html On the 126th, in response to the issues such as the cost of nucleic acid testing for the new coronavirus that have attracted much public attention in recent days, the person in charge of the relevant department of the National Medical Insurance Administration introduced that in accordance with the "Joint Prevention and Control Mechanism of the State Council in Response to the New Coronavirus Infection Pneumonia Epidemic" on normalizing the prevention and control of the new coronavirus pneumonia epidemic. "Guiding Opinions on Control Work" and "Implementation Opinions on Accelerating the Promotion of Nucleic Acid Testing for New Coronavirus", the required costs will be borne by local governments. Therefore, financial departments in various places currently provide financial support for normalized nucleic acid testing. This statement from the National Medical Insurance Administration clearly denies the "medical insurance payment theory" of normalized nucleic acid testing that has been circulated on the Internet.
However, it is worth asking what part of the cost of nucleic acid testing has been borne by medical insurance before, and how much has been spent? How much pressure is currently placed on medical insurance?
Why can't medical insurance pay for normalized nucleic acid?
As for who is paying, in fact, it has already been Regulation.
According to the "Guiding Opinions of the Joint Prevention and Control Mechanism of the State Council on the Regular Prevention and Control of the New Coronavirus Infection Pneumonia Epidemic" issued in May 2020, the costs required for "all necessary inspections" shall be borne by local governments , the expenses required for "willingness to inspect and carry out inspections" shall be borne by enterprises, institutions or individuals.
What needs to be asked is, does normalized nucleic acid belong to "should be tested and tested" or "will be tested and tested"?
Before, the "should be tested and tested" people were defined as including close contacts, overseas arrivals, fever outpatients, and inpatients And accompanying personnel, medical institution staff, port quarantine and border inspection personnel, prison staff, social welfare and elderly care institution staff, etc. The "willing to get tested" people are citizens who want to take a nucleic acid test in addition to the "should get tested".
Sino-Singapore Jingwei noticed that some provincial and municipal medical security bureaus will pay for the "exhaust inspections that should be carried out". According to a document issued by the Shenzhen Municipal Medical Security Bureau, if the insured person belongs to the "required to be tested" group and undergoes the new coronavirus nucleic acid test in Shenzhen according to regulations, the cost will be paid by the medical insurance coordinating fund and financial funds in proportion, and the individual does not need to bear it Fees will not be deducted from your personal medical insurance account.
However, the number of people faced by normalized nucleic acid is obviously much larger than the original group of people who "should be tested and tested", but it is not appropriate to define normalized nucleic acid as "willing to be tested and tested".
From a legal perspective, Tang Jun, a researcher at the Social Policy Research Center of the Chinese Academy of Social Sciences, responded to Sino-Singapore Jingwei that Article 28 of Chapter 3 "Basic Medical Insurance" of the "Social Insurance Law" stipulates that "in line with the basic medical insurance drug catalog, diagnosis and treatment Projects, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.” Paragraph 3 of Article 30 also stipulates that “those that should be borne by public health” “are not included. Basic medical insurance fund payment scope”.
The above-mentioned provisions of the "Social Insurance Law" point out the payment scope of the medical insurance fund, and "large-scale population nucleic acid testing" is obviously not among them. In fact, "large-scale population nucleic acid testing" falls within the scope of public health. The reason why the Social Insurance Law makes such a provision is, in theory, because public health and medical services are two completely different concepts.
"Medical insurance is different from pension insurance. According to the "Social Insurance Law", the funds for pension insurance come from the contributions of employees and employers and government financial subsidies, while the funds for medical insurance only come from the contributions of employees and employers. In comparison, , Medical insurance lacks the government's commitment to support 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 the public must be coordinated. The use of health service funds should increase the payment ratio to primary medical institutions and achieve an effective connection between public health services and medical services. However, such 'coordination' and 'connection' should be limited and mainly target the 'payment ratio of primary medical institutions'. It's not a random call," Tang Jun said.
How much of the nucleic acid testing costs does medical insurance bear?
Does medical insurance bear part of the nucleic acid testing costs? The answer is yes.
In June 2020, the National Medical Insurance Administration issued the "Notice on Cooperating with the Work to Further Improve the New Coronavirus Detection Capacity", which stated that factors such as the needs for the prevention and control of new coronavirus pneumonia and the payment ability of the local medical insurance fund should be comprehensively considered. On the basis of this, nucleic acid and antibody testing projects and related consumables for the new coronavirus will be included in the directory of provincial medical insurance diagnosis and treatment projects according to procedures, and payment conditions will be determined simultaneously.
Since then, many places have responded to the National Medical Insurance Administration and followed up. According to a document issued by the Shanghai Municipal Medical Security Bureau, medical insurance support for nucleic acid testing mainly includes two parts: first, promoting the procurement channels for new coronavirus testing reagents; second, including nucleic acid testing items in the catalog of medical insurance diagnosis and treatment items, and those needed for diagnosis and treatment during epidemic prevention and control. The cost of nucleic acid testing or antibody testing will be paid according to medical insurance regulations.
How to define "diagnosis and treatment needs"? Sino-Singapore Jingwei noticed that different regions have different reimbursement methods and proportions for nucleic acid testing medical insurance.
According to the Heilongjiang Provincial Medical Security Bureau, the new coronavirus nucleic acid testing project has been included in the directory of medical insurance diagnosis and treatment projects and is managed as a Category B project. All insured persons will enjoy medical insurance reimbursement due to medical needs.
According to the Zhejiang Provincial Medical Security Bureau, according to the "Notice of the Zhejiang Provincial Medical Security Bureau on Further Lowering the Price of New Coronavirus Nucleic Acid Testing Projects", starting from April 4, 2022, the price of new coronavirus nucleic acid testing will be adjusted to 28 yuan/time. . The price of the new coronavirus nucleic acid mixed test has been adjusted to 8 yuan per sample. The scope of medical insurance payment is limited to patients with fever outpatient clinics or patients with imaging characteristics of new coronary pneumonia, and payment is classified as Category A.
On the whole, medical insurance and finance jointly bear the cost of nucleic acid testing when residents undergo "all necessary tests" at designated medical institutions, as well as when they go to local medical institutions for hospitalization or fever outpatient clinics.
So how much did medical insurance cost during this process? Previously, various places have released some data.
The Linyi Municipal Medical Security Bureau previously pointed out at a work meeting that in 2021, through three rounds of price adjustments, the price of nucleic acid testing will be significantly reduced, with the prices per person for single testing and mixed testing for multiple people falling to 40 yuan and 10 yuan respectively. The medical insurance fund paid more than 68 million yuan for nucleic acid testing of "all tests required".
The Medical Security Bureau of Zhaoqing City, Guangdong Province issued a document stating that as of December 30, 2021, a total of 3.1943 million local insured persons for nucleic acid testing had been settled throughout the year, with a total medical expense of 124 million yuan, of which 95.15 million yuan was paid by medical insurance. The proportion reached 76.9%, and insured persons paid more than 1 million yuan for medical insurance for nucleic acid testing in other places.
According to the Shanghai Municipal Medical Insurance Bureau, as of the end of August 2021, Shanghai Medical Insurance has paid a total of more than 15 million new coronavirus nucleic acid and antibody tests, worth nearly 1.2 billion yuan.
Medical insurance funds are facing certain pressure
In fact, even if they do not pay for normalized nucleic acid testing, medical insurance funds in many places are already under certain pressure.
According to media reports, from January to October 2021, the basic medical insurance (including maternity insurance) fund income was 2,214.191 billion yuan, of which the employee basic medical insurance (including maternity insurance) fund income was 1,493.065 billion yuan, and the basic medical insurance fund income for urban and rural residents was 7,211.27 billion; basic medical insurance (including maternity insurance) fund expenditures were 1.901313 billion yuan, of which employee basic medical insurance (including maternity insurance) fund expenditures were 1.179556 billion yuan, and urban and rural residents basic medical insurance fund expenditures were 721.757 billion yuan.
That is to say, the Urban and Rural Residents Basic Medical Insurance Fund is "exhausting revenue", and the balance from January to October 2021 is negative (-630 million yuan). Tang Jun said that previous relevant research reports pointed out that in 2029, the urban employee basic medical insurance fund will be unable to cover its current revenue. In recent years, through the efforts of medical insurance departments at all levels from the central to local governments, the above situation has improved. From the current point of view, the reappearance of "making ends meet" is worthy of vigilance.
From the perspective of medical insurance’s support for epidemic prevention and control, combined with published data, as of July 19, 2020, there were 135,500 medical insurance settlements for confirmed and suspected patients with new coronavirus pneumonia in China, involving 1.847 billion yuan in medical expenses and 1.232 billion medical insurance payments. billion, the payment ratio reaches 67%, and the remaining part will be subsidized by the finance.In line with the principle of "treat first, settle later", the National Medical Insurance Administration has clarified that the medical expenses of COVID-19 patients will not occupy the total budget target for the year.
In 2021, the Party Central Committee and the State Council made a decision that the cost of the new coronavirus vaccine and vaccination will be borne by the medical insurance fund, with financial subsidies, and free vaccination for residents. The medical insurance fund will mainly be borne through the balance of previous years, which will not affect the current fund's income and expenditure. Previously, the person in charge of the National Medical Insurance Administration stated that at present, our country has received 3.2 billion doses of vaccines, and the vaccine cost is more than 120 billion yuan, which is shared by the medical insurance fund and the finance.
However, according to the "2021 Medical Security Development Statistical Report", the phenomenon of "insufficient revenue" of medical insurance funds has improved.
In 2021, the total revenue and total expenditure of the basic medical insurance fund (including maternity insurance) were 2,871.028 billion yuan and 2,401.109 billion yuan respectively. The cumulative balance of basic medical insurance (including maternity insurance) at the end of the year was 3,612.154 billion yuan.
However, it also stated that the income of the basic medical insurance fund for urban and rural residents for the whole year was 974.225 billion yuan, a year-on-year increase of 6.9%; the expenditure was 914.807 billion yuan, a year-on-year increase of 12.0%. Affected by the recovery of medical treatment and the new coronavirus vaccine and vaccination cost protection expenditure, in 2021 The year-on-year growth rate of urban and rural residents’ medical insurance fund expenditures is higher than the year-on-year growth rate of income.
Normalized nucleic acid testing frequency reduction?
It is worth noting that in the past two days, some places have successively announced that they will reduce the frequency of normalized nucleic acid testing.
html On May 26, Hangzhou, which was the first to announce the launch of normalized nucleic acid testing, announced that it would reduce the frequency of normalized nucleic acid testing and adjust it from one test every two days to one every three days.According to a notice from the Hangzhou New Coronavirus Pneumonia Epidemic Prevention and Control Leading Group Office, starting from 0:00 on May 27, the frequency of regular nucleic acid testing in Hangzhou will be extended from 48 hours to 72 hours. Residents within the city's jurisdiction and other people in Hangzhou should voluntarily complete a nucleic acid sampling every 72 hours. The frequency of nucleic acid testing for staff in high-risk positions and employees in the public service industry shall be implemented in accordance with relevant regulations. People coming to and returning from non-epidemic areas outside the city should provide proof of a negative nucleic acid test taken 48 hours before arriving in Hangzhou.
html On May 25, according to The Paper, following the adjustment of the frequency of nucleic acid testing in Xinyu, Jiangxi, the frequency of normalized nucleic acid testing in Fuzhou was also announced to be reduced.According to the WeChat public account "Fuzhou Release", employees working in key places in Fuzhou will be inspected once a day, and high-risk exposed staff will be inspected once every three days. Except for the first and second categories of personnel, non-key positions, non-special industries, and non-public General people in places and non-exposed service industries (including public officials), as well as students and their parents living together will be tested every 7 days.
Fuzhou City Epidemic Prevention and Control Headquarters stated that it will dynamically adjust the nucleic acid screening policy based on the requirements of the Provincial Epidemic Prevention and Control Headquarters and changes in the epidemic prevention and control situation.
Previously, employees working in key places in Fuzhou were tested once a day, high-risk exposed groups were tested once every two days, and the general population (including personnel in non-key positions, non-special industries, non-public places and non-exposure service industries) was tested. Public officials), inspections will be implemented every three days.
In addition to the reduction in testing frequency in some areas, the price of normalized nucleic acids is also falling further. On May 22, the Office of the National Medical Insurance Administration and the Medical Treatment Team of the Joint Prevention and Control Mechanism of the State Council issued the latest notice, requiring all localities to reduce the number of single-person nucleic acid tests for the new coronavirus to no higher than per person before June 10. It is 16 yuan per person, and the price for multiple people is reduced to no more than 5 yuan per person. For large-scale screening and normalized testing organized by the government, testing institutions are required to provide services based on mixed testing for multiple people, no more than 3.5 yuan per person.
