One: the National Health Insurance Bureau sent a letter to the local health insurance why can not pay for the normalization of nucleic acid?
Recently, a number of places across the country's health insurance departments have received a letter copied by the National Health Insurance Bureau, which clearly put forward the use of health insurance funds to pay for the cost of nucleic acid testing of large-scale populations is not in line with the provisions of the current health insurance policy, and require the relevant areas to immediately rectify the situation. A region in the south asked the NHPA for advice on whether to use health insurance funds to pay for large-scale population nucleic acid testing, and the NHPA office replied that this practice "does not comply with the current regulations". The source said, "The NHPA approved not to use the health insurance fund to pay for the cost of large-scale population nucleic acid testing, and asked the place to immediately rectify the situation, and copied the content of the letter to the health insurance departments of 31 provinces and cities across the country".
Why can't health insurance pay for regularized nucleic acid testing? There are actually long-standing rules about who pays the bill. According to the May 2020 release of the "State Council to deal with the new coronavirus infection pneumonia epidemic joint prevention and control mechanism on doing a good job in the new coronavirus pneumonia epidemic normalization prevention and control of the guiding opinions", "should be examined as much as possible" the costs required by the local government to bear the "willingness to be examined as much as possible "
The cost is borne by local governments, and the cost is borne by enterprises, institutions or individuals.
It is reported that some provinces and municipalities will pay for the medical security bureau for "should be examined". According to the Shenzhen Municipal Bureau of Medical Protection issued a letter, such as participants belong to the "should be examined" crowd, according to the provisions of the new Coronavirus nucleic acid test in Shenzhen, the cost of the integrated fund of medical insurance and financial funds in proportion to the cost of individuals do not need to bear the cost of the individual account of the medical insurance will not be deducted.
From the legal level, Tang Jun, a researcher at the Social Policy Research Center of the Chinese Academy of Social Sciences, said that Article 28 of Chapter III of the Social Insurance Law, "Basic Medical Insurance," provides that "in line with the basic medical insurance drug directory, diagnostic and treatment items, standards of medical services and facilities, as well as emergency, rescue medical expenses shall be paid from the basic medical insurance fund in accordance with state regulations." The third paragraph in Article 30 also provides that "those that should be borne by public * * * health" are "not included in the scope of payment by the basic medical insurance fund." In fact, "large-scale population screening" falls within the scope of public health. In contrast, medical insurance has less of a commitment to government support. The use of health insurance funds must be handled with the utmost care and prudence. According to the Opinions of the Central Committee and the State Council on Deepening the Reform of the Medical Security System, it is mentioned that the use of funds for medical security funds and public health services should be coordinated, that the proportion of payments to primary health care institutions should be increased, and that the effective connection between public health services and medical services should be realized. However, such "coordination" "convergence" should be limited, mainly for the "proportion of payment for primary health care institutions", rather than arbitrarily call.
Second: the weight of health insurance can not afford: many provinces and cities in the risk of health insurance through the bottom?
The health insurance fund balance seems to be a huge amount, but it is not inexhaustible. Large-scale nucleic acid testing is costly. It is estimated that the epidemic so far nucleic acid costs about 300 billion yuan, of which, the first four months of 2022 has cost nearly 150 billion yuan.May 25, the National Health Insurance Bureau of the latest document: government-organized large-scale screening, regular testing, multi-person mixed test price is not higher than 3.5 yuan per person copy.
The price of mixed tests may not seem high, but considering the total population of each province and city, as well as the health insurance balance, not every province's health insurance balance, can afford large-scale nuclear tests. There are large disparities in health insurance balances across different provinces in China. As of the end of 2020, the cumulative balance in the east exceeded 1.4 trillion yuan, while the cumulative balance in the center was less than 0.4 trillion yuan, according to the 2021 China Health Care Statistics Yearbook compiled by the National Health Care Commission.
According to the 2020 health insurance balance of each province and city, Beijing, Shanghai, Guangdong and Sichuan have larger balances, all of which are more than 20 billion yuan, while the balances of remote areas in the west, such as Tibet and Ningxia, are smaller, with only billions of yuan. According to the standardized requirement of "testing nucleic acid every 48 hours", the balance of medical insurance of Beijing and Shanghai in the current year can support the cost of nucleic acid testing for more than 600 days. But Henan, Shandong, such a populous province, its own health insurance balance is not much, the annual per capita balance is only about 120 yuan. If you take it for nucleic acid, the balance can only support about 70 days in that year.
In other words, in these places mentioned above, the health insurance money saved through collective purchasing and price negotiation, if used to pay for large-scale nucleic acid costs, may be spent in more than two months. Is Medicare picking up some of the cost of nucleic acid testing? The answer is yes. Previously, some data have been published around the world.
● Linyi Municipal Bureau of Medical Protection previously pointed out in a working meeting, 2021, through three rounds of price adjustment, the price of nuclear inspection is significantly reduced, single person single inspection, multi-person mixed inspection of the price per person down to 40 yuan and 10 yuan respectively. Medical insurance fund to pay "should be examined" nucleic acid testing costs of more than 68 million yuan.
● Zhaoqing City, Guangdong Province, Medical Protection Bureau said in a letter, 2021 annual **** settlement of nucleic acid test object local participants 3,194,300 times, the total medical costs 124 million yuan, of which 95.15 million yuan of the amount of payment of health insurance, the payment ratio of 76.9%, participants in the foreign medical treatment of nucleic acid test health insurance payment of more than 1 million yuan.
● According to the Shanghai Municipal Bureau of Medical Protection, as of the end of August 2021, the Shanghai medical insurance has paid for more than 15 million times of new coronavirus nucleic acid and antibody testing, spending nearly 1.2 billion yuan.
Dalian also announced in early May that it would temporarily include nucleic acid testing for multiple people in mixed tests in its health insurance payments. If not for the timely issuance of the National Health Insurance Bureau called a halt, there are some provinces and cities in the health insurance balance does have the ability to pay for the cost of nucleic acid testing.
With the increasing competition in the nucleic acid testing market, some companies in order to obtain benefits, through illegal ways to shorten the testing process or take unqualified testing methods for testing. Illegal multi-tube mixing test, artificial dilution of samples and other operations can reduce the cost of the testing organization, but together with the authenticity of the nucleic acid results have been pulled down. Just on May 29, another nucleic acid testing organization Beijing Zhongtong Lambo Medical Laboratory suspected of illegal and criminal notification, the agency's legal head was seized. Chaos is repeated, this year, a number of third-party testing organizations and other problems were exposed, involving the gold quasi-medical, Runda Medical, and medical, and medical, Novel Medical, Parkstone Medical, etc..
Three: how the normalization of testing will be spread in the future, whether it will be implemented on a long-term basis nationwide ? Whether the landing details will be further adjusted, are still unknown. But what is certain is that the nucleic acid testing of this sub-track, will also be clamoring. In the short term, nucleic acid testing market will undoubtedly remain prosperous; but in the long term, the epidemic brought about by the phased dividend will gradually recede, after the tide recedes, these third-party testing organizations in the naked swimming on the exposure of these third-party testing organizations, the sustainability of the profitability of these third-party testing organizations will be a major problem, leaving nucleic acid testing companies to adjust to the window of time, may be not much time.
Legal basis:
Social Insurance Law, Chapter III, "basic medical insurance," Article 28, "in line with the basic medical insurance drug directory, diagnostic and treatment items, medical services and facilities standards and emergency, Medical expenses that meet the standards of the basic medical insurance drug list, diagnostic and treatment items, medical service facilities, and emergency treatment and rescue shall be paid out of the basic medical insurance fund in accordance with state regulations." Article 30 of the third paragraph also provides that "should be borne by the public **** health", "not included in the scope of payment of the basic medical insurance fund".