By Fineline Cube The National Healthcare Security Administration (NHSA) has released its annual statistical report for 2022, detailing the financial performance of the Basic Medical Insurance (BMI) fund. Over the 12-month period, the BMI fund generated RMB 3.09 trillion (USD 430 billion) in income, marking a 7.6% year-on-year (YOY) increase, while outgoing expenditure reached RMB 2.46 trillion (USD 340 billion), up 2.3% YOY.
Medical Insurance Payment Status in 2022
In 2022, the NHSA funded 2.104 billion person visits under the employee-focused scheme, an increase of 3.1% YOY. This included 1.76 billion visits to regular outpatient and emergency departments, up 2.3% YOY. A total of 280 million outpatient visits were related to chronic or special diseases, an 8.3% YOY increase. Additionally, 60 million inpatients received reimbursement, up 6.4% YOY. Reimbursement was paid for 275 negotiation drugs in relation to 180 million people during the period. Negotiated price reductions resulted in over RMB 210 billion (USD 29.2 billion) in savings for patients throughout the year.
DRG/DIP Implementation Progress
By the end of 2022, 30 diagnosis-related group (DRG) pilot cities and 71 diagnosis-intervention packet (DIP) pilot cities had been successfully implemented. The goal of achieving 40% coverage for the new DRG/DIP system within three years has been met, with 206 coordinated areas implementing DRG/DIP live payments.
Drug Procurement Overview
In 2022, the total amount of orders collected through the provincial volume-based procurement (VBP) platform nationwide was RMB 1,085.6 billion, an increase of RMB 51.6 billion compared to 2021. Western medicines accounted for RMB 881 billion of that total, while traditional Chinese patent medicines and preparations accounted for RMB 204.6 billion and RMB 2.1 billion, respectively. National Reimbursement Drug List (NRDL) drugs made up RMB 928.6 billion, accounting for 85.5% of the total amount of online procurement orders.
Fund Security and Flying Inspections
In 2022, the NHSA organized 24 flying inspections and conducted inspections at 48 designated medical institutions and 23 medical insurance agencies across 23 provinces. Suspected irregular use of funding amounting to RMB 980 million was discovered. Among the inspected pharmaceutical institutions, RMB 13.87 billion was recovered through agreement processing, with RMB 11.60 billion refused or recovered, and RMB 1.89 billion in penalty charges issued. The refusal or recovery of funds involved 142,000 designated pharmaceutical institutions.
Long-Term Care Insurance Pilot Program
In 2022, a total of 169.902 million people participated in long-term care insurance in 49 pilot cities, and 1.208 million people enjoyed benefits. The fund revenue was RMB 24.08 billion, and fund expenditure was RMB 10.44 billion. There were 7,679 designated service institutions for long-term care insurance, with 331,000 nursing service personnel.-Fineline Info & Tech