The National Healthcare Security Administration (NHSA) and the Ministry of Finance (MOF) have issued two key notices aimed at enhancing the healthcare system in China. The first, ‘Notice on Further Strengthening the Management Service of Direct Settlement for Medical Treatment Incurred in Other Regions,’ outlines several measures to improve the direct settlement process for medical services received outside of a patient’s home region.
The notice emphasizes the need to strengthen the management of medical record filing for treatments outside the home region, with a ‘filing first, settlement later’ principle. It also calls for a reasonable determination of settlement and reimbursement policies, taking into account the fund balance and medical demand. The payment ratio for cross-provincial referrals and emergencies is to be reduced by 10 percentage points, while for non-emergency, non-referred temporary out-of-province treatments, it is reduced by 20 percentage points.
Additionally, the notice highlights the importance of managing medical treatment locations, with a focus on daily audits, cost investigation, and the inclusion of remote medical expenses in DRG/DIP management. It also calls for optimizing direct settlement services and strengthening monitoring and supervision mechanisms for medical treatment funds.
The second notice, ‘Notice on Steadily and Orderly Expanding the Scope of Outpatient Chronic and Special Diseases for Direct Settlement across Provinces,’ reports that as of August 2024, China has 69,000 designated medical institutions for outpatient chronic and special diseases, ensuring coverage in every county. This has benefited 8.9188 million people and reduced advance payments by RMB 9.078 billion. The notice sets goals to expand the number of outpatient chronic diseases eligible for direct settlement across provinces from 5 to 10 by the end of 2024.
These notices reflect China’s ongoing efforts to streamline healthcare services, improve accessibility, and enhance the efficiency of medical fund management. – Flcube.com
