"Countdown" to the reform of medical insurance accounts in many places!

　　The reform of medical insurance personal accounts is being further accelerated, and the out-of-hospital market of the pharmaceutical industry is ushering in major changes
.
A few days ago, the Beijing Municipal Medical Security Bureau issued the "Notice on Adjusting the Basic Medical Insurance Policy for Urban Employee in the City" to clarify that from September 1 this year, all basic medical insurance premiums paid by on-the-job employees will be included in their personal accounts.
The basic medical insurance premiums paid by the employer are all included in the overall fund
.
From the perspective of people in the pharmaceutical industry, the payment part of the medical insurance account unit is no longer included in the personal account, and all is included in the overall fund, which may mean that the funds in the personal account of the employee's medical insurance will shrink significantly.
Has the cost decreased?" The market has been deeply concerned about this
.
In fact, since the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Assistance Mechanism of Employee Basic Medical Insurance" (hereinafter referred to as the "Guiding Opinions") in April last year, the exploration of the reform of the employee medical insurance personal account system in various provinces and cities across the country is being carried out one after another.
, the pharmaceutical industry has always paid great attention to the policy trend of "reform of individual accounts"
.
According to incomplete statistics, in addition to Beijing, most provinces and cities such as Hebei, Anhui, Tianjin, and Sichuan have issued relevant policies on the outpatient mutual aid guarantee mechanism, and have clarified the implementation time of the improved personal account crediting method
.
The general trend of medical insurance reform is irreversible, and a wave sweeping the pharmacy industry is accelerating
.
The "3-year transition period" has been established in many provinces and cities since 1998.
The employee medical insurance adopts a security model that combines social pooling and personal accounts
.
Generally speaking, the overall fund covers inpatient and outpatient major illnesses, and the personal account covers the expenses for outpatient minor illnesses and medicines
.
According to the National Medical Insurance Bureau, as of the end of 2021, the national basic medical insurance fund has accumulated 3.
6 trillion yuan, of which the employee medical insurance personal account has accumulated 1.
1 trillion yuan.

.
With the development of the social economy and the increase in medical needs, the limitations of personal accounts, which account for nearly 1/3 of the medical insurance fund, have gradually become prominent, mainly due to insufficient security functions, insufficient mutual aid, and insignificant effect on reducing the burden
.
The core of the reform of the "Guiding Opinions" is the transformation from the original personal accumulation guarantee mode regarding outpatient medical expenses to the mutual fund guarantee mode
.
It is clear that it is necessary to establish and improve the mutual aid guarantee mechanism for employee medical insurance outpatient clinics, and to improve the method for recording individual accounts, and requires all provincial people's governments to issue implementation plans and set up a transition period of about 3 years
.
From the perspective of the industry, the content of the outpatient mutual aid reform is summarized as the realization of functional transformation through "one liter and one drop", that is, improving the method of calculating the employee medical insurance personal account, reducing the allocation of individual accounts, and simultaneously improving the employee medical insurance outpatient mutual aid guarantee mechanism.
Employee medical insurance outpatient mutual assistance level
.
As for the implementation time of the improved personal account crediting method, many provinces and cities have made it clear: Hebei, Anhui, Tianjin and other places have been implemented from January 1, 2022; Sichuan will be implemented from February 1, 2022; Guizhou, Beijing It will be implemented from September 1, 2022; Jiangsu, Gansu, Fujian, Guangxi, etc.
will be implemented from January 1, 2023; Shandong stipulates that the part of the pooled fund will be reduced to 50% of the current standard by the end of 2022, and by 2024 It will no longer be included in January of this year; Fujian stipulates that from March 2022, the proportion of basic medical insurance premiums paid by units in personal accounts will be halved on the existing basis, and basic medical insurance premiums paid by units before the end of 2023 will no longer be included in the account.
personal account
.
Jilin requires that by the end of 2022, all coordinating regions will issue detailed implementation rules for establishing and improving the mutual aid mechanism for employee medical insurance outpatient clinics, and by the end of 2023, all coordinating regions should implement the reform goals and tasks
.
This year, the General Office of the State Council issued the "Key Tasks for Deepening the Reform of the Medical and Health System in 2022", once again clarifying the reform goals in the field of medical insurance this year
.
The National Medical Insurance Bureau and other departments will also guide all localities to promote the overall planning of general outpatient medical insurance for employees, implement a differentiated payment policy for medical treatment in grass-roots medical and health institutions, and gradually include the general outpatient expenses for frequently-occurring and common diseases into the scope of payment of the overall fund
.
The market view believes that all these series of reforms are to make medical insurance better play the function of insuring serious illnesses, improve the efficiency of fund use, and allow medical insurance funds to focus on serving groups in real need; the next step is the direction of outpatient mutual aid reform.
It is to further increase the reimbursement ratio and lower the reimbursement threshold
.
Now that the medical needs of ordinary people are getting higher and higher, and the medical insurance rate is capped, it is of course lack of money to meet the growing demand with limited funds
.
Because of this, the efficiency of the use of medical insurance funds needs to be improved, so it is necessary to reform the reasonable arrangement of medical insurance accounts and payment methods
.
It also recommends the development of a progressive reform program
.
While establishing an outpatient mutual aid security mechanism and improving the level of cost-sharing for chronic diseases, we will do a good job in performance evaluation, so that employees can see the benefits of insured patients, so as to support the reform
.
Account shrinking? The “2021 Statistical Bulletin on the Development of National Medical Insurance Business” shows that the total medical expenses of employees covered by medical insurance in 2021 will be 1,499.
737 billion yuan, an increase of 12.
2% over the previous year, of which medical institutions have incurred 1,293.
645 billion yuan in personal accounts.
206.
092 billion yuan was spent in pharmacies
.
According to industry data, the sales volume of the national pharmacy retail market in 2021 will be 491.
6 billion yuan, and medical insurance will account for about 42% of retail revenue
.
With the implementation of the reform of medical insurance accounts, the development ecology of the industry has been quietly changed
.
"The reform will affect the way personal accounts are used, change personal drug buying behavior, affect the spending structure of personal accounts, and then affect the sales volume of retail pharmacies
.
"From the perspective of the industry, after the reform of the medical insurance account, the disposable funds of the insured personnel to purchase drugs in the pharmacy will decrease, and coupled with the mentality of "cherishing money", they will be more cautious in purchasing drugs.
The advantage is to reduce the personal medical insurance card.
" "Abusing" and "indiscriminate" behaviors, coupled with increased supervision, will effectively curb the "indiscriminate brushing" of medical insurance cards in retail pharmacies
.
A person in charge of a chain pharmacy analyzed that the reform of medical insurance accounts has three impacts on pharmacies: 1.
One is that the scale of account accumulation is reduced, and the resources for self-purchasing medicines are reduced, and the sales of pharmacies may shrink accordingly; the other is that the scope of personal account expenditure is limited, especially in some regions, the price of drugs in the pharmacy medical insurance catalogue is required to be consistent with the price of centralized procurement, and the country has expanded For the centralized procurement of large-volume drugs and high-value consumables, the sales of drugs in the designated pharmacies’ medical insurance catalogues will be affected; third, self-medication people “countercurrent” to the outpatient clinics to purchase medicines, and the customer base of designated pharmacies will decrease
.
It will have an impact of about 10% on the pharmacy's revenue, and the net profit may lose about 3%
.
"Actually, for larger chains, the impact is bearable, but the financial strength is not strong, or Small and medium-sized chains with a single business model have a great impact, but this is also conducive to accelerating industry consolidation
.
The person in charge of the above-mentioned chain pharmacy said
.
"Poverty is the desire to change", and the upgrading and transformation of the industry is an inevitable trend
.
All walks of life have basically reached a consensus on the general trend of medical insurance personal accounts shifting to outpatient co-ordination, and for retail terminals, it is expected that the outflow of prescriptions will actually be implemented.
, centering on hospital outpatient clinics, establishing DTP pharmacies to undertake the prescription drug market has become one of the important coping strategies
.
In fact, in the face of the prescription drug market opportunities brought by "dual channels", pharmaceutical companies , traditional retail chain pharmacies and "Internet + medicine" The company is rapidly expanding its DTP business layout, among which are not only large chain enterprises such as Common People, Yifeng, Dashenlin, Yixintang, Shuyu Civilian, and Jianzhijia, but also Shanghai Pharmaceuticals, China Resources Pharmaceuticals, Sinopharm Accord, and Liuyao.
Group, Luyan Pharmaceutical and other pharmaceutical companies, as well as "online + offline" platform companies such as Ali Health and JD Health
.
Small and medium-sized retail pharmacies need to take advantage of convenience, and the key is to "stick" to community residents
.
After the reform of medical insurance, incumbents can use their personal accounts to pay for the out-of-pocket part of medical insurance for their parents, which can boost the sales of drugs for chronic diseases in pharmacies
.
For such pharmacies, convenience is an advantage, professionalism is a shortcoming, and communityization is a trend.
Community-oriented chronic and special disease patients, elderly and elderly groups and other more market segments, from the "point-to-point" approach that welcomes customers Connecting "point-to-point" and "face-to-point" between pharmaceutical companies , hospitals
and patients and customers .
Explore the expansion of personal accounts to purchase chronic and special disease medicines outside the catalog in pharmacies , so as to improve the security and sense of gain of chronic and special disease patients .
Many provinces and cities in the "3-year transition period" of medicine have made it clear that the landing time and the account have shrunk? Medical Insurance Reform Compresses Retail Markets Enterprises Hospitals Pharmacies Drugs