Shanghai’s healthcare security administration has announced a comprehensive set of measures aimed at enhancing community healthcare service capabilities. These initiatives include an appropriate increase in the outpatient and emergency clinic reimbursement ratio in primary medical institutions, aligning with the city’s commitment to improving access to healthcare services for its residents.
Reimbursement Ratios and Drug Policies
The National Reimbursement Drug List (NRDL) Category B drugs used in primary medical institutions will now be reimbursed in a manner similar to Category A drugs. This change is expected to ease the financial burden on patients seeking treatment in community healthcare settings. Volume-based procurement (VBP) drugs will continue to follow existing payment policies, ensuring a consistent approach to drug reimbursement.
Outpatient Coordinated Services and Reimbursement Expansion
As of July 1, 2023, NRDL designated pharmacies have begun providing outpatient coordinated services. Insured individuals who purchase NRDL drugs from these pharmacies with electronic prescriptions from community health service centers will be included in the outpatient reimbursement scope. This move is designed to expand the channels for patient dispensing and ensure that patients receive the same level of outpatient treatment as they would at prescribing medical institutions.
Optimizing Drug Supply and Enhancing Connectivity
Additional measures include improving the allocation of community drugs, regular adjustments to the drug supply directory, and strengthening the connection between community drug use and the drug directories of second and third-level hospitals. Collaborative efforts will be made to enhance service measures such as medical insurance electronic prescriptions, extended prescriptions, and long-term prescriptions, aiming for consistency in the drug use directory for common diseases across medical institutions within the region.
Support for Internet Hospitals and Online Services
The measures also support the inclusion of internet hospitals established by grassroots medical institutions in the designated scope of medical insurance. This encouragement is aimed at facilitating online follow-up services for common and chronic diseases, leveraging technology to improve patient care and accessibility.
Budget Allocation and Service Volume Increase
The total budget of medical insurance is set to continue favoring grassroots medical institutions, with a focus on considering factors such as the increase in service volume due to medical treatment tickling down and chronic disease management. This budget allocation reflects the administration’s commitment to supporting community healthcare and ensuring the sustainability of these services.-Fineline Info & Tech
