Expand the scope of centralized procurement of pharmaceutical consumables, adjust medical service prices, and further expand direct settlement of outpatient fees across provinces... Recently, the General Office of the State Council issued the "Key Tasks for Deepening the Reform of the Medical and Health System in 2022", once again clarifying the reform goals in the medical insurance field this year.

Focus 1: Expand the scope of centralized procurement of pharmaceutical consumables. The task is clear. Continue to carry out centralized bulk procurement of pharmaceutical consumables, expand the scope of procurement, and strive to achieve a total of more than 350 generic names of national and local pharmaceuticals in each province.

This means that centralized drug purchasing will continue to expand, further squeezing the space for gold sales of drugs and expanding the scope of benefits for the common people.

In the past three years, centralized purchasing has entered a stage of normalization and institutionalization. The country has purchased 234 types of drugs in 6 batches of centralized purchasing, and the average number of centralized purchasing varieties in each province has reached 50.

The National Medical Insurance Administration has also made it clear before that centralized drug purchasing will be carried out in all three sectors: chemical drugs, Chinese patent drugs, and biological drugs.

Centralized purchasing not only reduces the price of purchased drugs, but also creates a catfish effect on the drug market.

Judging from the drug price monitoring data carried out by the National Medical Insurance Administration, the overall price level of drugs has continued to decline in the two years of 2019 and 2021, reaching an annual average of about 7%.

In terms of high-value medical consumables, a batch of high-value spinal medical consumables will be purchased at the national level in 2022.

For pharmaceutical consumables with large usage and high purchase amounts outside the national organization procurement, the National Medical Insurance Administration and other departments will guide each province to implement or participate in alliance procurement to implement at least one centralized mass procurement.

Focus 2: Promote medical service price reform Medical service price is an important livelihood price.

The task is clear. All provinces will issue relevant documents on establishing a dynamic adjustment mechanism for medical service prices before the end of June 2022, and remove medical service prices from the list of cost supervision and price hearings before the end of the year.

Previously, eight departments including the National Medical Insurance Administration jointly issued the "Pilot Plan for Deepening the Reform of Medical Service Prices", which clearly stated that through a 3 to 5-year pilot program, we will explore the formation of medical service price reform experience that can be replicated and promoted.

Five cities, Ganzhou, Suzhou, Xiamen, Tangshan and Leshan, have become pilot cities.

In 2022, the National Medical Insurance Administration and other departments will guide local governments to scientifically set the starting conditions, triggering standards and constraints for medical service price adjustments. A price adjustment assessment will be carried out within the year, and prices will be adjusted in a timely manner if conditions are met.

The relevant person in charge of the National Medical Insurance Administration said that while deepening the price reform of medical services, supporting measures will also be continuously improved to ensure the overall stability of the public's burden.

This includes assessing the feasibility of price adjustments, coordinating medical service prices and payment policies, and incorporating price adjustments into the scope of medical insurance payment as required.

Focus 3: Promote diversified and compound medical insurance payment methods. In order to promote the high-quality development of medical insurance, the mission is clear. Promote diversified and compound medical insurance payment methods that focus on payment based on disease type, and carry out grouping based on disease diagnosis in more than 40% of the coordinated areas across the country.

(DRG) payment or disease-based payment (DIP) payment reform work, the proportion of DRG payment or DIP payment medical insurance funds accounting for all eligible hospitalization medical insurance fund expenditures will reach 30%.

The implementation of a diversified and composite medical insurance payment method that focuses on disease-based payment will improve the efficiency of the use of medical insurance funds and reduce the individual burden on patients.

Since 2019, national pilots for DRG payment in 30 cities and national pilots for DIP payment in 71 cities have been launched, playing a positive role in slowing down the growth of medical expenses and standardizing medical behaviors.

According to reports, on the basis of national pilot projects, some provinces have also selected some cities with better basic conditions to carry out pilot projects. There have been more than 200 DRG and DIP pilot projects nationwide.

According to the arrangement, relevant departments will evaluate the pilot cities that have entered the actual payment stage and improve payment policies based on the evaluation results.

Focus 4: Promote the development of a multi-level medical security system. At present, my country has basically established a multi-level medical security system with basic medical insurance as the main body, medical assistance as the underpinning, and supplementary medical insurance.

In 2022, commercial insurance institutions will continue to be supported in developing commercial health insurance products that are connected with basic medical insurance to better cover expenses not covered by basic medical insurance.

In addition, the level of basic medical insurance co-ordination has been steadily improved. Most provinces in my country have implemented municipal-level co-ordination, and provinces such as Beijing, Tianjin, Shanghai, Chongqing and Hainan have explored provincial-level co-ordination.

Next, provincial-level coordination of basic medical insurance will continue to advance.

In terms of direct settlement of medical expenses across provinces and in different places, the direct settlement of outpatient expenses across provinces will be further expanded. At least one designated medical institution in each county can provide direct settlement services for medical expenses, including outpatient expenses, across provinces.

The National Medical Insurance Administration and other departments will also guide various localities to promote the overall outpatient coordination of employee medical insurance, implement differentiated payment policies for medical treatment in primary medical and health institutions, and gradually include general outpatient expenses for frequently-occurring and common diseases into the scope of payment of the overall fund.