Less than 20% of children with poor leukemia are reimbursed for medical insurance, and it is difficult to report imported drugs.

On May 28th, the China Red Cross Foundation and the Youth Research Institute of China Youth University for Political Science jointly released the Investigation Report on the Living Conditions of Poor Leukemia Children in China (hereinafter referred to as the Report). The report shows that medical insurance only accounts for 13.87% of children's treatment expenses. At the moment when the cure rate is nearly 70%, 40% of children with leukemia cannot receive transplantation because of poverty.

It is difficult to reimburse for treatment in different places

Some families need cross-provincial treatment in order to seek better therapeutic effects for their children, but these provincial and municipal hospitals have low reimbursement rates, high deductible lines and even cannot reimburse them.

In July last year, at the kick-off meeting of the leukemia rescue action project initiated by a non-profit organization, the father of a non-Beijing-born leukemia child asked: "My hometown can't cure my son's illness, and it is difficult to reimburse him for the high cost of treatment in Beijing. When will this problem be solved? "

No one responded at the scene.

At present, China's new rural cooperative medical system has different reimbursement rates for different places, different levels of hospitals and different types of leukemia.

The reimbursement rate of provincial and municipal hospitals is lower than that of counties and towns. In addition, it can only be reimbursed if it is referred to a medical institution in another place according to regulations. For direct medical treatment in different places, you need to go back to the insured place to go through the formalities within the specified time.

Chen Tao, a professor at the Youth Research Institute of China Youth University for Politics, who is in charge of the report, pointed out that the purpose of this system is to encourage nearby medical treatment and reduce unnecessary medical expenses, which is understandable.

However, under the current medical conditions in China, municipal hospitals are the first-class hospitals with the least conditions to treat leukemia, and patients can only choose municipal and provincial hospitals.

Some families even need cross-provincial treatment in order to give their children better treatment, but the reimbursement rate is low and the deductible line is high, and even medical institutions at these levels cannot reimburse them.

The report found that some parents finally gave up reimbursement because of complicated procedures, time-consuming and laborious work, low reimbursement rate and children's need for care.

From August 2065438 to August 2002, the National Development and Reform Commission, the Ministry of Health and the Ministry of Finance jointly issued the Guiding Opinions on Developing Serious Illness Insurance for Urban and Rural Residents, and various localities successively issued implementation measures, but there was still no obvious breakthrough in limiting the proportion of reimbursement for leapfrog and off-site treatment.

"Our children are treated in Beijing, and many of them can't be reimbursed when they go out of the province. Once they spent more than 300,000 yuan on surgery, thinking that they could at least reimburse100,000. I didn't expect to underreport 30,000 to 50,000. " A parent of a non-Beijing child said.

Down payment is often deducted.

Even if children with leukemia recover well, they should be hospitalized at least four times a year, that is to say, 2000 yuan and 3000 yuan will be deducted for reimbursement four times, which is enough for a new course of treatment.

Leukemia usually takes two to three years of treatment. Children who are mainly treated with chemotherapy have to go through several hospitalizations from the first half month and once a month to the next two months and four months. Under normal circumstances, the cost of each hospitalization chemotherapy will not be too high.

At present, medical reimbursement in China is based on the standard of one-time admission.

Taking Henan Province as an example, starting from 20 12, the new rural cooperative medical system in Henan Province introduced a new policy. If the one-time hospitalization expenses exceed 60,000 yuan, the hospitalization expenses within the scope of the new rural cooperative medical system will be compensated according to the proportion of 80% after deducting the deductible in the corresponding medical institution. If the one-time hospitalization expense exceeds 654.38+10,000 yuan, after deducting the deductible, it will be compensated according to the proportion of 90%. Although the reimbursement rate is higher than in the past, for patients who need to be hospitalized many times, they still can't get high compensation because they can't meet the prescribed standards every time.

According to the policy of Luoyang new rural cooperative medical system, the deductible line for hospitalization reimbursement in provincial hospitals is 2000 yuan, and that for inter-provincial hospitals is 3000 yuan.

"At present, even if the child recovers well, he will be hospitalized at least four times a year, which means that the reimbursement will be deducted for four times, 2,000 yuan and 3,000 yuan, which is enough for a new course of treatment." Chen Tao said.

In response to this policy, Chen Tao said that although the policy has taken into account the one-time cost of major surgery, if the cost of secondary treatment can be adjusted to the total annual medical expenses, it will have a better guarantee effect.

When asked about the reimbursement rate, the parents of a Guangdong child said: "The insurance stipulates that reimbursement will be made after each hospitalization. After deducting the minimum payment and self-funded medical expenses, the reimbursement will be tens of dollars, and we will not report it. "

The upper limit of medical insurance is low, and it is difficult to report imported drugs.

For children with low resistance and poor blood items after chemotherapy, many drugs are used outside the catalogue. Due to the need for regular chemotherapy, the actual reimbursement rate is very low, and deductibles and self-funded drugs are deducted every time.

According to the new medical reform policy of 20 12, the reimbursement rate of children with acute lymphoblastic leukemia and acute promyelocytic leukemia can reach 70%, and the reimbursement rate of special poor families can reach 90%.

However, the report shows that although the proportion of reimbursement has increased, due to the limitation of economic level, the total amount of medical insurance ceiling set in most areas is still low, and it is reimbursed in proportion within a limited amount, and the excess is still borne by individuals. At present, the upper limit of 74.34% medical insurance reimbursement is 50,000 to 65,438+10,000 yuan.

However, in the treatment period of two to three years for a leukemia child, the treatment cost is usually 6.5438+10,000 to 300,000 yuan, and the bone marrow transplant cost is about 300,000 to 6.5438+100,000 yuan. The actual medical expenses of children who have completed hematopoietic stem cell transplantation average 580,000 yuan, which is much higher than the capping line of 654.38+10,000 yuan a year.

In addition, because medical insurance only reimburses drugs in the prescribed list, many imported drugs are not in the list for children with low resistance and poor blood items after chemotherapy. Due to the need for regular chemotherapy, except deductible and self-funded drugs, the actual reimbursement rate is very low.

According to the report, the sources of treatment expenses for children with leukemia are financial support from relatives and friends, family income, medical insurance and donations from foundations and caring people. Medical insurance only accounts for 13.87%.

Liu Daihong, chief physician of the hematology research group of Beijing People's Hospital, said that chemotherapy and hematopoietic stem cell transplantation can alleviate 80% to 90% of leukemia and cure about 60% to 70% of patients.

Although the cure rate is close to 70%, the report points out that only 30.8 1% of the children who need hematopoietic stem cell transplantation have completed the transplantation. In the group with incomplete transplantation, 62.59% children thought the cost was too high to bear, accounting for 43.3% of all children.

This policy does not cover children aged 14 to 18.

For diseases with high treatment costs and more than 1 10,000 new cases each year, charitable organizations are required to have a relatively strong source of funds. Except the Little Angel Fund, which can help thousands of children with leukemia every year, other charitable organizations can only help hundreds or even dozens of people.

Leukemia is the most common malignant tumor disease in children and adolescents.

According to the China Cancer Registry Annual Report 20 1 1, the incidence of leukemia in children aged 0- 14 is 3.44/100000, and that in adolescents aged 0- 19 is 3.29/100000.

At present, China's medical insurance policies include new rural cooperative medical care, basic medical insurance for urban residents, urban and rural medical assistance and other policies.

The Guiding Opinions on Carrying out Serious Illness Insurance for Urban and Rural Residents issued on 20 12 has included childhood leukemia in the national coverage and carried out the pilot rescue work for chronic myeloid leukemia. However, this policy is only for children under 14, and there is a gap in the policy for minors under 14 to 18.

In order to make up for the lack of policies, many social organizations have intervened in this blank field.

China Red Cross Foundation's Little Angel Fund, New Sunshine Charity Foundation's "Relief Action for Children with Leukemia at the Age of 0‐8", Shenhua Charity Foundation's "Shenhua Love Action" and Wanda Charity Action have all carried out special relief for leukemia children.

The leukemia rescue project of China Siyuan Engineering Foundation for Poverty Alleviation is aimed at poor leukemia college students who have grown up but have no independent economic foundation.

"Although there are private forces involved, charitable organizations are required to have a relatively strong source of funds for diseases with high treatment costs and more than 1 10,000 new cases every year. Therefore, in addition to the Little Angel Fund, which can help thousands of children with leukemia every year, other charitable organizations can only help hundreds or even dozens of people. " Chen Feng said.

According to Li Xiaolin, vice chairman and secretary general of Siyuan Foundation, at present, due to various reasons, chronic myeloid leukemia and chronic lymphocytic leukemia have not been included in the scope of government protection. "Although national charities and caring people help the families of leukemia patients through various channels, their efforts are still limited." Li Xiaolin said.

The government should buy services from social organizations.

The government should open the rescue space of childhood leukemia to social organizations through financial support and policy purchase from the central government to the local government, so that social organizations can complete it.

In view of the high cost of treatment for childhood leukemia, Chen Tao said that because leukemia is a special disease with long treatment cycle and high cost, the government should consider comprehensive balance when formulating policies. If we are inclined to this disease, it may lead to policy imbalance for other diseases. Therefore, the root cause of this phenomenon is that there is no substantive child welfare policy in China.

"In many developed countries, children's groups enjoy priority. Even if medical equity is not fully realized, we can try our best to approach it. Consider children first as much as possible. " Chen Tao said.

The reform of medical policy and the emergence of child welfare policy will be a long-term process. Prior to this, Chen Tao suggested that the government should open up the rescue space for childhood leukemia to social organizations. "Through financial support and policy purchase from the central government to the local government, the government can do things that are not good for social organizations."

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.