Ministry of Health: increase the proportion of reimbursement for major diseases among children in rural areas

A few days ago, the Ministry of Health issued the opinions on carrying out pilot work to improve the level of medical security for rural children with major diseases. In the future, China will give priority to several major diseases that endanger the lives and health of children, have high medical costs and have a good prognosis after active treatment (prognosis refers to the disease development predicted according to experience). Through the close combination of various medical security systems such as NCMS and medical assistance, we will explore effective compensation and payment methods to improve the level of medical security for major diseases.

Priority is given to leukemia and heart disease.

In recent years, the problem that some rural children with serious illness can not be treated in time due to cost reasons has aroused widespread concern in the society.

The Ministry of Health requires that the pilot work start with solving two major diseases of acute leukemia and congenital heart disease in children aged 14 years (including 14 years old). Priority was given to children with acute lymphoblastic leukemia, acute promyelocytic leukemia, congenital atrial septal defect in children, congenital ventricular septal defect in children, patent ductus arteriosus in children, and congenital pulmonary valve stenosis in children.

All provinces (autonomous regions and cities) will choose three counties (cities) that have a large population to participate in the new rural cooperative medical system, have strong information management capabilities, and have carried out immediate settlement of provincial (city)-level designated medical institutions and "one-stop" medical assistance services.

All provinces (autonomous regions and municipalities) can also appropriately increase the number of pilot diseases according to the fund's ability to pay. In order to increase the number of pilot diseases, we should consider the benefit of the use of the fund and the fairness of the use of the fund at the same time.

On the basis of the pilot project, various localities will gradually explore ways to establish medical compensation for major diseases of the new rural cooperative medical system, so as to further alleviate the economic burden of major diseases of rural residents.

Reasonable determination of designated hospitals

All localities shall, according to the pilot diseases, the provincial health administrative departments shall select the provincial and municipal NCMS designated medical institutions with the conditions for diagnosis and treatment and high technical level of diagnosis and treatment within their jurisdiction, as the treatment hospitals for the selected diseases, and sign a designated medical service agreement with the treatment hospital. Designated medical institutions of NCMS at the county level that have the conditions and ability for diagnosis and treatment can also be selected as treatment hospitals for pilot diseases.

The provincial health administrative department shall determine the standardized diagnosis and treatment plan of the pilot disease according to the clinical path, clinical technical operation standard or diagnosis and treatment guide issued by the Ministry of Health, and according to the diagnosis and treatment plan and the designated medical service agreement, standardize the medical service behavior of treatment hospitals, strengthen supervision, and effectively control the diagnosis and treatment expenses of pilot diseases.

Significantly increase the proportion of reimbursement

Each province (autonomous region and city) should calculate and limit the reasonable diagnosis and treatment cost of the corresponding disease according to the standardized diagnosis and treatment plan of the pilot disease. On the basis of limiting the expenses, the NCMS and the medical assistance fund will pay according to the type of disease and significantly increase the proportion of reimbursement. In principle, the compensation proportion of NCMS for pilot diseases should reach about 70% of the limited cost of the province (autonomous region and city), and medical assistance should compensate eligible patients, and the compensation ratio should not be less than 20% of the limited cost. Participating patients shall enjoy the prescribed compensation for diagnosis and treatment in the corresponding designated medical institutions in the province (autonomous region and city).

The Ministry of Health requires that NCMS agencies at all levels should follow the principles of convenience and benefit to the people, do a good job in the referral of participating farmers in time, and simplify and standardize the settlement and reimbursement process of pilot diseases. The designated medical institutions of NCMS will be implemented to immediately close the report, and provide a "one-stop" service with medical assistance, so as to facilitate the participants to get compensation in time. It is necessary to simplify the relevant settlement procedures of designated medical institutions and settle the advance funds of medical institutions in a timely manner.

While carrying out the pilot work, the provincial health and civil affairs departments should actively strive for the support of the local Red Cross or charitable relief organizations for the pilot disease compensation work, link up with the basic medical security system in the aspects of project development, fund use, assistance objects, etc., form a joint force of assistance, explore the establishment of a multi-level basic medical security system in rural areas, and jointly improve the security level.