peasants and Workers Party’s sector group proposed to innovate the payment methods for rare disease diagnosis and treatment and medication, improve the affordability of diagnosis and treatment and medication for rare disease patients, and avoid the phenomenon of disease causing poverty or returning to poverty due to illness.

Zheng Bingwen, member of the National Committee of the Chinese People’s Political Consultative Conference and director of the World Social Security Research Center of the Chinese Academy of Social Sciences, believes that it is necessary to accelerate the development of commercial health insurance and formulate the "National Commercial Health Insurance Drugs, Diagnosis and Treatment Items and Medical Consumables Supplementary Catalog" (hereinafter referred to as the "Supplementary Catalog") to promote Deep integration of social insurance and commercial insurance.

Zheng Bingwen said in an interview with a reporter from 21st Century Business Herald: "If the "Supplementary Catalog" can be formulated, it will effectively stimulate the initiative and creativity of medical staff to formulate treatment plans for patients as needed, and meet the needs of consumers with different economic conditions and different preferences.

Pay attention to the breakthrough of medical insurance reform

The reform of the medical insurance system is the key to solving the problem of difficult and expensive medical care for the people.

To this end, on February 25, 2020, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", researching and proposing a "1+4+2" overall reform framework.

Before and after the release of the opinions, the National Medical Insurance Administration, in conjunction with relevant departments, adopted a series of measures to further advance the reform of the medical insurance system.

In terms of implementing settlement for medical treatment in different places, on the basis of comprehensively promoting the settlement of hospitalization expenses across provinces, 27 provinces across the country will carry out a trial operation of settlement of ordinary outpatient expenses across provinces starting from February 1 this year.

Regarding the supervision of medical insurance funds, the first "Regulations" in the field of medical insurance in China-"Regulations on the Supervision and Administration of the Use of Medical Security Funds" have been issued and will be formally implemented on May 1.

In addition, the National Medical Insurance Bureau has also made corresponding arrangements in combating fraudulent insurance fraud and promoting the refined management of medical insurance handling.

On this basis, on the eve of the two sessions this year, various democratic parties and representative members have made suggestions on the reform of the medical insurance system.

The proposal suggested that the reform responsibilities of “medical insurance, medical care, and medicine” need to be clarified, and the overall, systematic and coordinated of the system reform should be improved; the basic medical insurance positioning should be further clarified; and a unified national medical insurance information system should be established as soon as possible ; Improve and perfect the working mechanism of medical insurance services; improve the multi-level medical security system.

The Peasants and Workers' Party sub-sector views the reform of medical insurance from the perspective of protecting patients with rare diseases, and it emphasizes the need to innovate the payment methods for rare diseases diagnosis and treatment and medication.

In the "Proposal on Innovating the Protection Model for Rare Diseases", the Peasants and Workers' Party Sector Group believes that the ability to pay for patients with rare diseases is still poor, and it is necessary to actively explore the multi-channel payment model of "basic medical insurance + multi-level protection" to form a multi-party The fund-raising system improves the affordability of diagnosis, treatment and medication for patients with rare diseases, and avoids the phenomenon of poverty caused by illness or return to poverty due to illness.

In addition, it is necessary to further improve my country's medical security system, establish and improve the medical insurance management system for rare diseases and orphan drugs, promote national negotiations and a centralized mass procurement and supply model, and reduce the price of orphan drugs.

Guide commercial insurance companies to launch insurance programs for rare diseases to reduce the economic risk of rare disease treatment to families.
Establish special funds related to rare diseases, encourage individuals and enterprises to pay attention to and enrich the fund pool, and help more rare disease patients bear the cost of diagnosis and treatment and drugs.

Give full play to the power of social charity organizations to provide medical assistance to patients with rare diseases, and at the same time guide pharmaceutical production or distribution companies to carry out public welfare projects.

Promote the deep integration of social insurance and commercial insurance

Aiming at the development of a multi-level medical security system, Zheng Bingwen, member of the National Committee of the Chinese People's Political Consultative Conference and director of the World Social Security Research Center of the Chinese Academy of Social Sciences, believes that the development of commercial health insurance should be accelerated to promote the deep integration of social security and commercial insurance.

Zheng Bingwen said in an interview with a reporter from the 21st Century Business Herald: “At the end of 2020, my country’s commercial health insurance premium income was 764.
1 billion yuan, and the compensation expenditure was 253.
1 billion yuan.
By the end of 2025, there is a big gap between achieving the target of over 2 trillion yuan in the scale of the commercial health insurance market.
"

In order to promote the development of commercial health insurance, Zheng Bingwen plans to submit a proposal during the two sessions on the formulation of the "National Commercial Health Insurance Drugs, Diagnosis and Treatment Items, and Medical Consumables Supplementary Catalog.
"

He told the 21st Century Business Herald reporter: "If the "Supplementary Catalog" can be formulated, it will effectively stimulate the initiative and creativity of medical staff to formulate treatment plans for patients as needed, and meet the diverse and personal characteristics of consumers with different economic conditions and different preferences.
At the same time, the process of drug procurement and doctor's prescription will be more transparent, so that patients can have a basis for supervision.
"

Regarding the detailed key points of the "Supplementary Catalogue", Zheng Bingwen emphatically mentioned 7 aspects in his proposal.
The first is to build a consensus and regard the "Supplementary Catalogue" as a breakthrough in the integration and development of the multi-level medical insurance system; the second is to jointly take the lead by the China Banking Regulatory Commission and the Medical Insurance Bureau to demonstrate through topics, and then extensively cooperate with relevant organizations to jointly determine the "Supplementary The scope of the Catalogue; the third is to establish a dynamic adjustment mechanism, enterprise declaration and exit mechanism; the fourth is that the products included in the Supplementary Catalogue can be purchased with a net-to-net volume in accordance with the basic medical insurance procurement method, and the hospital should follow the equivalent of the basic medical insurance catalog.
Provision and use of benefits; fifth is the gradual implementation of information sharing between social insurance and commercial insurance to promote the realization of one-stop settlement; sixth is the "purchase, sale and storage" of drugs and consumables in the "Supplementary Catalog", and insurance companies’ compensation status is regular Summarize and report in time; Seventh, the "Supplementary Catalog" can be implemented in priority in tax-excellent health insurance, long-term medical insurance, Huimin Insurance, Million Medical Insurance and other products.