Soliciting Opinions On "Medical Insurance Law": The Industry Calls For Top-Level Design, And Multi Departments Work Together To Solve The Problems Of Financing, Distribution And Payment

On June 15, the official website of the State Medical Insurance Bureau released the medical security law (Draft for public opinions) (hereinafter referred to as the "draft for Soliciting Opinions"). China's medical security system has gone through the process of absorbing the experience of other countries, combining with the practical exploration of national conditions and constantly revising and improving the system design. As a programmatic and comprehensive medical security law, the above-mentioned medical security law is also known as "medical insurance law" in the industry, which will help to realize the high-quality development of China's medical security.

Wang Chenguang, Professor of Law School of Tsinghua University and executive vice president of China Health Law Association, pointed out in an interview with 21st century economic reporter that the formulation of medical security law is very important and necessary. However, in Wang Chenguang's view, from the perspective of the national health strategy, there are still some contents that need to be further improved and clarified, including top-level design, and joint efforts of multiple departments to solve problems such as financing, distribution ratio, specific payment mechanism and method.

Shi lichen, the head of Beijing Dingchen medical management consulting company, pointed out to the 21st century economic reporter that in the medical security law, we should strengthen the discourse power and bargaining power of medical insurance units, and at the same time, all departments should develop in coordination, and the responsibilities should be clearly divided. For example, the National Health Care Commission is responsible for technology incubation and maturity, and the National Medical Insurance Bureau coordinates the details of medical insurance payment methods, including online and offline.

"Medical insurance law" will help to realize the high-quality development of China's medical security. Visual China

Put forward the implementation of bidding procurement credit evaluation system

Prior to this, many NPC deputies and members called for the introduction of medical insurance related laws as soon as possible.

During the two sessions of the National People's Congress in 2020, Hu Jiqiang, deputy to the National People's Congress and chairman of Kangenbei group, put forward suggestions on speeding up the legislation of medical security and promoting the cause of medical security according to law. On August 28, 2020, the State Medical Security Bureau released "the reply of the State Medical Security Bureau to the No. 5326 proposal of the third session of the 13th National People's Congress" on its official website, which said that the State Medical Security Bureau was actively promoting the legislation of the medical security law and effectively responding to the expectations of all walks of life for the legal construction of medical security.

According to the reply, the establishment of an independent and complete legal system of medical security, under the guidance of the medical security law and accompanied by a number of administrative regulations and departmental rules, is a response to the practical needs of the people's expectations, and an inevitable requirement for deepening the reform of the medical security system and promoting the modernization of the medical security governance system and governance capacity, It is an inevitable choice to solve the problem that the overall development of medical security reform can not be relied on.

The "medical security law (Draft)" is divided into 8 chapters and 70 articles. In the draft, the financing and treatment of medical insurance, fund management, medical services, public management services, supervision and management and legal responsibilities are stipulated.

Among them, the fourth chapter "medical services" is closely related to pharmaceutical enterprises, including the centralized procurement system of drugs and medical consumables.

According to the above draft, the administrative department of medical security is responsible for investigating the cost and price of drugs and medical consumables, implementing the credit evaluation system for medical prices and bidding procurement, and strengthening the supervision and inspection of illegal acts that infringe on the medical security fund by means of price monopoly and price bidding.

At the same time, it also made clear the punishment for violation of regulations in the process of bidding and procurement, and proposed that in case of one of the four situations of pharmaceutical enterprises, the administrative department of medical security shall order them to make corrections and confiscate their illegal income; If the bid is accepted, the bid shall be invalid, and a fine of 5 ‰ to 10 ‰ of the bid winning project amount shall be imposed; The legal representative, the principal person in charge, the person in charge directly responsible and other responsible persons shall be fined not less than 5% but not more than 10% of the fine imposed on the unit; If the circumstances are serious, the qualification of relevant pharmaceutical enterprises or related drugs and medical consumables to participate in the centralized procurement shall be restricted or suspended and announced; Those who violate other laws and administrative regulations shall be punished by the relevant competent departments according to law.

In addition to the requirements for pharmaceutical enterprises, the medical security law (Draft for comments) also imposes restrictions on centralized purchasing institutions.

Wang Ying, CEO of Bosia management consulting, pointed out to the reporter of 21st century economic report that after several rounds of centralized purchasing, the mode has become mature and institutionalized. Some problems are also very clear, including low price competition. This draft has clear provisions on this, which will further improve the national centralized purchasing system.

Industry insiders suggest to enhance the voice of medical insurance units

In addition to the above-mentioned contents, the "legal responsibility" part of the medical security law (Draft for comments) also specifies the illegal acts and punishment measures of the staff of the medical security agency, designated medical institutions and individuals.

However, in the view of Shi lichen, we should strengthen the discourse right and bargaining power of medical insurance units in the medical security law“ Some policies have changed rapidly, but there should be a general outline, that is, the national medical insurance payment should be used to confirm. Medical services, medical technology, patient medication, equipment, examination and so on need to be confirmed by the medical insurance bureau. However, there are still a lot of data that have not been solved, and the payment standard has not been mastered. "

In fact, China's medical security system is still in the process of improvement.

At present, in the legal system of medical security in China, there are only 10 principled norms of basic medical insurance in the social insurance law, and there are no administrative regulations on medical security, which mainly rely on normative documents and local regulations to clarify the legal relationship of various medical security.

Wang Chenguang pointed out to the 21st century economic reporter that as a major law of medical security, there should be both special laws on medical insurance and detailed regulations on all aspects involved in medical insurance. It is very necessary to introduce the medical security law, but also need to strengthen the top-level design.

At the same time, in Wang Chenguang's view, the medical security law is the "fundamental law" in the field of medical security, which needs to strengthen the top-level design, solve institutional problems, and gradually improve relevant laws and regulations. For example, Germany has established a complete legal system of medical insurance through a series of relevant laws, including the health structure law (GSG), the drug expenditure restriction law, and the law on strengthening the competition of legal medical insurance.

According to Wang Chenguang, financing, distribution and payment are the key core issues in the medical security law“ Where does medical insurance come from? Where to pay? What is the distribution ratio of each party? What is the distribution ratio of hospitals at all levels and how to do so? "

Wang Chenguang suggested that the top-level design should be done by multiple departments, and the financing, distribution, payment and use of the whole health field should be coordinated as a complete system“ We should sort out some existing laws and then legislate systematically. "

(Intern Wei Xiao also contributed to this paper.)