Large-scale nucleic acid cannot be covered by medical insurance, who will pay for the tens of billions of tests?

Since the outbreak of the new crown, China has completed at least 15 billion nucleic acid tes.

There may be more in the futu.

Who pays for such a large-scale nucleic acid test? A public topic that concerns everyone, but no one has ever made it cle.

An article written by a brokerage macro analyst last weekend gave an explanation - "About 80% of the normalized nucleic acid costs are borne by medical insurance, and finance at all levels only needs to pay about 2

The discussion among netizens on the connection between nucleic acid testing and medical insurance reimbursement questions has also been fermenting for some time, and it is in need of a systematic explanation for the ex.

Medical insurance plus financial co-payment seems to be a reasonable explanati.

But the reversal happened so quick.

Some medical insurance experts told Eight Points Jianwen that the situation in the province is not universal, "because it has a large surplus of medical insuran.

8:00 Jianwen asked people from the medical insurance departments of many provinces and cities, and their areas are basically the same as the current medical insurance policies - only the nucleic acid costs of fever outpatients, inpatients, and new crown patients are covered, while the nucleic acid testing costs for large-scale populations is paid for by the financ.

However, some places hesitat.

Medical insurance payment normalized nucleic acid? unfounded by law

Regardless of the current medical insurance policy or the epidemic prevention and control policy, medical insurance is not the payer of large-scale nucleic acid testi.

As early as 2020, the .

The "National Medical Security Benefit List System" clearly stipulates that the expenses that should be borne by public health are not covered by medical insuran.

This is determined by the nature of basic medical insurance and the level of financi.

Medicare is a compliant reimbursement for the diagnosis and treatment of an insured person's illness to avoid or mitigate their financial ri.

In order to prevent hospital infection, routine nucleic acid screening for inpatients and fever clinics was included in the medical insurance catalog for the first time, but it was limited to th.

"Transformation" started from this year's normalized nucleic ac.

15-minute nucleic acid sampling circle, one inspection every two days, who will pay for the nucleic acid of all staff with high frequency, high density and high investment?

"Medical insurance to cure disease" and "public health disease prevention", from a legal point of view, public health expenditure in the finance is undoubtedly the first choi.

The so-called public health expenditure refers to preventive health services such as infectious disease prevention and control and chronic disease manageme.

A number of health law experts said that the new coronary pneumonia is a category B infectious disease prevention and control, vaccines and nucleic acid testing should be covered by financial expenditures, and only the diagnosis and treatment costs of individualized lesions of the insured can be borne by medical insuran.

In the face of hundreds of billions of normalized nucleic acids, public health spending is stretched th.

In 2020, China's public health expenditure is 389 billion yuan, which also includes a 160-fold increase in emergency public health emergency response fun.

In the face of the huge funding gap, some places are eyeing the "Tang monk meat" of medical insuran.

However, a number of health law experts said that this kind of practice is not complia.

Most of the medical insurance funds are self-raised by the insured, and they should be earmarked for their own use, and must not be embezzled, misappropriated or abus.

A small number of areas with large medical insurance balances have briefly implemented the "two burdens" of finance and medical insuran.

A health law scholar told 8:00 Jianwen that local medical insurance can set its own reimbursement catalog within a limited sco.

The reason for the suspension is that the medical insurance fund is "life-saving money" and is used to screen for misuse and misappropriation of fun.

Lou Yu, a professor at the School of Civil, Commercial and Economic Law of China University of Political Science and Law, said, "In such cases, we should first consider increasing the reimbursement ratio to increase the sense of acquisition of insured patients, and should not be consumed in excessive testi.

"

In fact, this is not the first concessi.

As early as October 2020, the National Medical Insurance Administration said in response to the vaccination consultation of the National People's Congress that medical insurance has not yet been able to expand the scope of payment to non-therapeutic items such as vaccin.

Three months later, the rolling balance of the financial and medical insurance funds will jointly share the cost of vaccinati.

The number of people vaccinated is large, the total cost is high, and the public health expenditure cannot be afford.

Out of humanitarian care, medical insurance has undertaken more than 120 billion yuan of it, Lou Yu analyz.

In fact, the "Medical Security Benefit List System" also leaves an opening for emergency situations, "if it has a significant impact on economic and social development, temporary adjustments can be made through legal procedur.

" As a result, the treatment costs of new crown patients have been properly apportion.

"The majority of medical insurance, and the remaining part of financial subsidies, has always relied on the top-down decision-making process, and has not broken through the scope of medical insurance," said a medical insurance expe.

A number of experts have suggested that the use of financial money to pay should be in line with the no.

Although the public health funds in the financial budget are not enough, the local government has a part of discretion in the emergency expenditure of public health, and it will ultimately need to pass the final accounts of the National People's Congre.

If the responsibility for normalized nucleic acid is to be shared, it is necessary to establish a special fund for nucleic acid after the National People's Congress has demonstrated and approved its rationality, rather than "removing the east wall to make up for the west wal.

Financial payment is not in place, and many hospitals make advance payments on their own

In a sense, large-scale, normalized nucleic acid testing is a brand new thi.

Although most provinces and cities follow the medical insurance policy, in the face of the new development of nucleic acid testing on a scale of tens of billions of people, there is still some room for turning around at the local implementation level; huge uncertain.

In February 2022, the Shenzhen Municipal Health Commission's official public account "Shen Xiaowei" issued a document, taking "Xiao Wang", a person who should be tested as an example, to explain in detail the proportion of nucleic acid costs: the medical insurance pooling funds 90%, fiscal 1

An employee of a community health service center in a community health service center in a southern province mentioned above who asked the National Medical Insurance Bureau also told Eight Points that the cost of large-scale nucleic acid testing they bear is jointly paid by medical insurance and finan.

In January 2021, the Beijing Municipal Health and Health Commission also publicly stated that the medical insurance fund and finance will jointly pay for the testing costs of the people who "should be tested and tested", and the insured part of the "willing to test" population will be reimbursed by medical insuran.

An employee of a Beijing community health center told Eight Points Jianwen, "After this year's normalization on a large scale, it was proposed that the government should pay for .

"

However, in fact, due to the tight financial situation in various places, many medical institutions and third-party medical laboratories reported that the process of financial payment is extremely lo.

"So far this year, it has not been stated how mu.

" The director of a county hospital in the north said, "Last year, I paid some, but I didn't pay 100% of the standard pri.

They were all given at a discou.

The nucleic acid test this year has not been completed y.

Because finances are very tight everywhe.

”

He also revealed that their hospital purchased 450,000 sets of nucleic acid detection reagents, all of which were paid by the hospital itself, and the county hospital next door was owed 20 million yuan for large-scale nucleic acid cos.

"We are here for normalized nucleic acid testing that started in May, and nucleic acid points have also been established, but the reagents and funds for testing key populations last year have not yet been made up," said a doctor from another tertiary hospital in northern Chi.

In Shanghai, a practitioner told Eight Points Jianwen that up to now, in this round of Shanghai epidemic, many nucleic acid testing fees of third-party testing institutions have not yet been settled, and the relevant settlement prices have not yet been clarifi.

"Only part of the nucleic acid test of inpatients is reimbursed by medical insurance, but in fact this is a very small part, most of which are required to be test.

Originally, it was financed, but it was not paid, and we paid for the patient in advan.

This is medical treatme.

The biggest burdenon the institution," said another medical worker from the Northern Maternity Hospit.

According to Eight Points Jianwen, in the implementation of various places, no matter whether the large-scale nucleic acid cost is ultimately paid by finance or medical insurance, it will not include the labor cost of medical care, and this part will be borne by medical institutio.

In the face of the "incoming" large-scale normalized nucleic acid, the burden on medical institutions may be a more realistic problem than the "drained medical insurance pool" that netizens worry abo.