Treatment of medical treatment guarantee listing management system a few big attraction

by:Celecare     2020-07-10
On July 31, the national health insurance bureau ( Hereinafter referred to as the national health insurance bureau) Released on establishing the management system of the treatment of medical treatment guarantee listing ( Draft) 》( Hereinafter referred to as the 'draft') , cause the extensive concern in the industry. 'Draft' in their quest to establish a list of medical treatment, can be seen as a positive list, in other words, the list was not included in the item can't perform. 'Draft' detailed list in the attachment list of the contents, the author found that the following aspects worth focusing on. One, the low level, the general principle of full cover the same again 'draft' reflected the general principles of health care system in China is low, full coverage, the basic medical insurance system, serious illness insurance, include within the scope of the medical assistance system, and formulate normative standards, will be in charge of by several ministries and commissions before work to the national health insurance bureau unified management, is conducive to unity in the execution. Across the region differentiation, be permitted to exist as we know, economic development level, different health care funding level. In Shanghai, for example, ginseng protect a worker to be able to use its medical insurance personal account balance of the money to buy commercial medical insurance, and other places are not necessarily so. 'Draft' in the basic pay pay policy section, around adjust measures to local conditions, within the scope of the provisions of the state for inpatient and outpatient fu biao, payment proportion and highest pay limitation. The author thinks that the rule is quite reasonable - - - - - - Around the medical insurance payment standard, medical level, demand different patients, the provinces ( Autonomous regions and municipalities) Appropriate adjustments can be made within the scope of the state allows. Yangtze river delta, the pearl river delta, bohai sea region compared with the western part of the underdeveloped areas, some items of payment should be different. Third, special fund is special account mesoscopic file contents, the author thinks that should according to the present in some areas of insurance fraud, embezzlement or abuse, and so on and so forth for the supervision and the stem, insurance funds should be special fund is special. Also need to consider is that if so file and change the whole medical security system, then the effect of the whole supply chain, and constraints on each link, need each related department to cooperate together. Four, supplementary medical security for the subsidiary medical insurance, the author thinks that, 'the draft' the content of the illness and hospitalization insurance for ginseng protect personnel to emphasis, fully embodies the huimin policy of the country. File, will also affect the developing of couplet of medical and medical advance speed. Especially the 'draft' in new clinics, outpatient service is slow, and other special payment policy, grade of for diagnosis and treatment of patients after prescription extension and slow disease strengths opened a convenient channel. Five, hope at the provincial level directory is not desirable in the future, each area must more strictly implements national health insurance directory. Previously, various areas allowed on health care in the directory b drugs have adjust right, call in and out total amount control within 15% the number of varieties. 'Draft' regulation: the national unified national basic medical insurance drug catalogue, all in strict accordance with the national basic medical insurance drug catalogue, in principle, shall not make directory on its own or with alternative ways to increase directory of drugs. This means that drug companies are hard to hope that the supplemented by provincial health insurance directory not to reach the national health insurance directory to compensate for the loss. Six, pay close attention to drug clinical usage limits for the enterprise, the importance of the related species into the national health insurance directory is self-evident, but into the national health insurance directory is not equal to the product sales picked up. Some drugs for clinical use is restricted, such as some exist in the national health insurance directory of varieties, for general diseases, the health care are not allowed to submit an expense account ( Except for inductrial injury) 。 For such drugs, companies still need to pay close attention to national health insurance directory for each variety of clinical usage restrictions. Seven, consider using various varieties of directory should pay attention to the industry, if the listing of any formal and national WeiJianWei previously released a new version of the catalog of national essential drugs 'recommended list first to encourage generics directory' and other documents from, medical institutions should be measured in terms of the use of specific varieties. If consider the factor of health care medicine total amount control, priority should be given to the use of health care in the directory varieties; Given the need to enhance the level of clinical treatment of varieties, the national WeiJianWei directory has more guidance. The author believes that the WeiJianWei issued in the national list of essential medicines can not yet on 11 varieties according to the clinical use effect into as soon as possible, is one of concern. In addition to the drug production enterprises, medical institutions, to cope with the patients also need to consider some problems, such as third-party payment, etc. On the whole, the 'draft' of publishing and official documents in the future of all involved departments of power and responsibility, how to coordinate and the related parties play a good role, is the key to the treatment of medical security system of listing work. For the follow-up issues of the papers, the industry will continue to focus on, and to be seen.
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