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Laws and regulations on medical insurance

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金地新聞千纖筆新聞知(zhī)識科普媒體報道

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Laws and regulations on medical insurance

分(fēn)類：媒體報道
作者：
來源：
發布時間：2018-03-22
訪問量：60

【概要描述】1. Why should we formulate the Interim Measures for the administration of the scope of use of basic medical insurance for urban employees?

Laws and regulations on medical insurance

【概要描述】1. Why should we formulate the Interim Measures for the administration of the scope of use of basic medical insurance for urban employees?

分(fēn)類：媒體報道
作者：
來源：
發布時間：2018-03-22
訪問量：60

詳情

1. Why should we formulate the Interim Measures for the administration of the scope of use of basic medical insurance for urban employees?

The notice on printing and distributing the Interim Measures for the administration of the scope of use of basic medical insurance for urban employees (LDF [1999] No. 15) on may12,1991 clearly stated that "in order to implement the decision of the State Council on establishing the basic medical insurance system for urban employees" (GF [1998] No. 44), "The Interim Measures for the administration of the scope of use of basic medical insurance for urban employees" have been formulated.

Specifically, at present, the number of drugs listed in China is large and there are many varieties. As of 1997, there have been 6391 pharmaceutical manufacturers in China, with a total of 4000 Western pharmaceutical preparations and more than 8000 Chinese patent medicines. Due to the imperfect management of drug circulation system, the price difference between different medical institutions, domestic and imported drugs of the same drug is increasing, and the retail price of some drugs is dozens of times different. In addition, the quality of listed drugs is different, the management of therapeutic and general health care drugs is mixed, which leads to a large amount of waste in the use of drugs. The formulation of the Interim Measures for the administration of the scope of use of basic medical insurance for urban employees can guarantee the basic medical use of the workers, reasonably control the drug costs and standardize the management of the scope of use of basic medical insurance.

2. What are the principles for determining the variety of the drug catalog?

The drug catalogue is the abbreviation of the catalogue of basic medical insurance drugs. Through the formulation of the catalogue, the management of the scope of the basic medical insurance drug use is realized. The principle of determining the varieties of traditional Chinese medicine in the drug catalogue is: "considering the basic needs of clinical treatment, we should also consider the economic differences and drug habits between regions, and attach equal importance to Chinese and Western medicines."

3. What drugs can be included in the selection scope of the drug catalogue?

According to the provisions of Article 3 of the Interim Measures for the administration of the scope of use of basic medical insurance for urban workers, the drugs included in the drug catalogue shall be the drugs necessary for clinical use, safe and effective, reasonable price, convenient to use and can be guaranteed by the market. At the same time, one of the following conditions must be met:

（1） Drugs that meet the standards issued by the State Drug Administration Department;

（2） The state drug regulatory department approves the officially imported drugs;

（3） The drugs contained in the Pharmacopoeia of the people's Republic of China (current edition).

4. What drugs can't be included in the selection scope of the drug catalogue?

According to Article 4 of the Interim Measures for the administration of the scope of use of basic medical insurance for urban workers, the following drugs cannot be included in the scope of selection of the drug catalogue:

（1） Various liquor preparations made from Chinese medicine and Chinese herbal pieces;

（2） Some of the organs of animals and animals that can be used as medicine, dry (water) fruits;

（3） Blood products and protein products (except for special indications, first aid and rescue);

（4） Fruit preparation and oral effervescent agent in various drugs;

（5） The main drugs that play the role of nutrition and nourishing;

（6） Other drugs that the Ministry of labor and Social Security stipulates that the basic medical insurance fund will not pay.

5. What types of drugs does the drug catalog include?

According to the provisions of Article 5 of the Interim Measures for the administration of the scope of use of basic medical insurance for urban workers, the drugs listed in the drug catalogue include western medicine, Chinese traditional medicine (including national medicine), and Chinese herbal medicine Pieces (including national medicine). Western medicine and Chinese patent medicine are listed in the list of drugs approved to be paid by the basic medical insurance fund. The name of the drug is general name and the dosage form is indicated. The Chinese herbal pieces are listed in the list of drugs that are not paid by the basic medical insurance fund, and the name of the drug is Pharmacopoeia.

6. Why should Western medicine and Chinese patent medicine be listed in the list of drugs approved to be paid by basic medical insurance fund?

Western medicine and Chinese patent medicine are listed in the list of drugs approved to be paid by basic medical insurance fund, and are classified into "category a catalogue" and "category B catalogue". Because their pharmaceutical components and treatment indications are relatively clear, the dosage form, dosage, specification and price of the drugs are clearly defined. At the same time, they are widely used and have good curative effect, It is necessary or available for clinical treatment.

7. Why is Chinese herbal medicine slices listed in the list of drugs that the basic medical insurance fund does not pay?

The drugs included in the "drug catalogue" must be necessary, safe and effective drugs in clinical practice. However, the source of Chinese herbal pieces is wide, the variety of medicines is various, and there is no clear dosage and specification. At the same time, considering the compatibility characteristics of traditional Chinese medicine in China, the Chinese herbal pieces do not meet the above conditions, so they are listed in the list that cannot be paid.

8. What living services and facilities are not covered by basic medical insurance?

According to the opinions on determining the scope and payment standard of basic medical insurance medical service facilities for urban employees, the basic medical insurance medical service facilities refer to the living service facilities provided by designated medical institutions. The life service facilities necessary for the insured personnel in the process of receiving diagnosis, treatment and nursing, mainly include the hospitalization bed fee and the door (emergency) diagnosis and retention bed fee. For the expenses of daily necessities, transportation supplies in hospital, water and electricity that have been included in the bed fee or door (emergency) room fee, the basic medical insurance fund shall not pay separately, and the designated medical institutions shall not charge the insured personnel separately.

The expenses of living services and service facilities that the basic medical insurance fund does not pay include the following five categories:

（1） The expenses of accompanying, labor, cleaning and treatment, and decocting medicine in outpatient department;

（2） Meal expenses;

（3） Air conditioning, TV, telephone, baby incubator, food, electric stove, refrigerator and damages to public property;

（4） Transportation and first aid vehicle fee for referral;

（5） Entertainment and other special living services.

Meanwhile, due to the differences in living environment and economic level of different regions, whether other medical service facilities (such as heating fees, etc.) are included in the payment scope of basic medical insurance fund shall be stipulated by the labor security administrative departments of each province (autonomous region and municipality directly under the central government).

9. What is the standard of bed fee payment in basic medical insurance? How to determine?

The standard for payment of bed fee for basic medical insurance in hospital shall be determined by the labor security administrative department of all regions in accordance with the standard of bed fee of general inpatient ward stipulated by the provincial price department. The standard for the payment of bed fee for the patients in need of isolation and critical care shall be determined by the overall planning area according to the actual situation.

The establishment of this standard mainly refers to the provisions of the public and labor insurance medical system on reimbursement of bed expenses in general ward. On the one hand, it is suitable for the conditions of the primary stage of socialism in China, and on the other hand, it is consistent with the basic medical insurance principle.

10. What is the standard of payment for the basic medical insurance door (emergency) diagnosis and retention bed fee?

The payment standard of the basic medical insurance door (emergency) outpatient and observation bed fee shall be determined according to the charging standard stipulated by the provincial price department, but it cannot exceed the payment standard of the bed fee of the basic medical insurance inpatient.

11. How to ensure that the insured get the appropriate medical service facilities when they visit the hospital?

According to the opinions on determining the scope and payment standard of basic medical insurance medical service facilities for urban employees, in order to ensure that the insured personnel get the appropriate medical service facilities in time, designated medical institutions must disclose the bed charge standard and the basic medical insurance bed fee payment standard. When arranging the ward or door (emergency) diagnosis and leaving the observation bed, the designated medical institutions must disclose the bed charge standard and the basic medical insurance bed fee payment standard, The insured or their family members shall be informed of the rate of bed charges arranged. The insured can choose different ward or door (emergency) room to stay at the hospital room according to the suggestion of designated medical institution. For the reasons of tight bed or other reasons, when the designated medical institution must arrange the insured in the super standard ward, the consent of the insured or his or her family members shall be obtained first.

12. Why are various health examination not included in the scope of basic medical insurance diagnosis and treatment items?

According to the opinions on the management of basic medical insurance diagnosis and treatment project of urban employees, the basic medical insurance diagnosis and treatment project refers to various medical technical labor projects that meet the following conditions and the diagnosis and treatment items carried out by using medical instruments, equipment and medical materials:

（1） The price department has formulated the charging standards;

（2） The clinical diagnosis is necessary, safe and effective, and the cost is appropriate;

（3） Within the scope of designated medical services provided by designated medical institutions for the insured.

Combined with the above conditions, in the appendix of the opinion "scope of national basic medical insurance diagnosis and treatment project", several non disease treatment including various health examination shall be included in the scope of the diagnosis and treatment items that are not paid by the basic medical insurance. At the same time, this provision is the continuation of the public fee and labor insurance medical policy in the past.

The physical examination is divided into general health examination and special purpose physical examination. General health examination is a general survey measure for preventive diseases organized by each employer for early detection and early treatment of diseases. The medical examination funds are borne by all employers and not paid in public expenses and labor insurance medical expenses; Special purpose health examination is the physical examination conducted by employees according to certain requirements, such as the physical examination conducted by employees in job hunting, going abroad, purchasing commercial medical insurance and other activities. The expenses are generally borne by individuals. Therefore, after the reform of medical insurance system, various health examination items are not included in the scope of basic medical insurance diagnosis and treatment, but the expenses for health examination organized by the units are borne by the employer; The cost of special purpose physical examination originally paid by the individual shall still be paid by the individual.

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