the cost of free nucleic acid will not be deducted from the medical insurance. The hospital has recently uploaded the cost of acid testing to the national medical insurance platform for settlement, and the related expenses are borne by social security and finance, which does not involve personal payment and there is no case that the social security card is deducted. However, the cost of nucleic acid detection when the insured patient goes to see a doctor can be paid by the medical insurance fund according to the regulations.
1. why can't the national medical insurance bureau send a letter to local medical insurance to pay for normalized nucleic acid?
Recently, the medical insurance departments in many parts of the country have received a letter copied by the National Medical Insurance Bureau, which clearly stated that it is not in line with the current medical insurance policy to use the medical insurance fund to pay for the nucleic acid detection of large-scale people, and asked the relevant regions to rectify it immediately. A certain place in the south asked the National Medical Insurance Bureau whether the medical insurance fund could be used to pay for the large-scale population nucleic acid detection, and the office of the National Medical Insurance Bureau replied that this practice was "not in line with the current regulations". A related person said that "the National Medical Insurance Bureau approved that the medical insurance fund should not be used to pay for the large-scale population nucleic acid detection, requiring the place to rectify immediately, and copying the contents of the letter to the medical insurance departments of 31 provinces and cities across the country".
why can't medical insurance pay for normalized nucleic acid testing? As for who is the buyer, there are already regulations. According to the Guiding Opinions of the Joint Prevention and Control Mechanism of the State Council in Response to novel coronavirus's Pneumonia Epidemic on Doing a Good Job in the Prevention and Control of COVID-19's Epidemic Normalization issued in May 2121, the cost of "due inspection and complete inspection" shall be borne by local governments, and the cost of "willing inspection and complete inspection" shall be borne by enterprises, institutions or individuals.
It is reported that some provincial and municipal medical insurance bureaus will pay for the "due inspection". According to a document issued by Shenzhen Medical Insurance Bureau, if the insured person belongs to the "check-up and check-up" group and receives Covid-19 nucleic acid test in Shenzhen according to regulations, the expenses will be paid by the medical insurance pooling fund and financial funds in proportion, and the individual does not have to bear the expenses, and the medical insurance personal account will not be deducted.
From the legal perspective, Tang Jun, a researcher at the Social Policy Research Center of China Academy of Social Sciences, said that Article 28 of Chapter III "Basic Medical Insurance" of the Social Insurance Law stipulates that "the medical expenses that meet the standards of the drug list, diagnosis and treatment items, medical service facilities and emergency and rescue of basic medical insurance shall be paid from the basic medical insurance fund in accordance with state regulations." The third paragraph of Article 31 also stipulates that "what should be borne by public health" shall not be included in the payment scope of the basic medical insurance fund ". In fact, "mass population verification" belongs to the scope of public health. In contrast, medical insurance lacks the government's commitment to the bottom. We must be extremely cautious in the use of medical insurance funds. According to the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System, it is mentioned that the medical security fund and public health service funds should be used as a whole, and the proportion of payment to primary medical institutions should be increased to realize the effective connection between public health service and medical service. However, such "co-ordination" and "convergence" should be limited, mainly aimed at "the payment ratio of primary medical institutions", rather than arbitrarily calling.
2. The unbearable burden of medical insurance: Does medical insurance in many provinces and cities have the risk of bottoming out?
The balance of medical insurance fund seems to be huge, but it is not inexhaustible. Large-scale nucleic acid detection is costly. It is estimated that the cost of nucleic acid since the epidemic is about 311 billion yuan, of which nearly 151 billion yuan has been spent in the first four months of 2122. On May 25th, the National Medical Insurance Bureau issued the latest document: The price of multi-person mixed inspection is not higher than 3.5 yuan per person for large-scale screening and normalization inspection organized by the government.
the price of mixed inspection seems low, but considering the total population of each province and city and the balance of medical insurance in various places, not every province's medical insurance balance can afford large-scale inspection. There is a big gap in the balance of medical insurance in different provinces of China. According to the 2121 China Health Statistical Yearbook compiled by National Health Commission, by the end of 2121, the accumulated balance in the east exceeded 1.4 trillion yuan, while the accumulated balance in the middle was less than 1.4 trillion yuan.
according to the balance of medical insurance in various provinces and cities in 2121, Beijing, Shanghai, Guangdong and Sichuan have more balances, all exceeding 21 billion yuan, while remote western regions like Tibet and Ningxia have less balances, only several billion yuan. According to the normalization requirement of "testing nucleic acid every 48 hours", the current medical insurance balance in Beijing and Shanghai can support the cost of nucleic acid testing for more than 611 days. However, in populous provinces such as Henan and Shandong, there are not many medical insurance balances, and the annual per capita balance is only about 1.21 yuan. If you take it as nucleic acid, the balance of the year can only last for about 71 days.
In other words, the medical insurance money saved by centralized procurement and price negotiation in these places may be spent in more than two months if it is used to pay for large-scale nucleic acid costs. Does medical insurance bear part of the cost of verification? The answer is yes. Previously, some data had been published in various places.
● Linyi Medical Insurance Bureau pointed out at the working meeting that in 2121, through three rounds of price adjustment, the price of nuclear inspection will be greatly reduced, and the price per person for single inspection and multi-person mixed inspection will be reduced to 41 yuan and 11 yuan respectively. The medical insurance fund paid more than 68 million yuan for nucleic acid testing.
● Zhaoqing Medical Insurance Bureau of Guangdong Province issued a document saying that in 2121, 3,194,311 local participants for nucleic acid testing were settled, and the total medical expenses were 24 million yuan, of which 95.15 million yuan was paid for medical insurance, accounting for 76.9%, and the insured paid more than 1 million yuan for medical treatment for nucleic acid testing in different places.
● According to Shanghai Medical Insurance Bureau, by the end of August, 2121, Shanghai Medical Insurance has paid more than 15 million times for novel coronavirus's nucleic acid and antibody tests, and spent nearly 1.2 billion yuan.
Dalian also announced in early May that the multi-person mixed test of nucleic acid detection will be temporarily included in the scope of medical insurance payment. If the National Medical Insurance Bureau hadn't issued a document to stop it in time, the medical insurance balance of some provinces and cities could really pay for nucleic acid testing.
With the increasing competition in the nucleic acid testing market, some enterprises shorten the testing procedures or adopt unqualified testing methods in order to obtain benefits. Illegal multi-tube mixed inspection and artificial dilution of samples can reduce the cost of testing institutions, but the authenticity of nucleic acid results is also dragged down. On May 29th, another nucleic acid testing institution, Beijing Zhongtong Lanbo Medical Laboratory, was notified of the suspected illegal crime, and the legal person in charge of the institution was seized. Chaos has been repeatedly banned. Since the beginning of this year, problems in a number of third-party inspection institutions have been exposed, involving Jin Zhun Medicine, Runda Medical, Hehe Medicine, Novell Medicine, and Park Stone Medicine.
three: how will the normalization test be rolled out in the future, and will it be implemented nationwide for a long time? Whether the landing details will be further adjusted is still unknown. But what is certain is that nucleic acid detection, a subdivision of the track, will be rampant. In the short term, the nucleic acid testing market will undoubtedly remain prosperous; However, in the long run, the phased dividends brought by the epidemic will gradually fade away. After the tide recedes, whether these third-party testing institutions are swimming naked will be exposed. The profitability sustainability of these third-party testing institutions will be a real problem, and the window time left for nucleic acid testing enterprises to adjust may be running out.
Legal basis:
Article 28 of Chapter III "Basic Medical Insurance" of the Social Insurance Law stipulates that "medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations." The third paragraph of Article 31 also stipulates that "what should be borne by public health" shall not be included in the payment scope of the basic medical insurance fund ".