By Fineline Cube The National Healthcare Security Administration (NHSA) has released the “Notice on Ensuring Basic Healthcare Security for Urban and Rural Residents in 2023,” outlining key adjustments to medical insurance funding standards and policies. The document sets the funding standard for urban and rural residents’ basic medical insurance (BMI) in 2023 at RMB 1,020, with a per capita financial assistance standard of no less than RMB 640 per person per year and an individual payment standard of RMB 380 per person per year.
Coordination of Funds and Major Illness Insurance
The notice requires the coordination of funds for residents’ medical insurance and urban and rural residents’ major illness insurance, ensuring that the level of major illness insurance benefits does not decrease. This measure aims to maintain a stable safety net for those facing significant healthcare costs.
Implementation of Medical Security Benefits List System
The document calls for the comprehensive implementation of the medical security benefits list system, consolidating the level of hospitalization benefits, and ensuring that the fund payment proportion within the policy scope remains stable at around 70%. It also emphasizes the steady improvement of outpatient service security, with a focus on strengthening outpatient drug security mechanisms, particularly for cardio cerebral vascular diseases, and enhancing the guarantee of maternity medical expenses for residents’ medical insurance.
Payment Methods and “Dual Channel” Management
In terms of medical insurance payment, the NHSA continues to improve and standardize the “dual channel” management of negotiated drugs, promoting the electronic circulation of “dual channel” prescriptions within the province. The notice also calls for the timely and dynamic adjustment of medical insurance access and the promotion of payment method reforms, aiming to coordinate the actual payment of DRG/DIP in 70% of regions by the end of the year.
Volume-Based Procurement and Price Management
The government will continue to expand the volume-based procurement (VBP) coverage of drugs and consumables, improve the functions of the VBP platform, and promote the implementation of national drug price monitoring. The document also outlines plans to conduct evaluations of pharmaceutical prices and bidding credit, as well as pilot evaluations of medical service price reform.
Expanding Insurance Coverage and Strengthening Management
Finally, the document sets forth requirements for promoting the expansion of insurance coverage, strengthening fund supervision and performance management, and improving the level of handling and management services, ensuring that the healthcare security system remains robust and accessible to all residents.-Fineline Info & Tech