? Direction 1: complete the control of the use of basic medical insurance drugs and create a dynamic adjustment mechanism for the medical insurance drug list?
On the other hand, in recent two years, we can analyze the sorting activities of medical insurance catalogue, and it is mature to establish a dynamic adjustment mechanism in business mechanism and technology. Working mechanism, after two comprehensive adjustments in 20 16 and 20 19 and two negotiations in 20 18 and 20 19, for example, 20 19 increased the medical insurance drug allocation process, increased the proportion of core experts in the evaluation process, and emphasized clinical evidence and drugs. Technically, is it possible? Once a year? Through the establishment of a unified national medical insurance drug coding database and medical insurance information management platform.
The second direction: do a good job in the basic work of the new drug catalogue, sublimate and simplify the work of various departments, and solve the problem of increasing or decreasing their respective varieties?
Before the 20 19 version of the medical insurance drug list, 15% of Class B drugs were adjustable rights in the local list, forming the so-called? Local supplementary catalogue? . However, after the publication of the 20 19 version of the catalogue, the person in charge of the national medical insurance bureau said in the interpretation. Unless there are special provisions, local governments do not adjust Class B drugs. In principle, the original supplementary varieties must be digested in stages within three years, giving priority to the varieties that enter the scope of national key supervision. ? Explicitly cancel the local supplementary catalogue. However, at the subsequent meeting of the medical insurance bureau? Delete 40%, 40% and 20% of provincial subsidies within three years? The adjustment period is more clear. ?
Direction 3: gradually establish the basic medical insurance system for large-scale medical consumables and implement the catalogue management of large-scale medical consumables?
According to the data of 5 o'clock in 20 19, the basic medical insurance access system for high-value medical consumables reviewed and approved by the Central Reform Commission can be summarized as two specific measures: first, establish the basic medical insurance access system for high-value medical consumables, implement the catalogue management of high-value medical consumables, implement the dynamic replacement system of complete catalogues, supplement necessary new technology products in time, and withdraw products that are not suitable for clinical use; Second, gradually negotiate the realization of medical insurance access price for high-value medical consumables? Trade quantity for price? . ?
Direction 4: Prepare to publicize the official standard documents of medical insurance drug payment, and gradually establish the medical insurance drug payment standard system?
In recent years, the research and exploration on the payment standard system of medical insurance drugs in China has never stopped, but no conclusive papers have been put forward in China. However, the importance of re-increasing the focus of medical insurance by 2020 is different from previous years. Because, in the past year, under the unified deployment of the State Council, the State Medical Insurance Supervision Administration was established in? Country? Drug purchase, because it fundamentally subverts the payment model, will have a great impact on the formation of medical insurance drug payment standards.
Direction 5: gradually centralize the national medical insurance catalogue system and narrow the differences in medical treatment in remote areas?
In the reply of NPC deputies from 2065438 to September 2009, the National Medical Insurance Bureau pointed out that there has been some progress in the management of medical insurance catalogue, or it is clear that there will be work to be carried out in the future: First, the Measures for the Administration of the Use Scope of Drugs in National Basic Medical Insurance will be revised to further exchange standardized medical insurance catalogues; The second is to revise the Measures for the Administration of the Scope of National Basic Medical Insurance Diagnosis and Treatment Projects and Medical Service Facilities, and establish standards for basic medical insurance diagnosis and treatment projects and medical service facilities that are in line with national conditions and acceptable to the Fund; The third is to promote the national coding of drugs and diagnosis and treatment projects, lay the foundation for the unified work of the national medical insurance catalogue, and is promoting the local implementation stage; The fourth is to formulate a catalogue of medical security benefits and gradually clarify the adjustment authority of medical security policies. 2065438+July 2009, the National Medical Insurance Bureau issued a draft for comments, clarifying the catalogue management of medical insurance benefits. ?