The national reimbursement for acute leukemia is 1-2%.

Less than 2% 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 Politics jointly released the Investigation Report on the Living Conditions of Children with Poor Leukemia in China (hereinafter referred to as the Report). According to the Report, medical insurance accounts for only 13.87% of the children's treatment expenses. At the moment when the cure rate is nearly 7%, 4% of children with leukemia cannot undergo 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 effect for their children, but the reimbursement rate in these provincial and municipal hospitals is low, the deductible line is high, and even they cannot be reimbursed.

In July last year, at the launch conference of leukemia rescue action project initiated by a public welfare organization, a 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 medical treatment in Beijing. When will this problem be solved?"

there was no response at the scene.

At present, the reimbursement rates of the new rural cooperative medical system in China are different for different places, different levels of hospitals and different types of leukemia.

The reimbursement rate of large hospitals at provincial and municipal levels is lower than that at county and town levels. In addition, reimbursement can only be given if it is referred to a medical institution in a different place according to regulations. If you seek medical treatment directly in a different place, 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 it is understandable that this system is designed to encourage nearby medical treatment and reduce unnecessary medical expenses.

However, under the current medical conditions in China, municipal hospitals are the lowest level hospitals with conditions for treating leukemia, so patients can only choose municipal and provincial hospitals.

Some families even need cross-provincial treatment in order to give their children better treatment. However, the reimbursement rate in these levels of medical institutions is low, and the deductible line is high, or even cannot be reimbursed.

The Report found that some parents finally gave up reimbursement due to complicated procedures, time-consuming and laborious procedures, low reimbursement rate, and the need to take care of their children.

In August, 212, six ministries and commissions, including the National Development and Reform Commission, the Ministry of Health and the Ministry of Finance, jointly issued the Guiding Opinions on Carrying out Serious Illness Insurance for Urban and Rural Residents, and various localities successively issued implementation measures, but there was still no obvious breakthrough in the limitation of reimbursement ratio for leapfrog and off-site treatment.

"Our children were treated in Beijing, and many of them could not be reimbursed outside the province. Once, they spent more than 3, yuan on an operation, thinking that they could be reimbursed at least 1, yuan. I didn't expect that they only reported less than 3, yuan or 5, yuan." A parent of a non-Beijing child said.

The initial payment is frequently deducted

Even if the children with leukemia recover well, they have to be hospitalized at least four times a year, which means that four RMB 2, and RMB 3, will be deducted during reimbursement, which is enough for a new course of treatment.

Leukemia usually needs two to three years of treatment. Children who are mainly treated with chemotherapy have to go through several hospitalizations from the first half a 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.

Take Henan Province as an example. Since 212, the new rural cooperative medical system in Henan Province has introduced a new policy. If the one-time hospitalization expenses exceed 6, yuan, the hospitalization expenses within the scope of the new rural cooperative medical system will be compensated at the rate of 8% after deducting the deductible line from the corresponding medical institutions. If the one-time hospitalization cost exceeds 1, yuan, after deducting the deductible, 9% of the expenses will be compensated. 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 new rural cooperative medical system policy in Luoyang, the deductible line for hospitalization reimbursement in provincial hospitals is 2, yuan, and if it is across provinces, it is 3, yuan.

"At present, even if the child recovers well, he has to be hospitalized at least four times a year, which means that four RMB 2, and RMB 3, will be deducted from the reimbursement, 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, it will have a better guarantee effect if the cost of secondary treatment can be adjusted to the total annual medical expenses.

When asked about the reimbursement ratio, a Guangdong child's parents said: "The insurance stipulates that reimbursement will be made after each hospitalization. After deducting the minimum payment and the self-funded medicine fee, the reimbursement will be tens of yuan, so 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, with deductible and self-funded drugs deducted each time.

according to the new policy of medical reform in 212, the reimbursement rate for children with acute lymphoblastic leukemia and acute promyelocytic leukemia has reached 7%, and the reimbursement rate for particularly poor families can reach 9%.

However, according to the Report, although the reimbursement rate has increased, due to the limitation of economic level, the total amount of medical insurance set in most areas is still low, and reimbursement is made in proportion within the limited amount, and the excess is still borne by individuals. At present, 74.34% of the medical insurance reimbursement has an upper limit of 5, to 1, yuan.

In the treatment period of two to three years for a leukemia child, the cost of treatment usually reaches 1, to 3,, and the cost of bone marrow transplantation is about 3, to 1 million yuan. The actual medical expenses of children who have completed hematopoietic stem cell transplantation are 58, yuan on average, which is much higher than the capping line of 1, yuan a year.

In addition, because medical insurance only reimburses drugs in the prescribed list, many imported drugs are out of the list for children with low resistance and poor blood items after chemotherapy. Due to the need for regular chemotherapy, the actual reimbursement rate is very low except deductible and self-funded drugs.

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

Liu Daihong, chief physician of hematology research group of Beijing People's Hospital, said that nowadays, 8% to 9% of leukemia can be alleviated by chemotherapy and hematopoietic stem cell transplantation, and about 6% to 7% of patients can be cured.

although the cure rate is nearly 7%, the report points out that only 3.81% of the children who need hematopoietic stem cell transplantation have completed the transplantation. In the group that didn't complete the transplant operation, 62.59% of the children were too expensive and unbearable, accounting for 43.3% of the whole children.

The policy does not cover children aged 14 to 18

For diseases with high treatment costs and more than 1, new cases every year, charitable organizations are required to have a relatively strong source of funds. Except for 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 a malignant tumor disease with the highest incidence among children and adolescents.

According to the 211 Annual Report of Cancer Registration in China, the incidence of leukemia in children aged -14 years in China is 3.44/1,, and that in adolescents aged -19 years is 3.29/1,.

At present, China's medical insurance policies include the new rural cooperative medical system, 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, published in p>212, included childhood leukemia in the scope of national protection, and carried out the pilot rescue work for chronic myeloid leukemia. However, the policy is only for children under 14 years old, and there is a gap in the policy for minors between 14 and 18 years old.

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

The leukemia relief project of China Siyuan Engineering Foundation for Poverty Alleviation aims at the leukemia patients of poor college students who have reached adulthood but have no independent economic foundation.

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

According to Li Xiaolin, vice chairman and secretary general of Siyuan Foundation, for various reasons, chronic myeloid leukemia and chronic lymphocytic leukemia have not been included in the scope of government protection. "Although charities and caring people all over the country help families of leukemia patients through various channels, their strength is still limited." Li Xiaolin said.

the government should purchase services from social organizations

the government should open the rescue space for children's leukemia to social organizations through financial support from the central government to local governments and policy purchase, so that social organizations can complete it.

In view of the high cost of treatment for children with leukemia, Chen Tao said: Because leukemia is a special disease with long treatment cycle and high cost, the government should consider comprehensive balance when formulating policies. If it is biased towards this disease, it may lead to an imbalance in policies on other diseases. Therefore, the fundamental reason for this phenomenon is that there is no substantive welfare policy for children in China.

"In many developed countries, children are given priority. Even if medical equity is not fully achieved, we can try our best to approach it. As far as possible, children should be given priority." Chen Tao said.

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

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