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The national drug reimbursement for acute leukemia is 10-20%.
Medicare reimbursement for poor children with leukemia is less than 20%, and it is difficult to report on imported drugs
On May 28, the Chinese Red Cross Foundation and the Institute of Youth and Young People's Studies of the China Institute of Youth and Politics*** jointly released the "Report on Survey of Survival of Poor Children with Leukemia in China" (hereinafter referred to as the "Report"). The Report shows that medical insurance accounts for only 13.87% of the cost of treatment for children with leukemia, and that 40% of children with leukemia are unable to undergo a transplant due to poverty at a time when the cure rate is nearly 70%.
Difficulty in reimbursement for treatment in other places
Some families need to seek better treatment for their children across provinces, and the reimbursement rate for treatment in these provincial and municipal hospitals is lower, the starting line is higher, and reimbursement is not even possible.
Last July, at the launch of a leukemia relief action project initiated by a public welfare organization, the father of a non-Beijing leukemia child asked, "We can't cure our son's disease at home, and it's expensive and difficult to get reimbursed for the treatment in Beijing, so when will this problem be solved?"
No one responded at the scene.
Currently, China's new rural cooperative reimbursement standards for different places, different levels of hospitals, different types of leukemia reimbursement rates are different.
The reimbursement rate for large hospitals at the provincial and municipal levels is lower than at the county and township levels. In addition, reimbursement will only be given in cases where referrals to off-site medical institutions are made in accordance with regulations, and if you seek medical treatment directly outside the country, you need to return to the place where you are insured to complete the procedures within a specified period of time.
Chen Tao, a professor at the China Youth Politics Institute's Youth Research Institute, who is in charge of the report, pointed out that the system is designed to encourage closer access to medical care and reduce unnecessary medical expenses, which is nothing to sneeze at.
But under China's current medical conditions, municipal hospitals are the lowest level of hospitals equipped to treat leukemia, so patients can only choose municipal and provincial hospitals.
Some families even need to travel across provinces for better treatment for their children, and the reimbursement rate for treatment at these levels of care is lower, the starting line is higher, or even not reimbursable.
The report found that some parents gave up on reimbursement due to the complexity and time-consuming procedures of going back to the place of insurance, the low reimbursement rate, and the need to take care of their children.
In August 2012, six ministries and commissions, including the Development and Reform Commission, the Ministry of Health and the Ministry of Finance, jointly issued the "Guiding Opinions on Carrying Out Major Disease Insurance for Urban and Rural Residents," and local governments have issued implementation measures one after another, but there has been no significant breakthrough in the limitations on reimbursement rates for over-the-counter and off-site treatment.
"Our children in Beijing treatment, out of the province, a lot of can not be reimbursed, an operation cost more than three hundred thousand, thought at least reimbursement of more than a hundred thousand, I did not expect only less than 30,000 or 50,000." A non-Beijing children's parents said.
Starting payments are frequently deducted
Even if a child with leukemia recovers well, he or she will be hospitalized at least four times a year, which means that four 2,000 yuan, 3,000 yuan will be deducted from the reimbursement, and these deductions are enough to cover the cost of a new course of treatment.
Leukemia usually requires two to three years of treatment. Children who are treated mainly with chemotherapy will have to be hospitalized several times, from half a month or once a month at first to two or four months later, and under normal circumstances, the cost of each hospitalization for chemotherapy will not be too high.
At present, medical reimbursement in China is based on a one-time admission standard.
Taking Henan Province as an example, starting in 2012, the new rural cooperative in Henan Province launched a new policy, hospitalization one-time cost of more than 60,000 yuan, hospitalization costs within the scope of the new rural cooperative policy according to the corresponding level of medical institutions, after deducting the starting line, 80% of the proportion of the reimbursement; hospitalization one-time cost of more than 100,000 yuan, after deducting the starting line, the proportion of the reimbursement by 90%. The reimbursement rate is higher than in the past, but for patients who need to be hospitalized many times, they still can't get high compensation because each hospitalization can't reach the required standard.
Luoyang city's new rural cooperative policy stipulates that the starting line for reimbursement of hospitalization in provincial hospitals is 2,000 yuan, or 3,000 yuan if the hospitalization is across provinces.
"At present, even if the child is recovering well, he or she has to be hospitalized at least four times a year, which means that four 2,000 yuan or 3,000 yuan will be deducted from the reimbursement, and these deductions will be enough to cover the cost of a new course of treatment." Chen Tao said.
In response to this policy, Chen Tao said that although the policy has taken into account the one-time cost of major surgery, it would provide better protection if the cost of secondary treatment could be adjusted to an annual total of medical expenses.
A Guangdong parent of a child said when asked about the reimbursement rate, "Insurance provides for reimbursement after each hospitalization, and after deducting the starting money and out-of-pocket drug costs, the reimbursement comes back to a few tens of dollars, so we don't report it."
Medicare cap low imported drugs difficult to report
For children with low resistance to chemotherapy and poor blood counts, many of the drugs used are off the list. Because of the need for regular chemotherapy, the actual reimbursement rate is very low after deducting the starting line and out-of-pocket expenses.
According to the new healthcare reform policy in 2012, the reimbursement rate for children with acute lymphoblastic leukemia and acute promyelocytic leukemia has reached 70 percent, and up to 90 percent for especially poor families.
But the report shows that although the reimbursement rate has risen, the total amount of the health insurance ceiling set in most regions is still low due to economic level constraints, and the individual is still responsible for the exceeding part of the reimbursement according to the proportion within the limited amount. At present, 74.34% of the medical insurance reimbursement ceiling is between 50,000 and 100,000 yuan.
While a child with leukemia usually costs $100,000 to $300,000 for treatment over a two- to three-year treatment period, the cost of a bone marrow transplant ranges from about $300,000 to 1 million yuan. The actual medical cost for a child who completes a hematopoietic stem cell transplant averages $580,000, well above the $100,000-a-year cap.
In addition, because health insurance only reimburses for drugs in the prescribed catalog, many imported drugs are out of the catalog for children with low resistance and poor blood counts after chemotherapy. Because of the need for regular chemotherapy, the actual percentage of reimbursement is very low after deducting the starting line and out-of-pocket expenses.
The report shows that the sources of treatment costs for children with leukemia are, in order of importance, financial support from relatives and friends, family income, medical insurance and donations from foundations and caring people. Among them, medical insurance accounted for only 13.87 percent.
Liu Daihong, chief physician of the hematology research group at Beijing People's Hospital, said that today, 80 to 90 percent of leukemias can be put into remission through chemotherapy and hematopoietic stem-cell transplants, and about 60 to 70 percent of patients can be cured.
While the cure rate has been nearly 70 percent, the Report noted that only 30.81 percent of the children who needed hematopoietic stem cell transplants had completed them. Among those who did not complete the transplant, 62.59 percent of the children, or 43.3 percent of the overall number of children, were unable to afford it because of the high cost.
Policy fails to cover children aged 14 to 18
For a disease that is expensive to treat and has more than 10,000 new cases each year, charitable organizations are required to have a relatively strong source of funding, except for the Little Angel Fund, which can help thousands of children with leukemia each year, while other charitable organizations can help only hundreds or even dozens of people.
Leukemia is a malignant tumor disease with the highest incidence among children and teenagers.
According to the 2011 China Tumor Registry Annual Report, the incidence rate of leukemia among Chinese children aged 0-14 years is 3.44 per 100,000, and the incidence rate of leukemia among adolescents aged 0-19 years is 3.29 per 100,000.
Currently, China's health insurance policies include the New Rural Cooperative for the rural population, basic medical insurance for urban residents, and urban and rural medical assistance policies.
The Guiding Opinions on Carrying Out Major Disease Insurance for Urban and Rural Residents, published in 2012, included children's leukemia in the national coverage and launched a pilot program to provide assistance for chronic granulocytic leukemia, but the policy is only aimed at children under the age of 14, and there is a break in the policy for minors between the ages of 14 and 18.
To make up for the lack of policy, many social organizations have stepped into this gaping area.
The Little Angel Fund of the Chinese Red Cross Foundation provides assistance to poor children with leukemia, the New Sunshine Charity Foundation's "Leukemia Rescue Action for Teenagers Aged 0-8", the Shenhua Charity Foundation's "Shenhua Love Action "Shenhua Charity Foundation's "Shenhua Love Action", Wanda Charity Care Action and other programs have carried out special assistance for children with leukemia.
The leukemia relief program of the China Siyuan Project Foundation for Poverty Alleviation even targets poor college students who have reached adulthood but do not yet have an independent financial base for leukemia.
"Although the civil power to intervene, but for the high cost of treatment, more than 10,000 new cases of the disease each year, the requirements of charitable organizations to have a relatively strong source of funding, so in addition to the Little Angel Fund can save thousands of children with leukemia each year, other charitable organizations can only save hundreds or even dozens of people." Chen Feng said.
According to Li Xiaolin, vice president and secretary-general of the Siyuan Foundation, chronic myeloid leukemia and chronic lymphocytic leukemia have not yet been included in the scope of the government's protection for a variety of reasons, "Although charities and caring people across the country have helped families of leukemia patients in a variety of ways, their power is still limited. " Li Xiaolin said.
Government should buy services from social organizations
The government should open up the space for children's leukemia relief to social organizations through financial support and policy purchases from the central to local levels.
Aiming at the problem of high treatment costs for children with leukemia, Chen Tao said: because leukemia is a relatively special disease, with a long treatment cycle and high costs, the government has to consider a comprehensive balance when formulating policies, and if there is a tilt towards this disease, it may result in an imbalance in the policies for other diseases. Therefore, the fundamental reason for this phenomenon is that China does not yet have a substantial welfare policy specifically for the children's group.
"In many developed countries, children's groups are prioritized, and medical fairness, even if it cannot be fully achieved, can be approached with effort, and to the extent possible, children should be considered first." Chen Tao said.
And both medical policy reform and the emergence of child welfare policies will be a long-term process. Until then, Chen Tao suggests that the government open up the space for children's leukemia to social organizations, and through financial support and policy purchases from the central to local levels, "let social organizations do what the government can't do well."