The National Healthcare Security Administration (NHSA), Ministry of Finance, National Health Commission, and Chinese Center for Disease Control and Prevention have released a Notice on “Optimizing Relevant Medical Insurance Policies for Treatment Expenses of Patients with Novel Coronavirus Infection after Implementation of ‘Class B and Class B Management’”. The guidelines outline management changes for COVID-19 medications following the recent downgrade of the condition to a Class B infectious disease.
Reimbursement and Funding Mechanisms
The Notice indicates that in-patient hospitalization expenses under the COVID-19 infection diagnosis and treatment guidelines will first be reimbursed by provincial Basic Medical Insurance (BMI) schemes, Major Disease insurance, and Medical Assistance schemes. Individual co-pays will be subsidized by the government. Local governments will initially cover all expenses, with the central government subsidizing up to 60% of the actual expenses incurred.
Grassroots Diagnosis and Treatment
The Notice emphasizes the use of tiered diagnosis and treatment, with increased medical reimbursement rates at the grassroots level. The reimbursement ratio should be at least 70% for outpatient and emergency expenses related to COVID-19 infection at all medical institutions. If these fees are incurred at non-BMI-covered medical institutions, Category B infectious disease medical insurance policies will apply. The Notice also requires the implementation of a temporary National Reimbursement Drug List (NRDL) with a temporary payment policy for all COVID-19 drugs. Provincial departments can propose temporary expansions to the NRDL due to insufficient drug supply, which can be implemented after filing with the national bureau. All related policies will be immediately effective until March 31, 2023.
Promotion of “Internet+” Medical Insurance Services
The Notice underscores the importance of providing “Internet+” medical insurance services, promoting online diagnosis and treatment. Online initial diagnosis services are encouraged, as are mobile payments for medical insurance, with reimbursement standards consistent with offline provision.
Future Outlook
The updated guidelines reflect China’s ongoing efforts to optimize medical insurance policies for COVID-19 treatment, ensuring accessible and affordable healthcare for patients. By enhancing reimbursement rates and promoting digital healthcare services, the government aims to improve patient outcomes and streamline the management of COVID-19 treatment expenses.-Fineline Info & Tech
