** High reimbursement rate becomes a trend

Since Qinghai Province took the lead in implementing the “Guiding Opinions on Conducting Major and Serious Disease Insurance for Urban and Rural Residents” in December 2012, more than 500 patients with major diseases have reported medical expenses. Recently, Shaanxi, Fujian, Zhejiang, and Jilin provinces have also issued their respective regulations. Critical illness insurance program.

According to reports from yesterday (February 17), nine provinces including Qinghai, Fujian, and Shandong Province have already promoted the implementation of the disease-prevention medical insurance program in the entire province (district), and other provinces are planning to implement it after the trial.

Through investigation, it has been found that the proportion of reimbursement for major illness medical insurance is higher than the national limit of 50%. There is no reimbursement limit in most regions, and the proportion of reimbursement in some regions even exceeds 90%.

Experts in the industry have stated that increasing the proportion of reimbursement for major illness medical insurance will, to a certain extent, boost the patient's medical behavior and will play a catalytic role in the development of the pharmaceutical industry.

There are no reimbursement limits

As to whether or not the reimbursement amount for major illness medical insurance is capped, Guo Guozhu, director of the Institute of Rural Insurance at the Capital University of Economics and Finance, said in an interview: “The level of reimbursement in each locality is related to the accumulation of its (medical insurance) fund. Places are not the same. Within the limits of funds, localities may not have a ceiling."

The guidelines issued by the National Development and Reform Commission, the Ministry of Health, and the Ministry of Finance suggest that the policy of serious illness insurance compensation should be reasonably determined and that the actual payment rate should not be less than 50%; the proportion of payment should be set according to the level of medical expenses, and the higher the medical cost in principle. The higher the payment rate.

In October last year, the General Office of the People's Government of Shandong Province issued the “Opinions on the Implementation of the Medical Insurance for Major Diseases of the New Rural Cooperative Medical System (Trial)”, requesting that the first purchase of commercial insurance services among the new rural cooperative medical insurance partners be carried out for 20 major categories. The compensation for the high compliant medical expenses incurred by the patients participating in the hospitalization will be compensated. The maximum annual compensation limit for an individual is 200,000 yuan.

Compared with the practice of setting a reimbursement ceiling in Shandong Province, most provinces such as Qinghai, Fujian, and Zhejiang have no restrictions on reimbursement caps, so as to help patients insured to reduce the burden of serious illness. Zhai Guozhu told reporters that there are many regions where the balance of health insurance in China is not enough, and it is not enough. According to this, most areas will not set a reimbursement limit.

Reimbursement up to 90%

According to the above guidelines, the actual payment rate for major illness medical insurance reimbursement is not less than 50%. However, from the point of view of the security documents already issued by the press, the actual reimbursement ratio is higher than 50%, and even more than 90% in some areas. According to Kuang Guozhu, 90% of the reimbursement rates should be considered relatively high, and the high reimbursement ratio will become a trend.

At present, China has adopted the system of superimposing reimbursement or superposition payment for major illness insurance. Whether it is the urban residents' medical insurance or the new rural cooperative medical system, the universal hospitalization reimbursement standard within the system has reached about 70%, and at least 70% of the above is reported at least again. 50% compliance expenses.

Under the framework of the overall reimbursement ratio, each province has a detailed request for reimbursement. For example, in Qinghai, after the reimbursement of basic medical insurance and major illness insurance, the actual reimbursement ratio of medical expenses for serious illness patients in urban and rural residents reached 80% to 90%. The three guarantee lines implemented in Qinghai Province are routine safeguards, that is, regular reimbursement according to the policies of the New Rural Cooperatives and Urban Residents Medical Insurance Coordinating Hospital Fund; the second is serious illness protection, and 80 percent of the compliance medical expenses for the deduction threshold of more than 5,000 yuan. The percentage of reimbursement for the second reimbursement; three for medical assistance, that is, after the reimbursement through the above two channels, belonging to the object of civil aid, reimbursement according to the medical assistance policy, so that the actual reimbursement of medical expenses of the object of relief ratio of more than 90%.

Civil assistance, social assistance, etc. also play a huge role in reimbursement of medical expenses. As stipulated by the Fujian Provincial Government, for the 20 specific diseases such as uremia and childhood leukemia, the basic medical insurance + major illness insurance + medical assistance approach is adopted, and the actual payment ratio for the civil assistance target compliance medical expenses is not less than 90%. In addition, after the provincial Red Cross Society reimbursed compensation for the new rural cooperative medical system, urban medical insurance, commercial insurance, and civil assistance, it provided another relief to those who were overburdened with medical expenses and were in financial difficulties.

The pharmaceutical industry welcomes good

An insider of the Ministry of Health stated that, from a national perspective, the poor people who participated in the new rural cooperative medical system were able to reimburse 90% or more of the reimbursement rate for medical treatment due to major diseases. The highest reimbursement rate was 70% for the new rural cooperative medical system. 20%.

New rural cooperative medical insurance and urban residents' serious illness guarantees will surely increase the demand for China's pharmaceutical market to some extent. Zang Guozhu believes that the implementation of the reimbursement for serious illnesses and medical insurance will cause the medical expenses in the entire market to increase exponentially, which will have a certain role in promoting the development of the pharmaceutical industry.

At present, China's medical expenses are relatively high, and the phenomenon of severe illness leading to poverty and severe illness returning to poverty occurs from time to time. In order to avoid medical expenses as much as possible, many people even resort to medical treatment and illnesses. However, after implementing a high-level reimbursement policy, this phenomenon will obviously change. Zhai Guozhu said that in the past when medical insurance was implemented in Taiwan, China had experienced major illnesses that could not be hospitalized without being hospitalized. However, after adjusting for related policies, it is now competing to go to hospital.

However, the director of the School of Insurance of Central University of Finance and Economics, Hao Yansu, put forward a different view. He believed that the expenses for reimbursement of major illnesses were mainly expenditures on medical technology services such as surgery, which had limited impact on the pharmaceutical market.