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Will PETCT be reimbursed by medical insurance in 2021?

Report.

PETCT can be said to be very popular in recent years, and more and more hospitals are gradually adding this equipment to examine tumors.

Because of its ability to detect tumors, it is also recognized and adopted by everyone.

A petct examination identifies the whole body and can detect all lesions, etc. However, this examination is not cheap, it is still a bit expensive!

Many patients feel that since it is too expensive, they do not undergo this examination.

PET-CT is a whole-body CT examination method after injecting contrast agent. It can detect diseases in many parts of the body, especially small changes or metastatic lesions. The cost of this examination is generally more than 10,000, and many medical insurance departments do not

For reimbursement, if there is no obvious condition, there is generally no need to do a PET-CT examination. You can do a regular CT or MRI examination, and these examinations can be reimbursed.

Because PETCT is a newly introduced advanced foreign equipment, and my country's current heavy medical burden can only provide basic medical insurance, PETCT examination has not yet been included in my country's medical insurance policy.

In fact, the current PET-CT examination prices in domestic hospitals are different from hospital to hospital. The national petct examination price ranges from about 7,000 to 13,000.

In the "Guiding Opinions of the General Office of the State Council on Establishing and Improving the Financial Security Mechanism for Employee Basic Medical Insurance Outpatient Clinics", a very important point is put forward, that is, all unit contributions of active employees will be included in the overall fund, which is mainly used to support

Improve outpatient financial security and improve outpatient benefits.

In other words, after the reform, some outpatient clinics with serious health damage and heavy cost burdens, as well as general outpatient expenses for chronic diseases, frequently-occurring diseases and common diseases will be gradually included in the overall fund payment.

As we all know, the examination fees for various medical devices are the most important part of outpatient medical expenses. Once this part of the examination fees is included in medical insurance reimbursement, it will inevitably stimulate a significant expansion of patients' consumption demand for medical devices, which means that hospitals purchase medical devices.

Demand will increase significantly.

Moreover, according to the unified deployment of the National Medical Insurance Administration, the national pilot of DRG payment and the actual payment of DIP payment pilot will be implemented before the end of 2021.

After the reform of the medical insurance payment method, the original "based on service quantity" has been changed to "based on service quality/value", thus forcing the hospital's most important profit source imaging, IVD and other testing items to become the cost side of the hospital.

Especially with the maturity of centralized purchasing methods such as medicines and consumables, medical insurance fee control will inevitably gradually transition to active fee control by hospitals, thereby reducing costs and increasing efficiency.

As a result, hospitals that were keen to spend money on imported medical equipment will gradually choose domestically produced medical equipment that is relatively cheaper and more cost-effective, especially some high-cost large-scale medical equipment.