Interpretation｜What signals will the national "medical insurance bill" release in 2020?

On June 8, 2021, the National Medical Insurance Administration officially released the "Statistical Communiqué on the Development of National Medical Security Undertakings in 2020" (hereinafter referred to as the "Communiqué")
.

Reading the contents of the "Communiqué" carefully, we can clearly feel that in the face of the economic and social impact of the new crown epidemic and the adverse effects of the continued deterioration of the international economic situation, the medical insurance work is improving quality and efficiency while seeking to ensure stability.

On June 8, 2021, the National Medical Insurance Administration officially released the "Statistical Communiqué on the Development of National Medical Security Undertakings in 2020" (hereinafter referred to as the "Communiqué")

Under the background that basic medical insurance has basically achieved universal coverage, maintaining the smooth operation and continuous development of the system should be the main theme and overall tone of the current medical security work
.

Specifically, it is: to maintain the basic stability of the basic medical insurance coverage, fund revenue and expenditure, and treatment level, while actively and steadily advancing the pilot work of long-term care insurance in depth

First, the coverage of medical insurance continued to remain stable
.

Since the 18th National Congress of the Communist Party of China, the basic medical insurance participation rate has been stable at around 95%

Second, the income and expenditure of the medical insurance fund are basically balanced
.

In 2020, the total income of the national basic medical insurance fund (including maternity insurance) was 2,484.
6 billion yuan, an increase of 1.
7% over the previous year; the total expenditure of the national basic medical insurance fund (including maternity insurance) was 21,032 billion yuan, an increase of 0.

The third is that the level of treatment guarantee has risen steadily
.

In 2020, the medical expenses incurred by employees in hospitals in tertiary, secondary, primary and lower medical institutions will be paid by the basic medical insurance fund for 84.
3%, 86.
9%, and 88.

Fourth, the pilot program of long-term care insurance has been steadily advanced
.

In 2015, the Fifth Plenary Session of the 18th Central Committee of the Communist Party of China proposed for the first time “exploring the establishment of a long-term care insurance system and launching a pilot program for long-term care insurance.
” In 2016, 15 cities were selected to carry out the pilot program for long-term care insurance

2.

Reflect a "excellent" word

In 2020, medical insurance departments at all levels will forge ahead and take responsibility for coordinating epidemic prevention and control and the development of medical insurance, and continue to promote the development of medical insurance to better quality
.

First, the insurance structure is better
.

On the one hand, among the 344.
5 million people who participated in employee medical insurance, there were 254.
29 million in-service employees and 90.
26 million retired employees.
The in-service retirement ratio was 2.
82, an increase of 0.
04 from the previous year
.
As retirees do not pay, the on-the-job retirement ratio has risen slightly, which means that the burden of inter-generational medical insurance has slowed down, indicating that the structure of employee medical insurance is gradually optimizing
.

On the other hand, among the total number of people participating in the basic medical insurance for urban and rural residents, adults, elementary and middle school students and children, and college students were 750.
1 million, 246.
1 million, and 20.
56 million, respectively, an increase of -2.
5%, 4.
6%, and 1.
7% over the previous year.
%, which means that the number of adults participating in urban and rural residents decreased by 19.
233 million compared with 2019
.
In the same period, the total number of people insured increased by 7.
24 million (13.
31 million people insured in 2020-135.
407 million people insured in 2019), and the number of people insured by employee medical insurance increased by 15.
3 million, indicating that a considerable part Adults who originally participated in the medical insurance for urban and rural residents have turned to participate in the employee medical insurance with a relatively high level of benefit protection, which means that the quality of the insurance is constantly improving
.

According to the "Communiqué", in 2020, 235.
67 million people nationwide participated in maternity insurance, an increase of 10.
0% over the previous year.
The combined implementation of maternity insurance and basic medical insurance has brought about an increase in the number of insured persons and the policy effects of structural optimization
.

The second is a better financial foundation
.
In 2020, the national basic medical insurance fund (including maternity insurance) has accumulated a balance of 3.
150 billion yuan, an increase of 380.
3 billion yuan over 2019
.
Among them: the current balance of the employee medical insurance pooling fund (including maternity insurance) is 121.
4 billion yuan, and the cumulative balance (including maternity insurance) is 1,532.
7 billion yuan, a decrease of 85.
2 billion yuan and 394.
3 billion yuan respectively from 2019; the current balance of personal accounts is 165 billion yuan, The cumulative balance was 109.
6 billion yuan, an increase of 53.
4 billion yuan and 167 billion yuan respectively over 2019; the cumulative balance of urban and rural residents' medical insurance funds was 607.
7 billion yuan, an increase of 93.
4 billion yuan over 2019
.
The current balance and cumulative balance of the employee medical insurance fund have decreased compared with 2019.
This is due to the impact of the epidemic.
From February to July 2020 across the country, a phased halving of employee medical insurance unit contributions was implemented in many places across the country, and the cumulative reduction was about 164.
9 billion yuan.
The medical insurance income of employees decreased from the previous year
.
Excluding the impact of the reduction factor, the total income of the employee medical insurance fund (including maternity insurance) will increase by 9.
6% over the previous year.
Accordingly, both the current balance and the cumulative balance will show a positive growth
.
It shows that the financial foundation of basic medical insurance has been further consolidated and optimized
.

On the other hand, in 2020, the central government will invest 26 billion yuan in medical assistance subsidies, an increase of 6% over 2019, and another 4 billion yuan in subsidies will be allocated specifically to improve the medical security of the rural poor in deeply impoverished areas such as the "three districts and three states".
At the same level, 1.
5 billion yuan of special transfer payment medical assistance subsidy funds have been arranged to further consolidate the financial foundation of medical security and improve medical security capabilities
.

The third is to ensure better quality
.
In 2020, after the adjustment of the National Medical Insurance Drug List, a total of 119 new drugs were added to the list, and another 29 drugs in the original list were removed from the list.
A total of 119 drugs were successfully negotiated, and the average price was reduced by 50.
6%; three batches of nationally organized drugs were launched Centralized volume procurement involves 112 varieties, with an average price reduction of 54%; the national organization of centralized procurement of coronary stents has reduced the average price of selected stents from about 13,000 yuan to about 700 yuan
.
At the same time, DRG-paying national pilot work was carried out in 30 cities, and all 30 pilot cities passed the evaluation and assessment before the simulation operation and entered the simulation operation stage; the regional point method total budget and DIP payment pilot work were carried out in 71 cities
.
The above-mentioned series of work has enabled the value purchase of medical insurance funds to be further brought into play, and the quality of treatment protection has been further improved
.

Fourth, better service management
.
In 2020, the number of designated medical institutions for direct settlement of hospitalization expenses across provinces and other places will reach 44,413; the number of valid records on the national platform is 7.
71 million
.
In the whole year, 5.
85 million hospitalizations were hospitalized across provinces and other places for medical treatment, of which 3.
0023 million were directly settled across provinces, medical expenses were settled directly across provinces 74.
28 billion yuan, and funds paid 43.
873 billion yuan
.
In 12 pilot provinces including the Beijing-Tianjin-Hebei, the Yangtze River Delta, and the five southwestern provinces, the total direct settlement of ordinary outpatient expenses across the provinces reached 3.
02 million.
The total medical expenses were 746 million yuan, and the medical insurance fund paid 429 million yuan
.
The continuous improvement of the quality of cross-province and remote medical services ensures that more high-quality medical resources can be enjoyed by more insured people, and enhances the people's sense of medical insurance access and well-being
.

On the other hand, the ongoing special governance actions against fraudulent acquisition of medical insurance funds have further ensured the safety of medical insurance funds
.
In 2020, medical insurance departments at all levels inspected 627,000 designated medical institutions, investigated and dealt with 401,000 medical institutions that violated laws and regulations, among which 6,008 medical insurance agreements were lifted, 5457 were administrative penalties, and 286 were transferred to judicial organs; all localities dealt with violations of laws and regulations.
There were 26,100 security personnel, of which 3,162 were suspended for settlement and 2,062 were transferred to judicial organs; a total of 22.
31 billion yuan was recovered in the whole year
.

While the normalization and institutionalization of unannounced medical insurance fund supervision has achieved good results, it has further improved the quality and level of medical insurance fund supervision
.
In 2020, the National Medical Insurance Administration will organize 61 unannounced inspection teams to conduct on-site inspections in various provinces across the country.
Unannounced inspection teams will inspect 91 designated medical institutions (including integrated medical care institutions), 56 medical insurance agencies, and undertake urban and rural residents.
Forty commercial insurance companies covering medical insurance and critical illness insurance have found a total of 540 million yuan in funds suspected of violating laws and regulations
.

Three, refraction a problem

According to the data released in the "Communiqué", in 2020, the hospitalization rate of employees covered by medical insurance decreased by 2.
8 percentage points compared with 2019.
Among them, the rate of hospitalization for employees covered by medical insurance decreased by 1.
5 percentage points and that of retirees by 6.
5 percentage points; A decrease of 1.
5 percentage points
.
On the surface, it is due to the impact of the new crown epidemic that has led to a decline in the hospitalization rate of insured people
.
But from another perspective, it shows that a considerable number of insured persons are not required to be hospitalized, but before the outbreak of the epidemic, the admission standards were lowered and admitted to the hospital, which increased the hospitalization rate
.
Retirees are more likely to be admitted to hospital by lowering the admission standards due to their age, weakness, and many medical conditions.
Due to the impact of the epidemic, their decline in hospitalization rate is 5 percentage points higher than that of other insured persons, indicating that many retirees are in the hospital.
In the past, he was actually induced to be hospitalized
.

Lowering the admission standards and inducing the insured patients to be hospitalized not only lead to the suspicion of excessive medical treatment, but also lead to the inefficient use and improper loss of medical insurance funds.
Sufficient attention should be paid to the supervision of medical insurance funds in the future and active treatment should be carried out
.