The National Healthcare Security Administration (NHSA) has issued a Notice seeking public feedback on draft proposals aimed at “Improving the Basic Medical Insurance Payment Management of Medical Consumables.” The proposals address the rapid development of the medical consumables industry in China and its increasing share of health expenditure, making it a significant component of the Basic Medical Insurance (BMI) system expenses for patients.
Local Healthcare Security Bureaus and Payment Disparities
According to the NHSA, medical consumables’ BMI insurance access is managed by local healthcare security (HSA) bureaus. The variations in process, payment scope, reimbursement method, and reimbursement ratio have led to significant disparities in reimbursement levels between local areas, an issue that the draft proposals aim to address.
Response to State Council’s 2019 Notice
The NHSA is responding to a State Council Notice issued in 2019, which called for a “Reform Plan for Managing High-value Medical Consumables,” among other things.
Key Points from the NHSA’s Notice
- Strengthening the Foundation of Medical Insurance Payment Management: The NHSA proposes to promote a unified classification and coding system for medical consumables, clarifying the scope of medical insurance payments products and gradually implementing a unified generic name system to establish a solid foundation for payment management.
- Enhancing Medical Insurance Access Management: Each province is expected to complete the development of a unified medical consumables medical insurance list and establish a dynamic adjustment mechanism, with the central government gradually developing a nationwide unified list.
- Improving Medical Insurance Payment Policy: The government plans to phase out extensive payment policies and explore the development of medical insurance payment standards for medical consumables, establishing a collaborative promotion mechanism with policies such as diagnosis-related group/diagnosis intervention payment (DRG/DIP) reforms.
- Organizational Implementation: Each province must establish a monitoring and evaluation mechanism for medical insurance payments related to consumables.
Introduction of Generic Names for Consumables
The introduction of “generic names” for consumables is designed to reduce the categories of consumables management based on a standardized classification, allowing products to be priced by their clinical value, and enhancing the scientific level of medical insurance payment management. Consumables already in the payment system will continue to be covered in principle.-Fineline Info & Tech
