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    Home > Medical News > Medical World News > Year end inventory: Top 10 news of medical insurance in 2019

    Year end inventory: Top 10 news of medical insurance in 2019

    • Last Update: 2020-01-03
    • Source: Internet
    • Author: User
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    As the largest media in the field of medical insurance, experts from the editorial board of China Medical Insurance selected and solicited opinions from some readers, selected the top ten news of medical insurance in 2019, and made relevant interpretation (in chronological order): 1 The state organizes the pilot of centralized drug purchase and use 2 Outpatient medication of hypertension and diabetes is included in the residents' medical insurance 3 The combination of maternity and medical insurance 4 DRG payment country pilot work started 5 Implementation of "two pilot and one demonstration" in health insurance supervision 6.15 medical insurance coding standards completed 7 The fourth plenary session first proposed the concept of people's livelihood security system 8 Issuance of the first medical insurance electronic certificate in China 9 Negotiation on access to the largest scale medical insurance drugs 10 opinions on deepening the reform of China 's medical security system approved by the Central Committee On January 1, the notice of the general office of the State Council on printing and distributing the pilot program for centralized drug procurement and use organized by the state (GBF [2019] No On February 28, the state health insurance bureau issued relevant supporting measures to standardize documents and ensure the smooth implementation of the pilot project In order to solve the problem of large price gap between the "4 + 7" pilot cities and non pilot areas of related drugs and make the reform achievements benefit more people, on September 25, nine departments, including the State Medical Security Bureau, issued the implementation opinions on expanding the regional scope of pilot drug centralized procurement and use organized by the state, and promoted the pilot area of centralized procurement and use of drugs organized by the state throughout the country Volume purchase mode Interpretation: the national organization of drug centralized purchase and use pilot is a major change of the previous drug centralized purchase system, further exploring and improving the drug centralized purchase mechanism and the market-oriented drug price formation mechanism, but also has a profound impact on the pharmaceutical industry, promoting the improvement of the quality level of clinical drugs in China, so that the people can use them at a relatively low price Better quality drugs On March 5, Premier Li Keqiang mentioned in the government work report that "prevention and treatment of common chronic diseases should be done well, and outpatient drugs such as hypertension and diabetes should be included in the reimbursement of medical insurance" On September 11, the 64th executive meeting of the State Council was devoted to the study and deployment of improving the drug use guarantee mechanism in outpatient clinics of urban and rural residents with "two diseases" On September 16, the state health insurance bureau and other four departments issued the guiding opinions on improving the drug use guarantee mechanism of outpatient service for urban and rural residents with hypertension and diabetes, exploring and improving the drug use guarantee mechanism for outpatient chronic diseases, and the cost of antihypertensive and hypoglycemic drugs for urban and rural residents with "two diseases" insured patients in outpatient service shall be paid by the overall planning fund, and the payment proportion within the policy scope shall reach more than 50% The policy will benefit more than 300 million "two diseases" patients Interpretation: the improvement of the outpatient medication guarantee mechanism of "two diseases" not only enhances the outpatient service guarantee ability of basic medical insurance, reduces the outpatient medication cost burden of patients, but also indirectly reduces the follow-up medical expense burden through effective and timely outpatient treatment to control the progress of chronic disease, reduce the economic burden of outpatient treatment or hospitalization after the aggravation of the disease In addition, through the innovation of outpatient management and payment mechanism of "two diseases", we can play an active role in promoting chronic disease health management, better control medical expenses and promote national health from the source On March 25, the opinions of the general office of the State Council on comprehensively promoting the merger and implementation of maternity insurance and basic medical insurance for employees was printed and distributed (GBF [2019] No 10) It is required to realize the merger and implementation of the two insurances by the end of 2019, so as to realize the synchronous registration of insurance participation, the merger and operation of funds, the consistency of collection and payment management, the unity of supervision and management, and the integration of handling services On April 3, the state health insurance bureau held a video conference with relevant ministries and commissions to carry out special deployment, clarify task requirements and implement them well Interpretation: comprehensively promoting the implementation of the merger of the two insurances is conducive to enhancing the system guarantee function, improving the management service efficiency, reducing the management operation cost, and improving the mutual aid ability of the fund At the same time, the combination of the two insurances is related to the population balanced development strategy and the protection of women's rights and interests, is conducive to the implementation of the two child policy in an all-round way, and is of great significance to adapt to the new situation and requirements of the economic and social development of the population On June 5, four departments, including the state health insurance bureau, jointly issued the notice on printing and distributing the list of pilot cities of countries that pay by disease diagnosis Under the unified leadership of the national DRG payment pilot working group, 30 pilot cities in Beijing and other countries are required to follow the three-step approach of "top-level design, simulation test and actual payment" in 2020 and start the actual payment in 2021 Fei This is a real exploration of DRG payment reform at the national level On October 23, the National Medical Insurance Bureau officially released the technical specifications for DRG grouping and payment of national medical insurance and the scheme for DRG (chs-drg) grouping of national medical insurance, making another key step in the pilot work Interpretation: medical insurance payment is the core of medical insurance work and the focus of "three medical linkage" To explore the establishment of DRG payment system as a breakthrough point, the implementation of multiple composite payment based on disease payment will further standardize the medical service behavior, promote the fine management of medical insurance, and improve the use efficiency of medical insurance funds At the same time, it indicates that the reform of medical insurance payment mode is advancing in depth, and the medical insurance payment system and mechanism are more scientific, standardized and standardized On June 5, the state health insurance bureau issued a document to decide to carry out the work of the innovation pilot of the supervision mode of medical insurance funds, the construction pilot of the fund supervision credit system and the medical insurance intelligent monitoring demonstration point (referred to as "two pilot and one demonstration") The state health insurance bureau proposed that, within two years, significant progress has been made in the innovation of supervision methods, the construction of credit system and the intelligent monitoring work in pilot (demonstration site) areas, forming experiences, models and standards that can be used for reference, copied and popularized, so as to make a new breakthrough in the supervision work of medical security funds Interpretation: it is an important duty of medical insurance to prevent fund risks and give full play to fund efficiency How to solve the worldwide problems of medical insurance fund supervision with Chinese methods, innovate supervision methods, improve supervision efficiency, and accelerate the construction of long-term mechanism of fund supervision is a new proposition of medical insurance work The work of "two pilot and one demonstration" carried out by the state medical insurance bureau is an important exploration of the innovation of governance concept, mechanism and technical means, and an important path to achieve high-quality and sustainable development of medical insurance On June 20, the state health insurance bureau issued guidance on the standardization of medical security It is suggested that by 2020, on the basis of the construction of the national unified medical security information system, 15 information business coding standards such as disease diagnosis and operation should be gradually implemented During the fourteenth Five Year Plan period, a list of national medical security standards was formed, and some medical security standards were started to be studied, formulated and trial perfected Interpretation: China's medical security system has been established and operated for more than 20 years, but has not yet formed a unified standardized system, which is difficult to meet the requirements of the modernization of medical security governance The only way to improve the fine management level of medical insurance and provide high-quality medical insurance services is to establish a unified national basic common standard of medical insurance and promote the formation of a unified national "common language" and standardized system of medical insurance information data It is also the basic support to promote the high-quality development of medical insurance and realize the modernization of medical insurance governance From October 28 to 31, the Fourth Plenary Session of the 19th Central Committee of the Communist Party of China was held in Beijing, at which the decision of the Central Committee of the Communist Party of China on several major issues concerning upholding and improving the socialist system with Chinese characteristics, promoting the modernization of national governance system and Governance capacity was deliberated and adopted It was decided to put forward the concept of people's livelihood security system for the first time "To improve the social security system covering the whole people" and "to strengthen the system security for improving the people's health level" are the important parts of the decision to adhere to and improve the urban and rural people's livelihood security system and meet the people's growing needs for a better life Interpretation: it was decided to put forward the concept of the people's livelihood security system for the first time and incorporate it into the socialist system with Chinese characteristics, which is the accurate qualitative and positioning of the people's livelihood security system Its complete description and deployment of the people's livelihood security system also revealed that China's future development will be more prominent in the overall planning and coordinated promotion of all people's livelihood security systems On November 24, the first medical insurance electronic voucher was issued in Jinan, Shandong Province Medical insurance electronic voucher is issued by the national medical insurance information platform It is the only identity voucher for online business of national medical insurance, and can serve all medical insurance business scenarios Interpretation: the issuance of medical insurance electronic certificate means that in the future, the national insured can "see a doctor without a card, only medical insurance code" As a high-quality carrier of high-quality medical insurance service, medical insurance electronic voucher has opened up online medical insurance service, broke through regional restrictions, and promoted medical insurance management and service to a higher level The masses can enjoy more convenient, intelligent and efficient medical insurance service On November 28, the list of drugs for access to the national health insurance negotiation in 2019 was released The negotiation involved 150 drugs in total, of which 119 new drugs were negotiated into 70, with an average price decrease of 60.7%; 31 renewal drugs were negotiated into 27, with an average price decrease of 26.4%, and the individual burden of patients will be reduced to less than 20% This is the largest medical insurance drug negotiation in China since the establishment of the medical insurance system Interpretation: both the quantity of new drugs and the total amount of drugs in this negotiation have reached a record high The price for quantity has driven the drug cost down significantly, and all innovations have been made in the negotiation form Through negotiation, the ability to guarantee major diseases has been significantly improved, highlighting the guidance of encouraging innovation, which is conducive to reducing the burden of drug costs on the majority of insured personnel, improving the accessibility and sense of access of patients to clinical medication, improving the use efficiency of medical insurance funds and the fairness of medical insurance system, and promoting the innovation and development of China's pharmaceutical industry.
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