Han Zheng three times investigated the medical insurance bureau to release what important signals?

Original: Wu Jing, Wu yeting Han Zheng, a member of the Standing Committee of the Political Bureau of the CPC Central Committee and vice premier of the State Council, has visited the National Health Insurance Bureau three times since its establishment less than two years ago On January 9, 2020, South Korea is holding a symposium with the National Health Insurance Bureau, giving an evaluation of the National Health Insurance Bureau in 2019: "dare to take on the responsibility Great achievements have been made in all aspects of work, which deserves full affirmation " From the top of the affirmation, no doubt let the health insurance bureau in the storm eat a reassuring pill "Too busy" and "no weekend" are the most frequently heard words from many staff members of the National Health Insurance Bureau at eight o'clock in the past year Since its establishment, nearly 40 policies and regulations have been promulgated, with an average rate of one heavyweight news release in January, which has lifted the appetite of the whole people and stirred the whole industry But work is not so easy Because of moving the cheese of relevant stakeholders, fighting against insurance fraud and carrying purchase met with great resistance in the early stage, "spent a lot of time to communicate", recalled the relevant leaders of the medical insurance bureau Han Zheng's first two visits to the health insurance bureau were: on July 10, 2018, the National Health Insurance Bureau was just listed for less than two months; on March 26, 2019, the national two sessions just ended The signals released to the outside world by the two surveys implied the priorities of the State Health Insurance Bureau in the next period of time If you open the official website of the National Health Insurance Bureau, you can clearly see that in 2019, the news of Han Zheng's research on the National Health Insurance Bureau has been on top of the dynamic column of the official website By contrast, this survey is "much easier" than the previous two, "not with too many tasks" and "mainly to encourage and affirm our work," said a leader of the National Health Insurance Bureau who attended the meeting However, in his speech at the symposium, Han still put forward the future work focus of the medical insurance bureau On the whole, it still continues the past volume purchase, medical insurance catalog adjustment and anti fraud insurance, but each has a new formulation It is worth noting that the two time is a big difference At the forum, Ma Xiaowei, director of the National Health Commission, was sitting on the right hand side of the Han side, and other departments such as the Ministry of personnel and social affairs also participated in the symposium △ drawn by: Wu yeting In July 10, 2018, the national health insurance agency was less than two months The first research of Han Zheng brought about the task There are three aspects in brief: accelerating the price reduction of anticancer drugs, perfecting the National Remote Medical settlement system and accelerating the "Internet plus medical insurance" These tasks are just the important livelihood issues that the government is eager to solve The release of "I am not the God of medicine" on July 5, 2018 has caused a heated discussion on the high price of imported anti-cancer drugs On the day after Han Zheng proposed "accelerating the price reduction of anti-cancer drugs", the state health insurance bureau held a corporate communication meeting on the special negotiation on the access of anti-cancer drugs to medical insurance, and the negotiation on anti-cancer drugs was put on the agenda This is the first drug negotiation since the establishment of the National Health Insurance Bureau There are 17 kinds of anticancer drugs, including multiple targeted drugs, with an average decrease of 56.7% △ image source: visual China From the end of the negotiation in the middle of September 2018 to October 25, 2018, the first prescription for medical insurance reimbursement was issued in China However, it took more than one month and only two and a half months to land in China by the end of November, with a record short landing time In contrast, the negotiation results in 2017 were all implemented in the whole country, taking about six months At the same time, in order to ensure the supply of drugs, the state health insurance bureau issued a number of documents within 20 days to refine the handling rules In order to dispel the concerns of medical institutions and pharmaceutical enterprises, the health insurance bureau stipulated that the negotiated varieties should be separately accounted for and reimbursed according to the facts Another major livelihood issue is the settlement of medical treatment in different places Nowadays, with the increasing frequency of population flow, medical treatment in different places has become the norm, but the problems such as the inability of real-time reimbursement make the floating population unable to obtain the proper medical security On August 22, 2018, Premier Li Keqiang presided over the executive meeting of the State Council, which decided to expand the scope of direct settlement of cross provincial hospitalization expenses of basic medical insurance, and determined the major groups included in the cross provincial settlement and the objectives to be achieved Two days later, on August 24, Li Tao, deputy director of the state health insurance bureau, introduced several measures the Bureau was taking at the regular briefing of the State Council The effect is very obvious In 2018, the national cross provincial medical and inpatient expenses were directly settled by 1.32 million people, 6.3 times of that in 2017 In 2019, 2.72 million person times of cross provincial and non local medical treatment will be settled directly, medical expenses will be 64.82 billion yuan, and fund payments will be 38.32 billion yuan, double the amount in 2018 The third problem is to accelerate the "Internet plus medical insurance" Before that, the development of Internet health care encountered a bottleneck The key problem was that it failed to get through the data of all regions and connect with medical insurance Since August 2018, the state health insurance bureau has invited industry experts to work hard for 10 months and completed the formulation of four core coding standards for medical insurance information business In August 30, 2019, the National Health Insurance Bureau issued the guidance on improving the policy of "Internet plus" medical insurance payment policy It extended the scope of medical insurance coverage from offline medical services to online for the first time Internet plus medical services will be conditionally included in the medical insurance payment system On November 24, 2019, the National Medical Insurance Bureau launched the national medical insurance electronic voucher system However, in 2018, the National Health Insurance Bureau brought the biggest shock to the industry It was the "4 + 7" pilot procurement bid opening on December 6, with 25 varieties winning the bid, with an average decrease of 52% and a maximum decrease of 94% It means that the ability of medical insurance to control the price and dosage of drugs has been strengthened, and medical service behavior has been forced to change in the opposite direction The past "sales with money" model of pharmaceutical enterprises has also met with great challenges After the national two sessions in 2019, Han Zheng came to the National Health Insurance Bureau for the second time for research, eight months apart from the last time He emphasized the next several key tasks, which are simply summarized as follows: cracking down on fraud and insurance fraud, adjusting the medical insurance catalog, doing well in the pilot of centralized drug purchase and use, and providing outpatient support for hypertension and diabetes Compared with 2018, "fight against fraud" appeared frequently in official documents in 2019 In January 2019, when Han Zheng attended the Symposium on medical insurance work, he stressed that we should crack down on fraud and insurance fraud, and build a long-term mechanism for the supervision of medical insurance funds as soon as possible The problem of fraudulent insurance has a long history In 2019, the official website of the state health insurance bureau reported three typical cases of fraudulent insurance funds, involving 24 medical insurance units in total, and more than 10 million medical insurance funds were defrauded There are various ways of fraud in the case: over inspection, false hospitalization, hanging bed hospitalization, replacement of drugs, medication without medical order, purchase of false purchase invoice, yin-yang prescription, replacement of medical insurance code, over payment of medical insurance to carry out diagnosis and treatment projects, forgery of inspection report, etc It may be hard for many people to imagine that a health center in Lankao County, Kaifeng City, Henan Province, has defrauded 2.6683 million yuan of medical insurance fund in more than one year by simply exchanging diagnosis and treatment items and over treating △ screenshot of animation propaganda film of the National Health Insurance Bureau against fraud From the perspective of 2019, the crackdown on deception has formed a high-pressure situation all over the country On November 17, the State Commission for Discipline Inspection of the Central Committee of the Communist Party of China announced that up to that time, 91600 designated medical institutions for fraudulent insurance had been investigated and dealt with, and RMB 2.632 billion of medical insurance funds and liquidated damages had been recovered, and RMB 194 million of administrative fines had been imposed; 63900 designated drugstores for fraudulent insurance had been investigated and dealt with, and RMB 214 million of medical insurance funds and liquidated damages had been recovered, and RMB 05 million of administrative fines had been imposed In 2019, the adjustment of medical insurance catalog was mentioned again Because of the interest barrier involved, all kinds of transfer in and out must have a strong scientific basis and persuasive force It took about 10 months for the health insurance bureau to prepare for the final decision, which took a long time In the medical insurance catalog, there are 150 kinds of conventional catalog transferred out and 148 kinds transferred in In the past three times, the adjustment of medical insurance catalog rarely transferred out the drugs in the catalog This time, the drug structure of these drugs, whose efficacy is not accurate and which are listed in the key monitoring by the health care Commission, has changed a lot, so it is evaluated as the "cage for birds" move in the industry With the negotiation experience of anticancer drugs in 2018, the negotiation of medical insurance in 2019 is very easy 150 varieties with high price and clinical value have been negotiated to 97, including 22 anticancer drugs, 7 drugs for rare diseases, 14 drugs for chronic diseases and 4 drugs for children Eight of the 12 major innovative drugs made in China have been negotiated, which has released clear signals of high-level support for innovative drugs Later, a negotiation video came out, "we are the whole country to negotiate with you", which clearly conveys the signal of the future of health insurance: take the population scale to make the pharmaceutical enterprises cover as many fields as possible, and ask the pharmaceutical enterprises to reduce the price according to the market scale It also reflects the strong bargaining power and purchasing power of the National Health Insurance Bureau, and brings a strong shock wave to the pharmaceutical industry in 2019 In 2019, with the trend of large-scale purchase, more and more regions are enjoying low-cost drugs, and more and more varieties are being cut in the medical insurance catalog At the end of 2018, 25 varieties won the bid for belt procurement were not implemented in 11 pilot cities for a long time In September 2019, the bid opening of the second round of belt procurement was extended to 25 provinces and regions across the country On the basis of the average reduction of 52% in the first round, the price dropped by 25% Many varieties included in the third round of collection belong to "two diseases" (hypertension and diabetes), which means that the scope of national collection began to gradually cover the field of chronic diseases On September 11, 2019, Premier Li Keqiang presided over the executive meeting of the State Council, which decided that for more than 300 million patients with hypertension and diabetes who participated in the basic medical insurance for urban and rural residents, their outpatient drugs within the scope of the national basic medical insurance drug catalog should be included in the medical insurance payment, and the proportion of sales report should be increased to more than 50% △ drawn by: Wu yeting On January 9, 2020, when Han Zheng investigated the medical insurance bureau for the third time, he gave instructions on the future work of medical insurance The key points are still to crack down on fraudulent insurance, volume purchase and the adjustment of medical insurance catalogue, but there are some new ideas for each one First of all, we should fight against deception, especially put forward "improving flight inspection methods" Flight inspection is a form of follow-up inspection It refers to the on-site inspection carried out by the inspected department without prior notice It is an effective way to crack down on all kinds of fraud and deception Including the famous Xiangya Second Hospital According to the notice of Hunan Medical Insurance Bureau: The new formulation of the adjustment of the medical insurance catalogue is "gradually bring more good drugs for life and emergency into the scope of medical insurance" It is believed that more drugs for the treatment of major diseases such as cancer and rare diseases are still the important direction for the next step However, there are a lot of new ideas for volume procurement: normalize centralized volume procurement, expand the scope of procurement varieties, and drive the reform of "three medical linkage" On January 17, the purchase of the third wheel belt will be officially opened, and the number of drugs to be purchased has increased from 25 in the previous two rounds to 35, and the region is expected to expand to public hospitals in all provinces In the future, the procurement with volume will be normalized gradually In addition to drugs, many places have launched a joint procurement test of consumables According to a person familiar with the matter, the national health insurance bureau is "promoting the volume procurement of high-value consumables" The adjustment of medical insurance catalogue and the normalization of purchasing with volume will bring about a more intense integration