Ministry of Health Announces Increase in Reimbursement Rate for Major Diseases of Rural Children
Recently, the Ministry of Health issued the "Opinions on Carrying Out Pilot Work to Raise the Level of Medical Security for Major Diseases of Rural Children." From now on, China will give priority to selecting several major diseases that endanger children's lives and health, have high medical costs, and have a relatively good prognosis after active treatment to carry out pilots (prognosis refers to the predicted development of a disease based on experience). Through the close integration of the new rural cooperative medical scheme and medical assistance and other medical security systems, effective compensation and payment methods will be explored to raise the level of medical security for major diseases.
Priority Pilots for Leukemia and Heart Disease
In recent years, the problem that some rural children with major diseases cannot receive timely treatment due to cost reasons has aroused widespread social concern.
The Ministry of Health requires that the pilot work first start with solving two major categories of diseases suffered by children aged 0—14 years (including 14 years): acute leukemia and congenital heart disease, giving priority to selecting 6 diseases for pilots, including childhood acute lymphoblastic leukemia, childhood acute promyelocytic leukemia, childhood congenital atrial septal defect, childhood congenital ventricular septal defect, childhood congenital patent ductus arteriosus, and childhood congenital pulmonary valve stenosis.
Each province (region, municipality) will select 2—3 counties (cities) with a large population participating in the new rural cooperative medical scheme, relatively strong information management capacity, and that have already carried out immediate reimbursement at provincial (municipal)-level designated medical institutions and “one-stop” medical assistance services to carry out the pilot work.
Each province (region, municipality) may also appropriately increase the pilot diseases according to the fund's payment capacity. Increasing pilot diseases should take into account the efficiency of fund use while also considering the fairness of fund use.
On the basis of the pilots, all localities will gradually explore and establish medical compensation methods for major diseases under the new rural cooperative medical scheme, further alleviating the economic burden of major diseases on rural residents.
Reasonably Determine Designated Hospitals
According to the pilot diseases, provincial health administrative departments should select, within their jurisdictions, provincial- and municipal-level new rural cooperative medical scheme designated medical institutions with diagnosis and treatment conditions and high levels of diagnostic and treatment technology as the treating hospitals for the selected diseases, and sign designated medical service agreements with the treating hospitals. County-level new rural cooperative medical scheme designated medical institutions that have the conditions and capacity for diagnosis and treatment may also be selected as treating hospitals for the pilot diseases.
Provincial health administrative departments should, according to the relevant clinical pathways, clinical technical operation standards, or diagnosis and treatment guidelines issued by the Ministry of Health, determine standardized diagnosis and treatment plans for the pilot diseases, and, based on the diagnosis and treatment plans and designated medical service agreements, standardize the medical service behavior of treating hospitals, strengthen supervision, and effectively control the diagnosis and treatment costs of the pilot diseases.
Significantly Increase the Reimbursement Rate
Each province (region, municipality) should, according to the standardized diagnosis and treatment plans for the pilot diseases, calculate and limit the reasonable diagnosis and treatment costs of the corresponding diseases. On the basis of the limited costs, the new rural cooperative medical scheme and medical assistance funds shall implement payment by disease type and significantly increase the reimbursement rate. In principle, the compensation rate of the new rural cooperative medical scheme for the pilot diseases should reach about 70% of the limited costs of the province (region, municipality), and medical assistance shall provide further compensation to eligible patients, with the compensation rate not lower than 20% of the limited costs. Participating patients who receive diagnosis and treatment at the corresponding designated medical institutions within their province (region, municipality) shall enjoy the prescribed compensation.
The Ministry of Health requires that new rural cooperative medical scheme agencies at all levels should follow the principles of convenience and benefit to the people, promptly carry out referral work for participating farmers, and simplify and standardize the settlement and reimbursement process for pilot diseases. Immediate reimbursement at new rural cooperative medical scheme designated medical institutions shall be implemented, together with “one-stop” medical assistance services, so that participating personnel can obtain compensation in a timely manner. The relevant settlement procedures of designated medical institutions shall be simplified, and the funds advanced by medical institutions shall be settled in a timely manner.
While carrying out the pilot work, provincial health and civil affairs departments should actively seek support from local Red Cross or charitable assistance organizations and other organizations for the compensation work for pilot diseases, align with the basic medical security system in terms of project implementation, fund use, and assistance recipients, form a joint force for assistance, explore the establishment of a multi-level rural basic medical security system, and jointly raise the level of security.