Reducing prices, running less, and re-ordinating—medical insurance reforms address the "worries" about the health of the people in the Yangtze River Delta

Source: Xinhuanet

High-value medical consumables alliance with volume purchase, out-of-patient clinics to achieve card settlement, establish a long-term mechanism for the supervision of medical insurance funds ... Under the "package" policy combination, what new changes have occurred in the Yangtze River Delta for medical treatment? Why is the medical insurance system undergoing "blade inward" reforms? How to achieve fair and comfortable medical treatment to meet the basic demands of the masses?

The "package" is good for people to gain a sense of gain

"This is already the lowest domestic price we can provide, and there is really no way to let it go." "The product with the largest decline will become a must-have product for the alliance unit." Start a "Tug of War" with the expert team. After three rounds of negotiations, among the final product quotations submitted by 10 product manufacturers, 4 products fell by more than 50%, and the highest decline was 66%.

In 2019, Jiangsu Province established the Provincial Sunshine Procurement Alliance, which consists of 157 third-level public medical institutions in the province, focusing on key varieties to carry out alliance procurement, involving heart stents, pacemakers, coronary balloons, artificial lenses, artificial hip joints, etc.5 381 varieties of high-value medical consumables were the first to carry out two rounds of alliance procurement in the country. The maximum decline of a single variety was 81%, and the annual savings of nearly 1 billion yuan. "Squeezing the moisture in the circulation field has significantly reduced the price of high-value medical consumables," said Wei Zijing, a member of the Expert Committee of the China Medical Education Association.

Starting in September 2018, the first eight pilot areas were opened in the Yangtze River Delta region to promote direct settlement of outpatient medical clinics in the Yangtze River Delta. Up to now, all 40 cities in the three provinces of Jiangsu, Zhejiang and Anhui have realized the "One Card" with Shanghai Medical Insurance, all the coordinated areas in Jiangsu and some pilot areas in Zhejiang.

Cao Lin, 60, worked in Xuzhou, Jiangsu when she was young, and lived in Shanghai after retirement. Seeing a doctor in Shanghai, medical insurance in Xuzhou. "In the past, I went to see a doctor in Shanghai, and took a stack of expense details and medical records to Xuzhou for reimbursement. Now it is very convenient to directly apply for a medical insurance card when visiting a clinic in Shanghai."

Xia Kejia, director of the Shanghai Municipal Medical Security Bureau, said that the direct settlement of outpatient clinics in the Yangtze River Delta is a useful attempt by medical insurance and health departments in three provinces and one city to promote integration through projectization, and enhance public awareness through the integration of public services.

"Blades inward" to reform hard bones

After comparing the financial data of more than 80 rehabilitation-designated medical institutions, it was found that in 2018, the average bed-day cost of the integrated medical and nursing medical institutions in the city was as high as 643.41 yuan. The Hangzhou Medical Security Bureau immediately set up a list of issues, negotiated penalties, and signed a supplementary agreement, requiring that bed-day costs be controlled below 450 yuan. Through this measure, from August to November 2019, the average bed-day cost of Hangzhou rehabilitation designated medical institutions decreased by more than 20% year-on-year, hospitalization costs decreased by 154 million yuan, and fund expenditure decreased by 145 million yuan.

"A lot of institutions didn't understand at the beginning, but we persevered." Fang Jianguo, secretary of the party group of the Hangzhou Medical Security Bureau, said that the process of establishing regulations and plugging loopholes is sometimes "risky", but it is necessary to do something Breakthrough.

Zhou Ying, director of the Jiangsu Medical Security Bureau, said that the expectations of the people reflect to some extent the imbalance in development and protection of medical insurance itself, inadequate fairness, and hidden concerns about sustainability, which urgently need to be enhanced through reform People's sense of gain, happiness and security in the field of medical insurance.

Taking Jiangsu's comprehensive promotion of municipal-level coordination as an example, it will be clear from January 1, 2020 that the "six unified" basic medical insurance and maternity insurance municipal-level coordination system will be implemented to implement basic policies and treatment standards. Unbalanced treatment and other issues. "This is a readjustment of interests. It is a reform of 'blades inward'. It is not easy. But reforms must not be afraid of stubborn bones." Zhou Ying said.

Promote the establishment of a multi-level medical security system

Health insurance policies are directly related to people's health and wallets. "Through medical insurance reform, the price reduction of medicines, including anticancer drugs, has become one of the most rewarding people's livelihood services in 2019. The increasing coverage of medical insurance is an important guarantee for the comprehensive construction of a well-off society." Fudan University Hu Shanlian, a professor at the School of Public Health, said.

Xia Kejia said that the reform of medical security must not only meet the requirements for high-quality development, but also take small steps without stopping. It must also do its best and do its best to ensure the basic and bottom line. From the standpoint of the masses, we will effectively reduce the falsely high drug prices and high-value medical consumables, simplify and optimize the medical insurance handling process, and keep the medical insurance fund's safety bottom line.

"It is necessary to clarify the relationship between the government, the market, and the society. Basic medical insurance mainly covers the basics and the bottom line. It is necessary to develop the market in accordance with market rules to meet diversified and differentiated needs." Zhou Ying said, promoting the effective connection between basic medical insurance and commercial insurance, and comprehensive A multi-level medical security system covering the entire population, urban and rural coordination, clear powers and responsibilities, and appropriate and sustainable safeguards will be established.

Ni Huping, director of the Reform and Development Division of the Zhejiang Medical Security Bureau, said that in the "three-medicine linkage" Chinese medical insurance cannot cover the world. The medical insurance reform must be linked with the reform of the public medical service system, modern hospital management system, and drug supply guarantee system. Promote the harmonious development and orderly balance between medical insurance, medical treatment and medicine.