July 2024
The National Healthcare Security Administration Has Issued a Notice on Further Promoting the Experience of Medical Reform in Sanming City to Continuously Promote the Innovative Development of Medical Insurance (Mainland China)
July 2024
Yanting Pei and Teresa Huang
On May 20, 2024, the National Healthcare Security Administration (hereinafter referred to as the NHSA) issued a notice titled "Medical Insurance Letter [2024] No. 25", which introduced new requirements to enhance the medical reform experience in Sanming City, Fujian Province. The notice mainly includes the following:
I. Point out the core spirit of medical reform
The notice mentions that "The experience of the medical reform in Sanming City is a vivid practice of primary-level Party committees, governments, and relevant departments continuously guaranteeing and improving people's livelihood and promoting people's well-being by persistently adhering to the people-centered philosophy of development. It is imperative to bear in mind the fundamental purpose, adhere to the commitment to the original aspiration, and constantly strive to realize, safeguard, and advance the fundamental interests of all our people so that the insured people can benefit more from the achievements of development in a fair way." It also points out that "The experience of the medical reform in Sanming City is a realistic achievement made by primary-level Party committees, governments, and relevant departments of persistently promoting the coordinated development and governance of medical insurance, medical services, and medicine (hereinafter collectively referred to as "Three Medicals")." From this, it can also be seen that the core of this medical reform is still to improve the medical insurance system and promote the reform of the medical and health system by improving the medical insurance system, while allowing the people to enjoy higher quality medical security.
II. Clarify the key tasks of the current medical reform
The notice emphasizes the importance of effectively implementing the institutional achievements of the Sanming Medical Reform, leveraging the fundamental role of medical insurance in the coordinated development and governance of the "Three Medicals", and providing strong support for further deepening the reform of the medical and health system. The following key areas should be focused on:
A. Accelerate the progress of reforming centralized procurement of pharmaceutical consumables
The notice points out that it is hoped to establish a new centralized procurement model with targeted expansion of the scope of centralized procurement of drugs and medical consumables, forming a centralized procurement system for drugs and high-value medical consumables organized by the state, a national alliance led by the province, and provincial centralized procurement to support the centralized procurement of drugs and high-value medical consumables. The goal is to reduce costs through centralized procurement, use the savings to invest in new drugs and treatment programs, and ultimately enable adjustments to medical service prices.
B. Increase medical insurance support for grassroots medical institutions
The notice advocates for the inclusion of eligible village clinics in designated medical insurance areas to improve medical access for rural residents. It suggests considering a closely integrated county-level medical community as a budgetary unit for medical insurance. Factors such as fund revenue and expenditure, personnel composition, historical costs, and shifts in disease patterns should be taken into account to establish a rational budget indicator for the overall medical community expenditure.
C. Focus on improving the management of medical insurance payments
The notice emphasizes the need to establish a sound and efficient medical insurance payment mechanism, expedite the adoption of a diverse and comprehensive medical insurance payment approach primarily focused on disease-specific payments, and strive to strengthen and enhance the quality and effectiveness of DRG/DIP payment method reform and comprehensive regional coverage by 2024.
D. Continuously strengthen the management of medical service prices
The notice emphasizes the full implementation of the dynamic adjustment mechanism for medical service prices. It highlights a further focus on clinical disciplines such as pediatrics, obstetrics, psychiatry, and traditional Chinese medicine, particularly on the pricing of diagnosis, nursing, emergency rescue, pathology, and other services. The notice also underscores the importance of increasing the proportion of technical labor costs in medical service pricing and reducing the prices of inspection items primarily related to equipment and material consumption.
E. Enhance the fund regulatory system and mechanisms continuously
According to the notice, fraudulent behaviors such as false diagnosis and treatment, false drug purchases, illegal reselling of medical insurance drugs, as well as problems such as embezzlement, delayed payment, and discrepancies between accounts and reality will continue to be the main targets of the crackdown.
F. Comprehensively promote the improvement and efficiency of medical insurance services
According to the notice, strengthening departmental collaboration and improving service quality and efficiency are also key tasks of the reform.
III. Propose ways and methods for medical reform
The notice mentioned that the current medical reform has entered uncharted waters, facing more complex situations and interest adjustments, various overlapping contradictions, and the accumulation of risks and hidden dangers. It encourages reformers to strengthen their confidence and bravely challenge difficulties.
In terms of reform measures, the notice points out that "It is imperative to comprehensively establish a multi-level medical and health security system. This system should have basic medical insurance as the primary component, with medical assistance as the foundation, and the collaborative development of supplementary medical insurance, charitable donations, and medical mutual aid. Additionally, it is crucial to support commercial insurance companies in creating commercial health insurance products that are connected to basic medical insurance." The notice also urges local governments to implement reforms based on their specific local conditions.
The NHSA also requires medical insurance departments at all levels to refine and improve measures and requirements to enhance the Sanming medical reform experience. This includes establishing task ledgers, tracking and monitoring progress, strengthening regular scheduling and supervision. Major reform issues should be reported according to procedures. The NHSA will closely monitor and evaluate the progress of promoting the Sanming medical reform experience in various regions.
Overall, even though the content of this notice is concise and simple, it clearly outlines the goals and directions of future medical reform. Pharmaceutical companies can use this information to make appropriate judgments on market trends and adjust their development strategies accordingly.
The contents of all newsletters of Shanghai Lee, Tsai & Partners (Content) available on the webpage belong to and remain with Shanghai Lee, Tsai & Partners. All rights are reserved by Shanghai Lee, Tsai & Partners, and the Content may not be reproduced, downloaded, disseminated, published, or transferred in any form or by any means, except with the prior permission of Shanghai Lee, Tsai & Partners.
The Content is for informational purposes only and is not offered as legal or professional advice on any particular issue or case. The Content may not reflect the most current legal and regulatory developments. Shanghai Lee, Tsai & Partners and the editors do not guarantee the accuracy of the Content and expressly disclaim any and all liability to any person in respect of the consequences of anything done or permitted to be done or omitted to be done wholly or partly in reliance upon the whole or any part of the Content. The contributing authors' opinions do not represent the position of Shanghai Lee, Tsai & Partners. If the reader has any suggestions or questions, please do not hesitate to contact Shanghai Lee, Tsai & Partners.
Yanting Pei and Teresa Huang
On May 20, 2024, the National Healthcare Security Administration (hereinafter referred to as the NHSA) issued a notice titled "Medical Insurance Letter [2024] No. 25", which introduced new requirements to enhance the medical reform experience in Sanming City, Fujian Province. The notice mainly includes the following:
I. Point out the core spirit of medical reform
The notice mentions that "The experience of the medical reform in Sanming City is a vivid practice of primary-level Party committees, governments, and relevant departments continuously guaranteeing and improving people's livelihood and promoting people's well-being by persistently adhering to the people-centered philosophy of development. It is imperative to bear in mind the fundamental purpose, adhere to the commitment to the original aspiration, and constantly strive to realize, safeguard, and advance the fundamental interests of all our people so that the insured people can benefit more from the achievements of development in a fair way." It also points out that "The experience of the medical reform in Sanming City is a realistic achievement made by primary-level Party committees, governments, and relevant departments of persistently promoting the coordinated development and governance of medical insurance, medical services, and medicine (hereinafter collectively referred to as "Three Medicals")." From this, it can also be seen that the core of this medical reform is still to improve the medical insurance system and promote the reform of the medical and health system by improving the medical insurance system, while allowing the people to enjoy higher quality medical security.
II. Clarify the key tasks of the current medical reform
The notice emphasizes the importance of effectively implementing the institutional achievements of the Sanming Medical Reform, leveraging the fundamental role of medical insurance in the coordinated development and governance of the "Three Medicals", and providing strong support for further deepening the reform of the medical and health system. The following key areas should be focused on:
A. Accelerate the progress of reforming centralized procurement of pharmaceutical consumables
The notice points out that it is hoped to establish a new centralized procurement model with targeted expansion of the scope of centralized procurement of drugs and medical consumables, forming a centralized procurement system for drugs and high-value medical consumables organized by the state, a national alliance led by the province, and provincial centralized procurement to support the centralized procurement of drugs and high-value medical consumables. The goal is to reduce costs through centralized procurement, use the savings to invest in new drugs and treatment programs, and ultimately enable adjustments to medical service prices.
B. Increase medical insurance support for grassroots medical institutions
The notice advocates for the inclusion of eligible village clinics in designated medical insurance areas to improve medical access for rural residents. It suggests considering a closely integrated county-level medical community as a budgetary unit for medical insurance. Factors such as fund revenue and expenditure, personnel composition, historical costs, and shifts in disease patterns should be taken into account to establish a rational budget indicator for the overall medical community expenditure.
C. Focus on improving the management of medical insurance payments
The notice emphasizes the need to establish a sound and efficient medical insurance payment mechanism, expedite the adoption of a diverse and comprehensive medical insurance payment approach primarily focused on disease-specific payments, and strive to strengthen and enhance the quality and effectiveness of DRG/DIP payment method reform and comprehensive regional coverage by 2024.
D. Continuously strengthen the management of medical service prices
The notice emphasizes the full implementation of the dynamic adjustment mechanism for medical service prices. It highlights a further focus on clinical disciplines such as pediatrics, obstetrics, psychiatry, and traditional Chinese medicine, particularly on the pricing of diagnosis, nursing, emergency rescue, pathology, and other services. The notice also underscores the importance of increasing the proportion of technical labor costs in medical service pricing and reducing the prices of inspection items primarily related to equipment and material consumption.
E. Enhance the fund regulatory system and mechanisms continuously
According to the notice, fraudulent behaviors such as false diagnosis and treatment, false drug purchases, illegal reselling of medical insurance drugs, as well as problems such as embezzlement, delayed payment, and discrepancies between accounts and reality will continue to be the main targets of the crackdown.
F. Comprehensively promote the improvement and efficiency of medical insurance services
According to the notice, strengthening departmental collaboration and improving service quality and efficiency are also key tasks of the reform.
III. Propose ways and methods for medical reform
The notice mentioned that the current medical reform has entered uncharted waters, facing more complex situations and interest adjustments, various overlapping contradictions, and the accumulation of risks and hidden dangers. It encourages reformers to strengthen their confidence and bravely challenge difficulties.
In terms of reform measures, the notice points out that "It is imperative to comprehensively establish a multi-level medical and health security system. This system should have basic medical insurance as the primary component, with medical assistance as the foundation, and the collaborative development of supplementary medical insurance, charitable donations, and medical mutual aid. Additionally, it is crucial to support commercial insurance companies in creating commercial health insurance products that are connected to basic medical insurance." The notice also urges local governments to implement reforms based on their specific local conditions.
The NHSA also requires medical insurance departments at all levels to refine and improve measures and requirements to enhance the Sanming medical reform experience. This includes establishing task ledgers, tracking and monitoring progress, strengthening regular scheduling and supervision. Major reform issues should be reported according to procedures. The NHSA will closely monitor and evaluate the progress of promoting the Sanming medical reform experience in various regions.
Overall, even though the content of this notice is concise and simple, it clearly outlines the goals and directions of future medical reform. Pharmaceutical companies can use this information to make appropriate judgments on market trends and adjust their development strategies accordingly.
The contents of all newsletters of Shanghai Lee, Tsai & Partners (Content) available on the webpage belong to and remain with Shanghai Lee, Tsai & Partners. All rights are reserved by Shanghai Lee, Tsai & Partners, and the Content may not be reproduced, downloaded, disseminated, published, or transferred in any form or by any means, except with the prior permission of Shanghai Lee, Tsai & Partners.
The Content is for informational purposes only and is not offered as legal or professional advice on any particular issue or case. The Content may not reflect the most current legal and regulatory developments. Shanghai Lee, Tsai & Partners and the editors do not guarantee the accuracy of the Content and expressly disclaim any and all liability to any person in respect of the consequences of anything done or permitted to be done or omitted to be done wholly or partly in reliance upon the whole or any part of the Content. The contributing authors' opinions do not represent the position of Shanghai Lee, Tsai & Partners. If the reader has any suggestions or questions, please do not hesitate to contact Shanghai Lee, Tsai & Partners.
