Schlagwort: ‘Health Reform’
Unified reimbursement rate of online and offline medical consultations
Recently, the NMPA issued the “Guidelines on Promoting the Medical Insurance Payment of Online Medial consultation services.” The “Guidelines” clarifies that medical entities can help eligible online medical institutions that rely on them to be included in medical insurance, and the reimbursement rate for online and offline medical institutions is the same. The “Guideline” indicates that the payment of consultations and drugs for patients that need further consultations is also included in the medical insurance, which should be paid according to the regulations in different cities.
国家医保局：“互联网+”医保支付采取线上线下一致
来源：医药网 2020.11.04
日前，国家医疗保障局印发《关于积极推进“互联网+”医疗服务医保支付工作的指导意见》。《意见》明确，符合条件的互联网医疗机构可以通过其依托的实体医疗机构，自愿“签约”纳入医保定点范围，“互联网+”医保支付将采取线上、线下一致的报销政策。《意见》提出，医保参保人在本统筹地区“互联网+”定点医疗机构复诊并开具处方发生的诊察费和药品费，可以按照当地医保规定支付。
The NMPA: implementation of Diagnosis-Intervention Packet
On October 19th, the NMPA issued the “Notice on the Pilot Work of the Regional Point-Based Medical Insurance Fund Allocation and the Diagnosis-Intervention Packet.” The “Notice” stipulates that medical institutions should change the costs of each medical services into points; the regional medical insurance bureaus should calculate the value of each point according to the amount of points provided by all medical institutions of each region and the budget of medical insurance funds to pay for those medical institutions (Diagnosis-Intervention Paket). The “Notice” indicates that a data center on the basis of the unified national medical insurance information coding list should be established, which can inspect the quality of medical insurance settlement checklists, medical insurance cost schedule etc.
国家医保局发布区域点数法总额预算和按病种分值付费试点工作方案
来源：HIT专家网 2020.10.20
10月19日，国家医保局下发《国家医疗保障局办公室关于印发区域点数法总额预算和按病种分值付费试点工作方案的通知》（以下简称《通知》）。《通知》要求，医疗机构应将治疗项目等付费单元转化为一定点数；医保部门年底根据各医疗机构所提供服务的总点数以及地区医保基金支出预算得出每个点的实际价值，按照各医疗机构实际点数付费。《通知》指出，应打造数据中心，在全国统一的相关医保信息业务编码的基础上，开展医保结算清单、医保费用明细表等质量控制工作。
Reimbursing online medical consulting services
On July 21st, the General Office of the State Council issued the “Opinions on Optimizing the Business Environment to Better Serve the Market Participants”. The “Opinions” indicates that under the premise of ensuring the medical safety and quality, the range of the online medical consulting services should be extended and qualified online medical consulting services should be included in the reimbursement list. In addition, a national unified approval requirement for online medical consulting services should be formulated and announced.
国务院：进一步放宽互联网诊疗范围， 将符合条件的医疗服务纳入医保报销
来源：搜狐网 2020.07.23
7月21日，国务院办公厅发布《关于进一步优化营商环境更好服务市场主体的实施意见》（以下简称《意见》）。《意见》指出，在保证医疗安全和质量的前提下，应进一步放宽互联网诊疗范围，将符合条件的互联网医疗服务纳入医保报销范围，并制定公布全国统一的互联网医疗审批标准。
Implementing online medical insurance settlement of prescriptions
On May 20th, the “Opinion on Settling the Price and Medical Insurance Payment of ‘Internet+’ Medical Services” issued by the Healthcare Security Administration of Chongqing province came into effect. The “Opinion” stipulates that for the pilot program of the “Internet+” medical insurance services for common and chronic diseases, doctors can issue electronic prescriptions after online consultations and settle up the medication costs online through medical insurance, and it is allowed to deliver medicines to patients in many ways.
线上处方医保支付落地！处方流转迎来新机遇！
来源：医药网 2020.05.21
5月20日，重庆市医疗保障局《关于“互联网+”医疗服务价格和医保支付政策的实施意见》开始实施。《意见》提出，对于正在试点的常见病、慢性病“互联网+”医保服务，患者通过网上问诊后，可由医生开出电子处方，医保在线结算，并且允许通过多种方式为患者进行配送。
Deepening the reform of the medical and health care system
On February 25th, the State Council issued the “Opinions on Deepening the Reform of the Medical and Health Care System.” The “Opinion” stipulates that medical institutions should improve the management of drug reimbursement lists, medical service protocols, and medicare settlement or increase the efficiency of medicare payment. Besides, the use of medical insurance funds should be strictly supervised, and insurance fraud will be dealt with according to legislation. In addition, the reform of centralized drug procurement should be deepened, and a pricing system that depends on the market should be established. Moreover, medical institutions should improve their service capacity and standardize new medical services, such as consulting over the internet.
关于深化医疗保障制度改革的意见
来源：医药网 2020.03.06
2月25日，国务院发布《关于深化医疗保障制度改革的意见》。《意见》要求，应完善医保目录、协议、结算管理，提升医保支付效率；完善医保基金监管，依法追究欺诈骗保行为；深化药品集中带量采购制度改革，并建立以市场为主导的药品价格形成机制；增强医疗服务能力，规范“互联网+医疗”等新服务模式发展。
Standardising DRG (Diagnosis Related Groups) payment
On October 23rd, the National Medical Insurance Bureau issued the “Notification on Technical Specifications and Grouping Plans of Pilot Works of DRG Payment” including the “Technical Specifications of DRG Grouping and Payment” and “Grouping Plans of DRG(CHS-DRG) Payment.” The “Notification” stipulated that because the CHS-DRG covers nearly all treatments of diseases, it will become the only standard for DRG payment implemented by the National Medical Insurance. In addition, pilot cities of DRG payment should execute the “Grouping Plan” and formulate local subdivided DRGs according to the unified guidelines of grouping and the actual situation of each city.
国家医保局发文 DRG付费标准正式走向统一
来源： 医药网 2019.10.25
10月23日，国家医保局正式公布《关于疾病诊断相关分组（DRG）付费国家试点技术规范和分组方案的通知》，包含《国家医疗保障DRG分组与付费技术规范》和《国家医疗保障DRG（CHS-DRG）分组方案》。《通知》指出，CHS-DRG可基本实现疾病治疗全覆盖，将成为全国医保部门实行DRG付费的唯一标准；各试点城市应严格执行《分组方案》，按照统一的分组操作指南，并结合各地实际情况制定本地的细分DRG分组。
“Prescription Sharing” supported
On September 29th, 21 commission and administrations, including the National Development and Reform Commission, the National Healthcare Security Administration, the National Health Commission, the National Medical Product Administration, jointly issued the “Guideline of Promoting a High-quality Development of the Health Industry (2019-2022).” The “Guideline” stipulated that channels for the interconnection and real-time sharing of information on drug consumption and on prescriptions of online diagnosis and treatment should be established nationwide. In the meantime, third-party platforms are suggested to deliver online prescribed drugs to encourage Medical e-commerces to offer “ordering online and delivered offline” services.
21部门发文力挺处方外流
来源：医药网 2019.09.30
9月29日，国家发改委、国家医保局、国家卫健委、国家药监局等21部委联合发布《促进健康产业高质量发展行动纲要（2019-2022年）》（下称“行动纲要”）。《行动纲要》要求，各地应建立互联网诊疗处方信息与药品零售消费信息互联互通、实时共享的渠道；支持在线开具处方药品的第三方配送；加速医药电商发展向患者提供“网订（药）店取，网订(药)店送”等服务。
Internet Hospital established by Yifeng Pharmacy
On September 19th, Yifeng Pharmacy announced a joint venture with Visum Pharmaceutical Co., Ltd. to establish Hainan Yifeng Medical Technology Co., Ltd., which aims to provide patients with services such as Internet Hospitals, Prescription Sharing Platform, family doctors, health management, online medical consultations, and patient education.
他来了！这家连锁药店巨头开建互联网医院
来源：新浪医药新闻 2019.09.22
9月19日，益丰大药房宣布与海南华益合资设立海南益丰医疗科技有限公司，旨在为用户提供互联网医院、处方流转平台、家庭私人医生、健康管理、轻问诊、患者教育等服务。
The National Medical Insurance Bureau issued new regulations
On August 30th, the National Medical Insurance Bureau issued the “Guidelines of Improving the price management of the ‘Internet+’ Medical Services and the Policies of Medical Insurance Payment.” The “Guidelines” proposed that the price management of the “Internet+” medical services should be included in the policy system of general medical services to realise a unified regulation. The eligible “Internet+” medial services will be regulated under proper medical insurance payment policies in accordance with the principle of online and offline consistency, and its management of medical insurance agreement(Every citizen contracts with a specific hospital) and the settlement process should be improved.
国家医保局公布新规，影响所有医药人
来源：医药网 2019.09.02
8月30日，国家医保局发布《关于完善“互联网+”医疗服务价格和医保支付政策的指导意见》（以下简称《指导意见》）。《指导意见》提出，应将“互联网+”医疗服务价格纳入先行医疗服务价格的政策体系统一管理；符合条件的“互联网+”医疗服务，按照线上线下公平的原则配套医保支付政策，并根据服务特点完善协议管理、结算流程。
The Xi’an Municipal Government launches the submission of increased purchase of selected drugs(“4+7”)
On August 6th, the Xi’an Municipal Government issued the “Notification on Launching the Submission of Increased Purchase of Selected Drugs in Xi’an from the ‘Office of the Leading Group for the Implementation of Centralized Drug Procurement and Pilot Work’”. It is decided to increase the purchase of selected drugs in Xi’an because its procurement exceeds expectations. Besides, the deferred payment of the increased procurement should be paid in time.
“4+7″采购量完成超预期，启动中选药品增加采购量报送
来源：医药网 2019.08.07
8月6日，西安市发布《落实国家组织药品集中采购和试点工作领导小组办公室关于启动西安地区中选药品增加采购量报送工作的通知》。因西安地区”4+7″准备采购量完成情况已经超过预期，经研究，决定启动西安地区中选药品增加采购量报送工作。同时，对于增加的采购量，应确保及时回款。