I. Expand the scope of centralized banded procurement of drugs and consumables.
1. The task is clear, continue to carry out centralized banded procurement of drugs and consumables, and expand the scope of procurement, and strive for the combined number of generic names of drugs for national and local procurement in each province to exceed 350. This means that the centralized procurement of medicines will continue to expand, further squeezing the space of drug banding sales, and expanding the benefit of the people.
2. Over the past three years, the collection has entered a normalized, institutionalized stage, the state cumulative 6 batches of collection **** procurement of 234 kinds of drugs, an average of each province drug collection varieties has reached a cumulative total of 50. The National Health Insurance Bureau has also previously made it clear that the drug collection will be carried out in a comprehensive manner in three major segments: chemical drugs, proprietary Chinese medicines and biological drugs.
3. The collection not only realizes the price reduction of the purchased drugs, but also produces catfish effect on the drug market. From the drug price monitoring data carried out by the National Health Insurance Bureau, the overall price level of drugs continued to decline in the two years of 2019 and 2021, reaching an annual average of about 7%.
4. In terms of high-value medical consumables, a batch of spinal high-value medical consumables collection and procurement will be carried out at the national level in 2022. For drugs and consumables with large dosages and high procurement amounts outside of state-organized procurement, the National Health Insurance Bureau and other departments will guide provinces to implement or participate in alliance procurement to implement at least one centralized banded procurement each
2. Promote medical service price reform.
1. The price of medical services is an important livelihood price. The task is clear, the provinces before the end of June 2022 issued a document related to the establishment of a dynamic adjustment mechanism for medical service prices, before the end of the year, the price of medical services will be transferred out of the cost monitoring and price hearing catalog.
2. Previously, the National Health Insurance Bureau and other eight departments jointly issued the "deepen medical service price reform pilot program", clear through the pilot in 3 to 5 years, explore the formation of replicable and scalable medical service price reform experience. Ganzhou, Suzhou, Xiamen, Tangshan, Leshan five cities become pilot cities.
3. In 2022, the State Medical Insurance Bureau and other departments will guide localities to scientifically set up the starting conditions, trigger standards and constraints for medical service price adjustments, and carry out one price adjustment assessment during the year, and timely price adjustments will be made for those who meet the conditions.
4. The person in charge of the NHPA said that while deepening the reform of medical service prices, it will also continue to improve supporting measures to ensure the overall stability of the burden on the public. Including a good assessment of the feasibility of price adjustments, good synergy between medical service prices and payment policies, and will be part of the price adjustment into the scope of payment of medical insurance in accordance with the regulations.
Three. Implementing multiple and composite health insurance payment methods
1. In order to promote the high-quality development of health insurance, the task specifies the implementation of multiple and composite health insurance payment methods mainly based on payment for each type of disease, and to carry out the reform work of payment according to the Diagnosis-Related Grouping of Diseases (DRG) or payment according to the Disease Infection Points (DIP) in more than 40% of the coordinated areas across the country, with the health insurance fund for DRG payment or DIP payment accounting for the entire The proportion of eligible hospitalization medical insurance fund expenditures in DRG payment or DIP payment reaches 30%.
2. The implementation of a multi-faceted and composite health insurance payment method based on per-case payment will improve the efficiency of the use of the health insurance fund and reduce the personal burden of patients.Since 2019, national pilots of DRG payment in 30 cities and DIP payment in 71 cities have been launched, playing a positive role in slowing down the growth rate of medical costs and standardizing medical behavior.
3. According to the report, on the basis of the national pilots, some provinces have also selected some cities with better basic conditions to carry out the pilots, and the national pilots of DRG and DIP have exceeded 200. According to the arrangement, the relevant departments will evaluate the pilot cities that have entered the actual payment stage, and improve the payment policy based on the evaluation results.
IV. Promoting the development of a multi-level medical insurance system
1. At present, China has basically built a multi-level medical insurance system with basic medical insurance as the mainstay, medical assistance as the backbone, and supplementary medical insurance and other **** with the development of the system. in 2022, it will continue to support commercial insurance organizations to develop commercial health insurance products that are connected with basic medical insurance, so as to better cover the costs not covered by basic medical insurance.
2. In addition, the level of basic medical insurance coordination has been steadily improving, and the vast majority of provinces in China have realized municipal-level coordination, while provinces such as Beijing, Tianjin, Shanghai, Chongqing and Hainan have explored provincial-level coordination. Next, basic medical insurance provincial coordination will continue to be promoted.
3. In terms of direct settlement of cross-provincial outpatient medical treatment, the direct settlement of outpatient expenses across provinces will be further expanded, with at least one designated medical institution in each county able to provide cross-provincial direct settlement of medical expenses, including outpatient expenses.
4. The State Medical Insurance Bureau and other departments will also guide localities to promote the general outpatient coordination of employees' medical insurance, implement a differentiated payment policy for medical treatment at primary medical and healthcare institutions, and gradually incorporate general outpatient expenses for multiple and common diseases into the scope of payment by the coordinated fund.
Legal basis:
"Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers"
Article 2: The following units in cities and towns in this province and their employees must participate in basic medical insurance in accordance with these regulations:
(1) Enterprises and their employees;
(2) Organs, institutions, intermediary organizations, and social groups, private non-enterprise units and their employees;
(c) employing units belonging to the armed forces and their employees without military status.
Retirees of the above units shall be subject to these Regulations.
Article 3 establishes the basic medical insurance fund for urban employees and implements a system combining individual medical accounts (hereinafter referred to as individual accounts) and payments from the basic medical coordinating fund (hereinafter referred to as the coordinating fund). The ownership of the individual account belongs to the individual. The ownership of the integrated fund belongs to all participants in the basic medical insurance.