The "medium cure rate" is linked to medical insurance payment!

Zhejiang implements the inheritance, innovation and development of traditional Chinese medicine, which points out that the comprehensive implementation of "medium treatment rate" in all regions is linked to medical insurance payment.
medical income ratio
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Whether the "medium cure rate" will become an indicator of the allocation of proprietary Chinese medicines, we will wait and see! On January 17, the Office of Zhejiang Provincial Medical Security Bureau issued a notice on further implementing the "Implementation Opinions on Supporting the Inheritance, Innovation and Development of Traditional Chinese Medicine".
Among them, the term "moderate governance rate" was proposed, which deserves great attention from the industry! The notice pointed out that the "Implementation Opinions of the Zhejiang Provincial Medical Security Bureau on Supporting the Inheritance, Innovation and Development of Traditional Chinese Medicine" has been implemented since January 1, but some institutions have not strictly implemented it
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In order to promote the comprehensive implementation of the policy and effectively regulate the behavior of relevant designated medical institutions, relevant matters have been clarified
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The central treatment rate is linked to medical insurance payment Zhejiang's "Opinions" pointed out that in the DRG payment and settlement work in 2021, all localities should fully implement a positive incentive mechanism in which the central treatment rate of traditional Chinese medicine medical institutions is linked to medical insurance payment
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The rate of traditional Chinese medicine treatment refers to the proportion of the total income of inpatient TCM decoction pieces, TCM medical service items, and traditional Chinese medicine in TCM medical institutions in the proportion of inpatient medical income
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This means that the management of traditional Chinese medicine services has also begun to develop in the direction of quantification, and it is expected that the "medium treatment rate" will be included in the daily assessment of traditional Chinese medicine medical institutions
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On December 30, 2021, the National Medical Insurance Administration and the State Administration of Traditional Chinese Medicine jointly issued the "Guiding Opinions on Medical Insurance Supporting the Inheritance and Innovation of Traditional Chinese Medicine" (hereinafter referred to as the "Opinions").
Traditional Chinese medicine will receive strong support from medical insurance, and enjoy the particularity of the development of traditional Chinese medicine in terms of medical insurance payment scope and payment policy
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Among them, general TCM medical service items can continue to be paid by item, TCM institutions can temporarily not implement DRG payment, and TCM decoction pieces can continue to be subject to a 25% policy, which makes a large number of western medicine manufacturers who have encountered a cost control crisis envied
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And the "Implementation Opinions" of Zhejiang this time is a pioneering proposal to put forward the "medium treatment rate", which will fully implement the positive incentive mechanism linking the medium treatment rate and medical insurance payment in TCM medical institutions in various places
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With the promotion of specific policies of medical insurance, it is believed that the enthusiasm of TCM medical institutions to use TCM decoction pieces and proprietary Chinese medicines will be greatly improved, which may also reverse the situation that TCM hospitals use more Western medicines than proprietary Chinese medicines
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However, we should also see that this is the formulation of the Zhejiang Provincial Medical Insurance Bureau.
Since the daily management of TCM medical institutions rests with the TCM Administration, the latter has decisive constraints on doctors' diagnosis and treatment behavior, drug allocation and use.
assessment mechanism
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Next, the "medium treatment rate" created by Zhejiang Medical Insurance should have specific implementation rules at the medical insurance payment level, which is worthy of attention
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In addition to the "medium treatment rate", Zhejiang's "Implementation Opinions" also stipulates the addition and medical insurance payment for Chinese herbal medicine pieces, and the medical insurance payment for formula granules
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The price of Chinese herbal decoction pieces shall not exceed 25% of the sales price.
The Chinese herbal decoction pieces of designated public medical institutions shall be sold in strict accordance with the actual purchase price and shall not exceed 25% of the sales price
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The prices of TCM decoction pieces of other designated medical institutions shall be implemented in accordance with the two-set agreement
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The medical insurance payment standard is formulated in accordance with the actual purchase price plus no more than 25%
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Formula granules are included in the medical insurance payment in batches The traditional Chinese medicine formula granules are included in the medical insurance fund payment scope in batches
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For varieties that have not obtained the national Chinese medicine formula granule code, the cost can be temporarily settled according to the Chinese medicine decoction piece code
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(This will undoubtedly bring benefits to the traditional Chinese medicine formula granules!) To find out the prices of some traditional Chinese medicine pieces The notice requires local medical insurance bureaus and medical institutions to implement policies in a timely manner in accordance with the requirements of this notice
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Local medical insurance agencies should improve the relevant provisions of the two agreements in a timely manner
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The medical insurance bureaus of each district and city should conduct a thorough investigation of the prices of some Chinese medicine decoction pieces in the local municipal hospital of traditional Chinese medicine and the municipal people's hospital
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The actual purchase price is filled in according to the purchase invoice of the medical institution, and the sales price is filled in according to the settlement data of the information system of the handling institution
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Before January 20, the medical insurance bureaus of districts and cities and provincial medical institutions shall report the implementation of relevant policies, the changes in actual purchase prices, and the implementation of the policy on addition of Chinese herbal decoction pieces to the provincial bureau
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