China's social health insurance has three major catalogs, which are the basic health insurance drug catalog, diagnostic and treatment items catalog, and medical service facilities catalog, and these three catalogs are the most basic guidelines for the implementation of China's health insurance policy and reimbursement. Among the three major catalogs of medical insurance, the catalog of medicines and treatment items are divided into "Class A" and "Class B". But what does "Class A" and "Class B" mean, and what is the difference in the scope of reimbursement for their corresponding drugs and diagnostic and therapeutic items?
What is the meaning of "Class A" and "Class B" in the medical insurance drug catalog
In response to this question, the staff of the Municipal Bureau of Medical Protection said that in recent years, especially through the new crown epidemic, people are paying more attention to the medical insurance. The city's medical security bureau said. Our three major catalogs of social health insurance are the most basic guidelines for the implementation and reimbursement of our health insurance policy. Of course, these three catalogs are not static, they are adjusted and improved with the development of society and the increasing improvement of people's living standards. For example, at the end of 2019, the National Health Insurance Bureau added 128 drugs to the health insurance catalog through negotiated access. At that time, it triggered a lot of attention and won the people's unanimous applause.
Life, people say the most and pay the most attention to, when it comes to the basic medical insurance drug catalog. It is the policy basis and standard for medical, industrial and commercial, and maternity insurance to pay for medicines, and it is based on the selection of national essential medicines that are necessary for treatment, inexpensive, and have good therapeutic effects.
The medicines included in the scope of payment of basic medical insurance are divided into two categories, Class A and Class B. The Class A medicines are the national basic uniform medicines, and the Class B medicines are the national basic uniform medicines. Class A drugs are those that are basically uniform throughout the country, necessary for clinical treatment, widely used, effective, and low-priced among similar drugs, and are able to guarantee the basic needs of clinical treatment. The costs of these drugs are covered by the Basic Medical Insurance Fund and are paid in accordance with the Basic Medical Insurance Benefit Criteria. Participants are fully reimbursed for the use of "Category A" medicines. Category B drugs, which are also set by the state, are drugs that are available for clinical treatment, have good therapeutic effects, and are more expensive than Category A drugs in the same category. When a participant uses "Class B" medicines, if the proportion of personal burden is not labeled, he/she has to bear a certain proportion of the medicine cost first (the regulations vary from place to place), and the rest will be included in the scope of payment of the medical insurance fund. If the proportion of individual's burden has been marked, the individual shall first bear a certain proportion of the drug cost according to the marked proportion, and the rest shall be included in the scope of payment of the medical insurance fund. Provinces and municipalities can make adjustments on their own, and the adjustments cannot exceed the 15% set by the State. Generally speaking, the out-of-pocket ratio of Class B drugs is between 10-30%.
Drugs that are not included in the "Class A" and "Class B" drug lists are "off-catalog" drugs, and off-catalog drugs are self-paid (commonly known as "Class C" drugs). "The most important thing to remember is that you should be able to get the best out of your medication. Of course, with the continuous improvement of health insurance policy and social welfare, every year there will be some self-financed drugs adjusted to Class A, Class B, and the successive listing of new drugs into the self-financed class. on January 1, 2020, China implemented the 2020 version of the "Medical Insurance Drug List". This time, the catalog was adjusted with the following three main changes: 1. More good drugs were included. The number of drugs in the new version of the medical insurance catalog reaches 2,535. This adjustment has taken out 150 old drugs (mainly including drugs with canceled approval numbers, unreasonable use and outdated drugs) and added 148 new good drugs, which are more life-saving drugs, including drugs for serious illnesses such as cancer and rare diseases, and chronic drugs for chronic diseases such as diabetes. As a result, more drugs with better efficacy have been included in the list, and the scope of reimbursement for specific major diseases has become broader, which naturally reduces the pressure on the people's healthcare expenditures.2. Making medicines more affordable. This time, the state negotiated with pharmaceutical companies to reduce prices, and included 128 anti-cancer drugs into the medical insurance catalog, which are much cheaper than before, with the highest being 70% cheaper, and the lowest being nearly 40% cheaper. Taking Ebitux for colorectal cancer as an example, the price of Ebitux has dropped from 4,232 yuan to 1,295 yuan per bottle, which is the lowest price in the world; after the negotiation, the price of OXITINI for lung cancer has been drastically reduced by 71%. The inclusion of "expensive anticancer drugs" in the medical insurance policy has indeed reduced the pressure on patients, and it is believed that more good drugs will enter the medical insurance policy in the future. 3. The reimbursement rate has been increased. This new version of the medical insurance catalog, will be 74 kinds of Class B drugs, all adjusted to Class A, such as: pediatric fever and cold tablets, double yellow lotus oral liquid, strong loquat lozenges, which means that to take these drugs, the original is to pay 10-30%, but now can be 100% reimbursement. So, all in all, this catalog adjustment is a great thing for the people.
While out-of-pocket medicines are likely to be adjusted to the health insurance catalog, the following out-of-pocket medicines, at least for now, are explicitly excluded from the scope of coverage of the "basic health insurance fund," including: medicines that are mainly nutritional supplements, animal and animal organs that can be partially used as medicine, dried fruits and fruits that can be partially used as medicine, Chinese medicine and traditional Chinese medicine, and other medicines that can be used as medicine. Fruits, all kinds of wine preparations made from Chinese medicine and Chinese medicine tablets, fruit-flavored preparations of all kinds of medicines, oral effervescent preparations, blood products and protein products other than those used in first aid and rescue, and so on.
What is the meaning of "Class A" and "Class B" in the catalog of medical treatment items
The so-called catalog of medical treatment items refers to clinical treatments, examinations and other items used by hospitals for medical treatment, such as treatment fees, examination fees and surgical fees. The first is to make sure that you have a good understanding of what you are doing and how you are doing it. Generally speaking, the basic medical insurance diagnostic and treatment items should meet the following three criteria: First, the clinical treatment is necessary, safe and effective, and the cost is appropriate; Second, the price department to set the relevant charges; Third, the designated medical institutions need to be within the scope of the designated medical services for the insured person.
Diagnostic and therapeutic items are also divided into "Category A items" and "Category B items". The diagnostic and therapeutic items in the "Category A Catalog" are those that are necessary for clinical diagnosis and treatment, safe and effective, and at an appropriate cost. The diagnostic and therapeutic items in the "Category B List" are those that can be selected for use in clinical diagnosis and treatment, and the effects are certain but need to be appropriately controlled. Some of the items in the "Category B List" are limited according to clinical indications, hospital level and specialty characteristics, and qualifications of medical technicians. Similarly, Category A items are fully covered by reimbursement, while Category B items require the individual to pay part of the cost up front, and the rest of the cost is covered by reimbursement.
In addition, the diagnostic and treatment items are divided into full-coverage items, that is, all of them are included in the overall payment; partial-coverage items, which require individuals to pay a certain percentage before being included in the overall coverage, for example, in some provinces and cities, the cost of the CT examination, the individual has to pay 20% of the remaining costs before being included in the overall payment; and out-of-coverage items, which are completely at the expense of the individual. The catalog of diagnostic and therapeutic items is the same as the catalog of medicines, it is not static, and will certainly be adjusted in the direction of being more and more favorable to the people. Those that are now "out-of-scope" may be adjusted to "partially co-ordinated", and those that are now "partially co-ordinated" may be adjusted to "fully co-ordinated" in the future. The current "partial co-ordination" may also be adjusted to "full co-ordination" in the future.
At present, among the out-of-scope items, the following items are explicitly excluded from the scope of benefits of the Basic Medical Insurance Fund, such as: computerized appointment registration fee, initial consultation fee for case construction, and casebook fee under the item of "registration fee"; "medical examination fee"; "medical examination fee"; "medical examination fee"; and "medical examination fee". Imaging, laboratory and special examination fees under the "Physical Examination Fee" item; Disposable supplies under the "Bed Fee" item; Nursing care fees under the "Nursing Care Fee" item Drugs, special consumable materials, and special instruments under the "Nursing care" item; monitoring instruments under the "Monitoring fee" item; and laboratory tests and special examinations under the "First aid fee" item, treatment, medication, blood transfusion, etc.
China's social medical insurance is the "most basic" medical insurance
In addition to the above two major catalogs, the third major catalog is the "Medical Service Facilities Catalog", which refers to the standard catalog of medical service facilities and environments that are selected, necessary, and appropriate for treatment. The third catalog is the "Medical Service Facilities Catalog", which refers to the standard catalog of medical service facilities and environments that are necessary and appropriate for treatment. The insurance coverage for medical service facilities is provided by the designated hospitals, and mainly includes inpatient hospital beds and outpatient emergency beds. Different provinces and cities have different payment scopes. Those within the scope are reimbursed in accordance with the standard; those exceeding the standard are paid out of pocket. At present, it is clear that the "basic medical insurance fund" does not pay for the medical service facility costs mainly include: consultation (referral) transportation fees, emergency ambulance fees; air-conditioning fees, television fees, telephone fees, baby warming box fees, food warming box fees, electric stoves, refrigerators, damage to public property compensation fees; escort fees, nursing fees, cleaning fees, outpatient decoction fees, meals; recreation and entertainment costs, and the cost of the hospital. Meals, recreational activities, and other special living services.
Legal basis
Notice of the Ministry of Labor and Social Security, the State Development Planning Commission and the State Economic and Trade Commission on the issuance of the Interim Measures for the Management of the Scope of Medicines Used in the Basic Medical Insurance for Urban Employees Article 8: Expenses incurred by the participants of the basic medical insurance for the use of medicines in the Medicines Catalogue are paid according to the following principles. Article 8 Expenses incurred for the use of drugs in the "Class A Catalog" shall be paid in accordance with the provisions of the basic medical insurance. Expenses incurred for the use of drugs in the "Class B List" will be paid by the insured person at a certain percentage of his/her own expense, and then paid in accordance with the provisions of the basic medical insurance. The specific proportion of out-of-pocket payment by individuals shall be stipulated by the coordinating area and reported to the labor security administrative departments of provinces, autonomous regions and municipalities directly under the central government for the record. The costs incurred in the use of traditional Chinese medicine tablets, in addition to the basic medical insurance fund does not pay for drugs, are paid in accordance with the provisions of the basic medical insurance.