Read in Chinese

Speakers:

Mr. Hu Jinglin, administrator of the National Healthcare Security Administration (NHSA)

Mr. Shi Zihai, vice administrator of the NHSA

Ms. Li Tao, vice administrator of the NHSA

Mr. Huang Huabo, vice administrator of the NHSA

Chairperson:

Ms. Xing Huina, deputy director general of the Press Bureau of the State Council Information Office (SCIO) and spokesperson of the SCIO

Date:

May 18, 2023

Xing Huina:

Ladies and gentlemen, good afternoon. Welcome to this press conference held by the State Council Information Office (SCIO). This is the 16th briefing in the series "Embarking on the New Journey — A Government Perspective." Today, we have invited Mr. Hu Jinglin, administrator of the National Healthcare Security Administration (NHSA), to brief you on implementing the major decisions of the 20th National Congress of the Communist Party of China (CPC) and promoting the high-quality development of healthcare security. He will also take your questions. Also joining us today are three vice administrators of the NHSA, Mr. Shi Zihai, Ms. Li Tao, and Mr. Huang Huabo.

Now, I'll give the floor to Mr. Hu Jinglin for a brief introduction.

Hu Jinglin:

Ladies and gentlemen, friends from the media, good morning. It is my pleasure to meet you here. To begin with, on behalf of the NHSA, I would like to express my heartfelt gratitude to our journalist friends for their long-term support for the healthcare sector's development as well as their work to communicate and explain related policies.

In 2018, the CPC Central Committee with Comrade Xi Jinping at its core strategically decided to establish the NHSA. Since the institute's establishment, China's healthcare security system has focused on the major political task put forward by General Secretary Xi Jinping of "relieving people of worries about diseases and healthcare services." It has remained committed to the people-centered approach, overcome difficulties to promote systemic and institutional reforms, and made historic breakthrough in the domestic healthcare security sector. It has also played a vital role in resolving the problem of difficult and expensive access to medical treatment. Moreover, it has supported the development of the healthcare sector, safeguarding social harmony and stability, and helping to achieve the goal of common prosperity.

Over the past five years, the NHSA has made stability our top priority and established the world's largest basic healthcare security network. From 2018 to 2022, medical insurance coverage was maintained at around 95%. Meanwhile, the reimbursement rate for hospitalization expenses covered by related policies for urban workers reached 80% and around 70% for rural and non-working urban residents. The level of basic medical insurance coverage for low-income rural residents and people no longer in poverty has been maintained at over 99%, and medical insurance has successfully helped nearly 10 million poor households shake off poverty. The annual revenue of basic medical insurance funds, including maternity insurance, increased from 2.14 trillion ($302.56 billion) to 3.09 trillion yuan, and annual expenses rose from 1.78 trillion to 2.46 trillion yuan. The fund operates in a stable manner with a surplus. The annual per capita government subsidy for insured residents rose from 490 yuan to 610 yuan. In 2022 alone, government subsidies in this regard reached 600 billion yuan.

Over the past five years, the NHSA has been committed to bringing benefits to the public and strived to reduce people's burden on seeking medical treatment. The NHSA has expedited negotiations on insured medicines. Many exclusive varieties of anti-cancer and rare disease drugs, such as carrelizumab and nusinersen, have been included in the national medical insurance system at reasonable prices. This has reduced patients' medical expenses by more than 500 billion yuan after reimbursement and helped tens of millions of people suffering from serious illness and their families regain hope for life. The NHSA has worked to make bulk government purchases of medicines and medical consumables. Under the bulk government purchase scheme, the price of 333 medicines has declined by 50% on average. In addition, eight high-value medical consumables, such as heart stents and artificial joints, dropped by over 80% on average. Meanwhile, the NHSA has collaborated with local regions on drug-procurement programs, which has reduced related expenses by nearly 500 billion yuan. The NHSA has reformed insurance measures for people suffering from chronic diseases by including outpatient medicine expenses for hypertension and diabetes in national medical insurance, which has benefitted 140 million people with chronic diseases. The NHSA has continued to streamline procedures for settling healthcare costs directly where incurred. The scale of interprovincial on-the-spot settlement of medical bills has surged from 1.32 million applications in 2018 to 38.12 million in 2022, a 28-fold increase. In the face of the COVID-19 pandemic, the NHSA decisively implemented the policy of ensuring that patients will not be denied timely treatment due to medical costs and that the medical treatment at designated medical institutions is not affected due to healthcare insurance budget concerns. The NHSA also guaranteed the affordability of COVID-19 vaccines and vaccination services, contributing to the decisive victory of pandemic prevention and control. Additionally, the NHSA has kept extending pilot long-term care insurance schemes. Today, the schemes have covered 169 million people in 49 cities and benefitted 1.95 million people with disabilities, bringing quality and dignity to their lives.

Over the past five years, the NHSA has adhered to an innovation-driven approach and promoted the high-quality development of the pharmaceutical industry. The NHSA has encouraged research and development (R&D) and innovation in the sector and established a medical insurance access and negotiation renewal mechanism focusing on new drugs. Nowadays, it only takes two years on average for new drugs to be included in the medical insurance catalog, which is much shorter than the five-year time on average in the past. Some new drugs were included in the catalog after only six months on the market. Medical insurance expenditure on new drugs has increased from 5.95 billion yuan in 2019 to 48.19 billion yuan in 2022, a 7.1-fold increase. The NHSA has expanded the sales channels of insured drugs after medical insurance negotiations. Through a dual-channel management mechanism, some of these drugs that were mainly available in large hospitals are now also available in 155,000 designated medical insurance pharmacies and reimbursed by the health insurance fund. The NHSA has worked to ensure a clean environment for the pharmaceutical industry. By launching bulk government purchases institutionally and regularly, the NHSA has worked continuously to address the inflated price of medicines and medical consumables and avoid sales activities that take kickbacks from pharmaceutical companies. The innovation momentum of pharmaceutical companies keeps growing. The total R&D investment of the top 10 pharmaceutical companies in the A-share market by market value is 2.48 times that of 2018.

Over the past five years, the NHSA has followed a systemic and integrated philosophy and worked for the coordinated development and management of healthcare services, medical insurance, and medicine. The NHSA has supported the work to improve the wage compensation mechanism for medical workers and to clarify the fund surplus of public medical institutions due to bulk government purchases and medical insurance payment reforms, which can be used for staff salary expenses. The NHSA has worked to reform the mechanism of medical insurance fund allocation. Most regions under unified management have established a medical insurance fund flow system. Under the system, medical insurance funds are prepaid to medical institutions at the beginning of each year, which has reduced the pressure on hospitals to make advance payments. The NHSA has comprehensively established a dynamic adjustment mechanism for medical service prices. In addition to significantly reducing the price of medicines and medical consumables, the NHSA has also adjusted the prices of hospital service items, such as surgeries and traditional Chinese treatments, which reflect the value and capability of technical labor. The NHSA has supported the high-quality development of public hospitals. The NHSA has also supported the development of primary-level medical institutions. By increasing the medical insurance reimbursement rate and lowering the deductible line of medical treatment expenses at primary-level hospitals, the NHSA has worked to guide patients to purchase medicines and take healthcare services in these hospitals. The NHSA has established a medical insurance fund supervision system with proactive measures and a human touch. The NHSA has dealt with 1.54 million illegal medical insurance-related cases, and institutions recovered 77.13 billion yuan of medical insurance funds and exposed 245,000 typical cases. For medical institutions that take the initiative to conduct self-examination and self-correction, the NHSA has offered them leniency in accordance with the law. The NHSA has also made every effort to promote the standardization of diagnosis and treatment behaviors.

In summary, over the past five years, significant progress has been made in the coordinated development and governance of medical insurance, medical services, and pharmaceuticals. This has led to a win-win situation where the public benefits, the funds are more secure, hospitals are experiencing development, and enterprises are witnessing growth.

Ladies and gentlemen, friends from the media, these achievements are fundamentally attributed to the leadership of General Secretary Xi Jinping at the core of the Party and its Central Committee and the science-based guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era. As we embark on the first year of fully implementing the guiding principles of the 20th CPC National Congress, the NHSA will adhere to the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era. We will seize the themed education campaign as an opportunity to comprehend the tasks and requirements put forward during the 20th CPC National Congress on healthcare security and strive to create a new era in which healthcare security brings more benefits and convenience to the general public.

Next, my colleagues and I are ready to answer your questions. We look forward to exchanging ideas with you. Thank you.

Xing Huina:

Thank you, Mr. Hu, for your opening remarks. The floor is now open to questions. Please identify the media outlet you represent before raising your questions.

CCTV:

As we know, healthcare security plays a pivotal role in preventing individuals from descending into or reverting back to poverty due to illness. Could you elaborate on the specific measures you have taken to tackle these issues? What additional measures will you take to consolidate the progress made in poverty reduction and stimulate rural revitalization? Thank you.

Hu Jinglin:

Thank you. I'll take this question.

Since the 18th CPC National Congress, the CPC Central Committee with Comrade Xi Jinping at its core has led the Chinese people in winning the battle against poverty, putting an end to the long-standing issue of absolute poverty that has plagued the Chinese nation for thousands of years. This remarkable achievement is nothing short of a miracle in human history. As General Secretary Xi Jinping pointed out, "Being lifted out of poverty is not an end in itself but the starting point of a new life and a new pursuit." Following the successful poverty alleviation campaign, the healthcare security departments have been resolutely implementing the decisions made by the CPC Central Committee and the State Council in synchronizing poverty alleviation with rural revitalization. We have continuously deepened the reform in the healthcare security system, steadfastly provided basic healthcare security to low-income rural residents, and ensured that individuals do not fall back into poverty on a large scale due to illness.

First, we have ensured key populations are provided with comprehensive healthcare. The central government has consistently increased subsidies for residents' medical insurance. It also offers targeted financial assistance to individuals facing extreme difficulty, recipients of subsistence allowances, and those who have fallen back into poverty or are at risk of falling back into poverty. It also ensures that rural low-income individuals can access institutional safeguards for medical treatment. In 2022, 97.66 million people in need received subsidies, and the insurance participation rate among rural low-income individuals remained stable at over 99%.

Second, we have strengthened the effectiveness of the three-tier relief system. This system encompasses basic medical insurance, serious illness insurance, and medical assistance. First, we strive to maintain a stable level of inpatient benefits for basic medical insurance and improve the mechanism for outpatient mutual aid. Second, we enhance the reimbursement levels for residents facing major illnesses while implementing targeted and preferential payment measures for special vulnerable groups. Third, we reinforce the medical insurance and assistance system for major and catastrophic diseases, ensuring comprehensive safeguarding measures are in place. According to monitoring data, in 2022, the three-tier relief system benefited rural low-income individuals with 145 million outpatient visits, alleviating their financial burdens by 148.7 billion yuan.

Third, we have improved our long-term mechanisms to prevent people from falling back into poverty because of illness. We are guiding regional departments in monitoring and issuing early warnings for patients burdened by high medical expenses. We promptly included eligible individuals under key monitoring into the scope of medical assistance and coordinated with relevant departments to provide comprehensive support. Since 2021, over 7.4 million warning messages have been sent nationwide. Additionally, we have adjusted the healthcare insurance catalog and implemented regular volume-based procurement of pharmaceuticals and medical supplies to reduce healthcare costs for low-income rural residents.

Moving forward, we will resolutely implement the decisions and arrangements of the CPC Central Committee and the State Council. Building on the achievements of "guaranteeing access to basic medical services," we will actively promote healthcare security to support the comprehensive revitalization of rural areas. Our key priorities include the following: First, we aim to establish a diversified medical assistance system, perfect a unified and standardized medical assistance system, and coordinate efforts to improve assistance for families grappling with major illnesses. Second, we will strengthen the comprehensive support mechanism for patients burdened with high medical expenses by engaging various social forces such as charitable organizations, commercial health insurance, and mutual medical aid to better harness collective support. Third, we will consolidate and expand the achievements in poverty alleviation through healthcare insurance by establishing liaison offices, learning from local best practices, and exploring targeted assistance initiatives to support key counties in the national rural revitalization campaign through healthcare security. Thank you!

Beijing Youth Daily:

We understand the safe and stable operation of medical insurance funds is directly linked to the vital interests of every insured individual. My question is, what measures have you taken, since 2018, to combat insurance fraud? What follow-up measures will be taken to protect the money that people rely on to pay their medical bills? Thank you. 

Hu Jinglin:

Thank you for raising this crucial question. Medical insurance funds are vital in providing financial support for healthcare expenses. The NHSA has been diligently implementing Comrade Xi's instructions and considers the supervision and protection of medical insurance funds our top priority. We have taken strong actions to combat any fraudulent or unlawful use of these funds, ensuring that they do not become a source of misuse or exploitation.

After five years of efforts, we have employed a comprehensive approach, combining multiple strategies, to establish a stringent oversight system for medical insurance funds.

First, we have carried out flight checks in a targeted manner to uncover illegal and non-compliant behaviors. We have adopted the mechanism of "no prior notification, top-down and cross-checking," which addressed the issue of ineffective oversight at the same level due to familiarity among parties. As a result, we have struck a heavy blow to unlawful and non-compliant behaviors, showcasing the role of flight checks as an effective tool. Additionally, we have encouraged designated medical institutions to learn from their mistakes and conduct self-examination to prevent similar illegal and non-compliant behaviors. Medical institutions that take the initiative to conduct self-examinations will be given leniency in terms of inspection frequency and punishment. This is in line with the law enforcement philosophy of balancing punishment and clemency. Since 2019, the NHSA has deployed 184 flight check teams, inspecting 384 designated medical institutions. The inspections have uncovered suspected illegal and non-compliant use of medical insurance funds totaling 4.35 billion yuan. 

Second, we have launched special campaigns to address malpractices in crucial areas. Medical insurance departments, in cooperation with health and public security authorities, have focused on key fields such as orthopedics, hemodialysis, and cardiology. They have also tackled significant issues like the use of essential drugs and medical supplies, fake medical record, and the resale of medicines covered by the national medical insurance system for profit. These targeted oversight and inspection efforts have eliminated the root causes that threaten people's "life-saving money." In 2022 alone, officials cracked 2,682 cases and arrested 7,261 suspects. A total of 1.07 billion yuan of improperly used medical funds have been retrieved.

Third, we have conducted daily oversight with the help of data-based technologies. By fully utilizing modern information technologies such as intelligent monitoring and big data, we have accelerated our efforts to establish a comprehensive, tiered, and multifaceted regulatory system. In 2022, we denied payment of and recovered 3.85 billion yuan through intelligent monitoring, accounting for about 26% of the total amount recovered. With the help of a big data model for false hospitalization, we have been able to identify crime clues precisely. As a result, nearly 500 people were arrested and 100 million yuan was investigated. 

Next, we will continue to strengthen flight checks and carry out special campaigns to crack down on medical insurance fraud. Efforts will be made to investigate a number of significant cases, knock out a number of major gangs, and publicly expose a number of typical cases. These will help to maintain a tough stance against medical insurance fraud, ensuring that no one dares to cheat. We will strengthen big data regulations and build a network for public supervision, leaving no opportunities for anyone to cheat. We will also improve policies such as global budget and allowing medical institutions to keep the surplus of allocated funds as encouragement for use of drugs centrally procured. Efforts will be made to guide designated medical institutions and designated retail pharmacies, as well as medical personnel, to regulate their behaviors, thus pushing for the establishment of a long-term mechanism that prevents the intention of committing fraud. Thank you!

Xinhua News Agency:

What's the current rate of participation in the basic medical insurance system in China? In addition, how will we achieve the two tasks outlined in the report to the 20th CPC National Congress, namely making sure the system covers the entire population and expanding the coverage of social insurance programs? Thank you.

Shi Zihai:

Thank you very much for your questions. I will answer them. Expanding medical insurance to cover the entire population is a fundamental and comprehensive task in the development of medical insurance programs. Since the establishment of the NHSA, it has always prioritized the implementation of full coverage of medical insurance. The administration has worked tirelessly to expand the coverage of medical insurance and improve its quality by optimizing policies, upgrading services, removing impediments in the system, and pressing forward with responsibilities. In recent years, the coverage of medical insurance has stabilized at above 95%. By the end of last year, the total number of people covered by the country's basic medical insurance reached 1.34592 billion, including 362.43 million people covered by the basic medical insurance system for working urban residents and 983.49 million covered by basic medical insurance system for non-working urban residents. As you mentioned, the 20th National Congress of the CPC clearly outlined the requirements of making sure the system covers the entire population and expanding the coverage of social insurance programs. To implement the tasks, we will focus on the following aspects:

First, we will enhance the precision of expanding medical insurance coverage through data comparison. We will establish and refine the data sharing mechanism in collaboration with relevant departments. Efforts will be made to strengthen data comparison and improve the medical insurance database that covers the entire population, enabling real-time and dynamic data tracking. Additionally, by leveraging the unified national medical insurance information platform built last year, we will expand data comparison efforts from a provincial level to a national scope. This will allow us to identify individuals with discontinued social security contribution or not even covered by the system. By eliminating instances of duplicate insurance, we will effectively promote the accuracy of expanded medical insurance coverage across various provinces.

Second, we will focus on expanding medical insurance coverage in a more targeted manner through inter-departmental coordination. We will establish communication and collaboration mechanisms with education departments to ensure that more college students are covered by medical insurance. Additionally, we will strengthen cooperation with health departments and utilize the mechanism of a "one-stop service for birth-related matters" to ensure that newborns are covered by medical insurance promptly. Furthermore, we will enhance our medical insurance services for the migrant population and rural migrant workers.

Third, we will grant easier access to medical insurance by upgrading services. We will strengthen cooperation with tax authorities to facilitate the public to enroll in medical insurance and pay contributions through a unified online platform or at one single office that offers integrated services. By offering a "one-stop" service, we will make it easier for people to access medical insurance services.

Fourth, we will ensure the long-term effectiveness of our efforts of expanding coverage by improving policies. We will refine the individual payment mechanism for medical insurance and encourage more working people to participate in insurance in the places where they receive medical treatment or their permanent residence. These efforts will support the orderly movement of people across provinces and cities and promote the high-quality implementation of full coverage of medical insurance. Thank you!

CNR:

The report to the 20th CPC National Congress proposed improving the population development strategy, establishing a policy system to boost birth rates, and bringing down the costs of pregnancy and childbirth, child-rearing, and schooling. What measures have we carried out in terms of reducing pregnancy and childbirth costs? What are the considerations for the next step? Thank you. 

Li Tao:

Thank you for your questions. Population development is of great importance to the Chinese nation. The report of the 20th CPC National Congress made clear requirements to optimize the population development strategy, establish a policy system to boost birth rates and bring down the costs of pregnancy and childbirth, child-rearing, and schooling. The NHSA has resolutely implemented the decisions and arrangements of the CPC Central Committee and the State Council and carried out works on improving maternity insurance and basic medical insurance. The administration has also actively conducted studies and refined supporting policies such as maternity insurance.

First, we have continued to leverage the protective function of maternity insurance. Maternity insurance covers employers and their employees, pays maternity medical expenses and provides maternity allowances. In 2022, 240 million people across the country were covered by maternity insurance, and the expenditure was 89.1 billion yuan. As a form of social insurance, maternity insurance provides mutual assistance by distributing maternity-related expenses of a single employer among all employers, thus balancing the labor costs of employers and alleviating the concerns of employers in hiring female workers. This is of great significance in eliminating gender discrimination in employment.

Second, we have strived to ensure three-child maternity insurance benefits for female employees. All localities have been guided to fully implement maternity insurance benefits for insured female employees having three children, guaranteeing the benefits to which they are entitled. All localities have been required to include the eligible maternity medical expenses and allowances of insured female employees into the maternity insurance benefits in a prompt manner and ensure full payment. At the same time, we have done a good job in providing maternity medical benefits for both urban and rural residents, implementing the policy of immediately enrolling newborns in medical insurance, and ensuring the convergence of benefits and timely settlement. All the 31 provincial-level regions and the Xinjiang Production and Construction Corps on the Chinese mainland have issued relevant documents, promulgated relevant policies, and optimized work processes, to ensure that female employees who are insured and have three children can enjoy corresponding treatment according to regulations. 

Third, we have taken multiple measures to improve and implement active childbearing support measures. In July 2022, the NHSA and 17 departments jointly issued the Guiding Opinions on Further Improving and Implementing Active Childbearing Support Measures, which makes it clear that flexible employment personnel are included in maternity insurance coverage. They guided local governments to comprehensively consider the affordability of the insurance fund, relevant technical norms, and other factors to gradually include the expenses incurred by using technological means to ease labor pains and assist reproduction under the coverage of the insurance according to procedures.

In the next step, we will continue to guide local governments to do a good job with maternity and basic medical insurance. We will consolidate and expand maternity insurance coverage and do more to ensure maternity medical benefits. At the same time, we will strengthen interdepartmental coordination and promote the dovetailing of maternity insurance policies and related economic and social policies to jointly promote the population's long-term balanced development. Thank you.

ThePaper.cn:

In recent years, commercial medical insurance such as Huiminbao that links up with basic medical insurance has appeared in many places, further reducing the burden of medical treatment for the people. It has received widespread attention from society. What considerations and measures are there for promoting commercial insurance development? Thank you.

Huang Huabo:

Thank you for your question. The report to the 20th CPC National Congress pointed out that China will promote the orderly linking up of medical insurance programs at different levels and vigorously develop commercial medical insurance. The Huiminbao program has been implemented in recent years in various localities. We believe that it can be used as a kind of inclusive commercial medical insurance. It is also a helpful exploration into improving the multi-level medical insurance system. On the basis of clarifying the liability boundary between basic and commercial medical insurance, the medical insurance department explored and adopted some measures to help the development of commercial medical insurance. It is specifically reflected in three aspects.

First, we have vigorously promoted information sharing. On the prerequisite of ensuring the security of medical insurance data, we have carried out pilot projects for authorized inquiry and use of personal medical insurance information in 12 cities across the country to tap into the full potential of medical insurance data and serve more local residents. In the pilot cities, insured persons can access personal medical insurance-related information through various online and offline channels. Upon receiving authorization from individuals, their relevant personal information is made accessible to commercial insurance companies. This streamlines the process of purchasing commercial insurance and filing claims. We are committed to providing the greatest convenience for people through information sharing. By doing so, we strive to improve the public's sense of fulfillment and satisfaction with commercial insurance products.

Second, we have vigorously supported service coordination. Convenient and quick claims settlement has always been an urgent need for insured people. We have encouraged commercial insurance companies to participate in critical illness insurance, long-term care insurance, and medical insurance fund supervision. Undertaking businesses relevant to basic medical insurance will not only help commercial insurance companies to further improve their services but also helps them optimize insurance service processes and unclog service channels. Some localities also support and guide commercial insurance companies to simplify the claims procedures to greatly increase the attractiveness of commercial insurance products. For example, Zhejiang province and some other places have implemented one-stop insurance settlement of Huiminbao insurance programs, basic medical insurance, critical illness insurance, and medical assistance, among others. This system has effectively solved or alleviated the problems relating to advance payments, errands, and long processing times, which have received the most complaints. 

Third, we are diligently working to improve the effectiveness of the fund. We have deepened the reform of bulk government purchases and medical insurance payments while continually conducting national drug catalog access negotiations. We continue to strengthen fund supervision and crack down on insurance fraud. These measures not only alleviate the burden of medical treatment for insured patients but also, to a certain extent, alleviate the bottleneck problems of commercial insurance companies. These include difficulties with hospital supervision, weak bargaining power, and high risk- control costs. These efforts have fostered a good medical service environment for commercial medical insurance companies to reasonably control fees and reduce operating pressure.

Next, we will work with relevant departments to actively explore the proper and effective methods for synergized development and mutual complementation of basic and commercial medical insurance to better meet the needs of the public's multi-level medical security. Thank you!

Cover News:

What measures has the NHSA taken in recent years to ensure that medical insurance system covers more lifesaving and emergency medicines that are newly developed and with good effect? What are the policy considerations and arrangements for the next step? Thank you.

Li Tao:

Thank you for your questions. The management of the national medical insurance drug catalog is of wide concern to society. Since its establishment, the NHSA has maintained its role of ensuring the basic needs, continuously optimized the catalog, and significantly improved drug security for the masses. It is mainly reflected in the following aspects:

First, the catalog is updated annually, ensuring new drugs benefit patients more quickly. Over 80% of new medicines are covered by medical insurance system within two years of launch. For example, among the 108 new medicines added through negotiations and bids in the 2022 catalog, 105 were new medicines launched within five years, and a significant portion of these drugs were approved and included in the catalog within the same year.

Second, the number of medicines in the catalog has significantly increased, and the scope of insurance is constantly expanding. Over the last five years, 618 medicines have been added to the catalog, covering clinical treatment fields such as COVID-19 infection, tumors, cardiovascular and cerebrovascular diseases, rare diseases, and pediatrics. A large number of drugs based on new therapeutic mechanisms and new targeted drugs have been included in the catalog. Among the top 20 categories in terms of medical institution expenses, there are now very few auxiliary drugs with uncertain efficacy and potential for abuse, as they have been replaced by therapeutic drugs for major diseases and chronic conditions. The current version of the national medical insurance drug catalog has a total of 2,967 types covering all fields of clinical treatment. The clinical medication needs of insured patients are now better addressed.

Third, great emphasis has been placed on the implementation and provision of drugs in the catalog, leading to a significant improvement in drug accessibility. We have collaborated with the National Health Commission to introduce a series of policies, including the "dual channel" (designated medical institutions and retail drug stores) for accessing medicines included in the catalog through negotiations, to support the implementation of the catalog. By the end of December 2022, 209,000 designated hospitals and pharmacies nationwide were equipped with the negotiated drugs included in the catalog.

Fourth, the national innovation-driven development strategy has been implemented, and medical technology innovation has been supported. Over the past five years, out of the 70 newly developed drugs under major programs that engaged in negotiations, 66 were successful, achieving a success rate of 94%. This has enabled the swift clinical application of these innovative drugs. Enterprises' initial investments in research and development have been duly rewarded, fostering a significant boost in innovation enthusiasm.

The adjustments made to the national medical insurance drug catalog in the past five years have greatly benefitted insured individuals. Patients now have access to innovative drugs that offer superior therapeutic effects at more affordable prices. This positive trend reinforces a robust trajectory of research and development for our country's medical sector. Moving forward, we are committed to continuing our efforts to optimize and refine the management of the medical insurance drug catalog. This will include adding more qualified medications to the catalog and further meeting the medication needs of insured residents. Thank you!

MASTV:

As the frequency of population mobility increases, people's demand for seeking medical service in different places is also increasing. What is the progress of directly settling medical expenses incurred outside a patient's home province? What other measures will be introduced to boost convenience for people in the next step? Thank you.

Hu Jinglin:

Thank you. I'll answer your questions.

The direct settlement of medical expenses incurred outside of a patient's home province is directly related to people's access to medical treatment. Since the establishment of the NHSA, we have acted in accordance with the policy decisions and plans of the CPC Central Committee and the State Council, focusing on the inconvenience of reimbursing medical expenses incurred outside the home province. We have vigorously promoted the direct settlement of such expenses. Progress has been made in the following four areas:

First, it is more convenient for people to settle inpatient expenses incurred outside their home province. At present, there are 68,800 designated medical institutions within an inter-provincial network of hospitalization expenses, an eight-fold increase over 2017. The rate of directly settling inpatient expenses incurred outside of the home province has increased from less than 5% in 2017 to about 65% in 2022, benefiting a total of 20.3876 million people.

Second, a breakthrough has been made in the direct settlement of general outpatient services across provinces. At least one designated medical institution in each county can directly reimburse outpatient expenses for cross-provincial medical treatment. There is a network of 382,100 designated medical institutions for general outpatient services settlement across provinces, benefiting a total of 69.5991 million people.

Third, progress has been made in directly settling treatment costs related to outpatient chronic and specific critical diseases across provinces. At least one designated medical institution in each area of overall planning will be able to directly reimburse the expenses of five types of outpatient chronic and specific critical diseases, namely hypertension, diabetes, outpatient radiotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplantation. There are 24,600 designated medical institutions nationwide within inter-provincial networks for outpatient chronic and specific critical diseases settlement, benefiting 730,200 people.

Fourth, the cross-provincial registration for medical services has been continuously optimized. In recent years, we continue to expand the scope of people who can access the cross-provincial registration system and reduce the documents required for filing procedures. At the same time, relying on the national unified online filing systems such as the app of the National Medical Insurance Service platform and the WeChat official account of the NHSA, we have realized online and mobile filing for medical treatment in different places. The Beijing-Tianjin-Hebei region has also implemented the policy of "regarding drug purchasing and medical treatment as the filing" within the region. There is no need to go through the filing procedures, and patients will be able to directly use the settlement service for medical treatment in the region.

In the next step, we will further implement the cross-provincial settlement for medical treatment. First, we will increase publicity of the policy. In June, we will conduct a one-month nationwide intensive promotion for the policies of cross-provincial medical treatment so as to inform more insured people to acknowledge the methods of filing for medical treatment in other places. Second, we will continue to expand the coverage. We will promote more medical institutions to be designated for the cross-provincial settlement of medical bills so that insured people are able to access the convenient direct settlement services for medical expenses incurred outside of their home provinces. Third, we will continue to optimize the filing process and encourage more regions to conduct self-filing for cross-provincial medical services, continue to increase the proportion of direct settlement and make it easier for people seeking medical treatment in other places. Thanks!

Red Star News:

According to the report to the 20th CPC National Congress, it calls for promoting coordinated development and regulation of medical insurance, medical services, and pharmaceuticals. What work has been done in this regard? And what work should be considered in the next step? Thank you. 

Li Tao:

Thank you for your questions. Since the establishment of the NHSA, it has attached great importance to the fundamental role of medical insurance in the coordinated medical service, medical insurance, and pharmaceutical reforms. It has also promoted positive interaction and coordinated reforms between the medical security system and medical service system, as well as the drug supply system.

First, we focus on reducing the burden of seeking medical treatment for the general public. By improving the medical security system with basic medical insurance as the main body, medical assistance as the support, and with the joint development of other tools, such as supplementary medical insurance, commercial health insurance, and charitable donations, the proportion of health care expenses borne by individuals has constantly reduced.

Second, we have promoted the high-quality development of medical institutions. We have improved payment methods and incentive and constraint mechanisms for medical insurance and comprehensively promoted the diversified, compound medical insurance payment model based on disease-related payment. In 2022, 206 cities in China adopted the new payment model, which charge hospitalization fees based on DRG and DIP classification. We have guided medical institutions to change their development models, taking actions to control costs, and regulating medical behavior. 

Third, we have supported and encouraged pharmaceutical technological innovation. Through measures such as bulk government purchases, and making timely adjustments to the catalogue of medicines covered by medical insurance, we have supported the rapid entry of innovative drugs and medical devices into clinical use, and promoted the high-quality development of the pharmaceutical industry.

In the next step, in accordance with the decisions and deployments of the CPC Central Committee and the State Council, we will continue to further promote the coordinated development and regulation of medical insurance, medical services, and pharmaceuticals.

First, we will promote both a well-functioning government and an efficient market. We will make bulk government purchase a regular and institutionalized practice, upgrade the functions of the pharmaceutical procurement platform, improve the pricing mechanism for pharmaceutical services, and deepen the supply-side reform of pharmaceutical services.

Second, we will promote better coordinated reforms of medical insurance and public hospitals. We will deepen reform of public hospitals to see that they truly serve the public interest, coordinately advance the expansion and balanced regional distribution of quality medical resources. We will also support the modes of graded diagnosis and treatment, and the healthy development of community-level healthcare institutions.

Third, we will promote medical insurance reform and pharmaceutical innovation to reinforce each other. We will make timely adjustments to the catalogue of medicines covered by medical insurance so as to ensure the new drugs and technologies be able to benefit people in a timely manner and jointly promote the high-quality development of the pharmaceutical industry. Thanks.

Xing Huina:

Due to time constraints, there will be two final questions.

Yicai:

What are the impacts of centralized procurement of medicines and high-value medical consumables on patients, hospitals, and the pharmaceutical industry? And what specific tasks will be accomplished to implement the achievements of the reform and expand the scope of the reform? Thank you.

Shi Zihai:

Thank you for your questions. For a long time, the prices of pharmaceutical drugs and high-value medical consumables in China have been inflated; especially for certain "imported old drugs," even though their patent periods have expired, they are still sold at relatively high prices in China. And the high-value medical consumables are priced at an even much higher level above the international standards. To address this situation, in accordance with the decisions and deployments of the CPC Central Committee and the State Council, the NHSA has worked with relevant departments to actively promote centralized procurement of medicines and high-value medical consumables, reduce the prices of selected products by reducing the production and marketing costs for selected enterprises.

Over the past five years of reform, the effectiveness of centralized procurement has been demonstrated. First, the burden of pharmaceutical expenses for the general public has significantly reduced. Through centralized procurement, we started to reverse the trend of continuous rise in drug prices in China. According to relevant calculations, compared with 2018, the medicine purchase price index decreased by 19% in 2022. Many people may remember the movie "Dying to Survive," released a few years ago. In the movie, there was a medicine called imatinib, which is used in the treatment of leukemia. The original drug was priced at over 10,000 yuan per box. When the first batch of centralized procurement was launched, we included this drug in the procurement scope. With centralized procurement, the price of generic drugs winning the bid was reduced to about 600 yuan per box. Although the original drug was not selected, its price was also affected by the centralized procurement, and it dropped from over 10,000 yuan per box to just over 7,000 yuan per box, which brought real benefits to leukemia patients. At the same time, the main consumables for cardiology and orthopedics, which people are strongly concerned about, have also been included in the centralized procurement; and the prices of the selected products have decreased significantly; as a result, there was a clear reduction in the burden on patients.

Second, medicine quality has been significantly improved. We paid great attention to the quality of selected products during centralized medicine procurement. By reducing medicine prices, the accessibility of high-quality drugs and consumables has been effectively improved. For example, the proportion of patients using high-quality medicine, such as original drugs and eligible copycat drugs that passed quality consistency evaluation increased from 50% to over 90% after the centralized medicine procurement was launched. The using ratio of chrome alloy stents which have better properties and perform better raised from 60% to more than 90%, after centralized medicine procurement, while stainless-steel stents which originally occupied a larger share of market and have average properties have been generally phased out.

Third, the pharmaceutical industry has become healthier and more sustainable. The centralized medicine procurement guided pharmaceutical enterprises changed their focus from channels and sales towards quality and price. Enterprises' internal driving force – pursuing development through quality improvement – has been strengthened constantly. Since 2018, thanks to centralized medicine procurement, the number of copycat drugs that passed quality and curative effect consistency evaluation rapidly increased to more than 3,000 from less than 200. High-quality drugs are gradually occupying the mainstream of clinical drugs.

Next, we will continuously expand the scale and improve the quality of centralized medicine procurement. Central and local governments will work together to advance progress. On a state level, we have already carried out the eighth round of centralized medicine procurement this year and will work on the fourth round of centralized medicine procurement for high-value medical consumables, mainly intraocular lens and orthopedic sports medicine consumables. A new round of centralized drug procurement will also be carried out. On local level, cross-provincial cooperative procurement will be carried out for those drugs not included in national-level centralized medicine procurement, such as chemical drugs, Chinese patent medicines, interferon, neurosurgical consumables, and in-vitro diagnostic reagents. We will also work with relevant departments to strengthen quality control and supply assurance for products of centralized medicine procurement and urge medical institutions to prioritize purchasing and using selected products so as to ensure the people truly enjoy the fruits of reform. Thank you.

Southern Metropolis Daily:

It has been three years since the pilot programs on long-term care insurance were expanded. What's your consideration in establishing the long-term care insurance system? How about those pilot programs? What's your priorities for the next step? Thank you.

Hu Jinglin:

Thanks for your questions, and I will answer them.

The long-term care insurance system is a major decision and deployment made by the CPC Central Committee and the State Council to actively cope with population aging, and also an important institutional arrangement to address weak links in the country's social insurance system. By the end of 2022, with 280 million people aged 60 and over who occupy 19.8% of the total population, China will soon enter a moderate aging society. With the acceleration of population aging and the increasing number of incapacitated elderly individuals, long-term care has gradually become a social focus. In order to properly take care of persons with disabilities, we have carried out a trial program on long-term care insurance in 15 cities nationwide since 2016 in accordance with the decisions and deployments of the CPC Central Committee and the State Council. Since its establishment in 2018, the NHSA has made continuous efforts on this issue. We conducted follow-up assessments on the trail program with relevant departments and increased the number of pilot cities to 49. Till the end of last year, insured people in long-term care reached 169 million, and 1.95 million of them have already enjoyed the benefits. The accumulated fund expenditure reached 62.4 billion yuan, or 14,000 yuan per person per year.

At present, the trial program is progressing smoothly and achieved its phased targets. First, it effectively reduced the economic burden of families with persons with disabilities. Second, it promoted the development of the service system. The number of service institutions in pilot areas reached 7,600, four times the original number. Third, it created a large number of jobs. The number of nursing staff increased from more than 30,000 to 330,000, which has multiplied many times.

The 20th CPC National Congress made a strategic deployment of long-term care insurance system, and clarified the direction of reform. The NHSA will follow the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era and strive to establish a long-term care insurance system with Chinese characteristics. Next, our work will focus on the following two aspects:

First, we will make continuous and solid efforts for the existing trial program. We will continue to study and improve the multi-party co-financing mechanism, guarantee mechanism for fair and appropriate treatment and other mechanisms formed in previous trail programs. Local governments will be guided to optimize and implement the criteria for assessing disability levels that were approved at the state level. We will also conduct pilot evaluation and targeted research on problems and weak links and then give solutions. Coordinated efforts with other departments will be made to forge policy synergy.

Second, we will work at top-level design for the long-term care insurance system. On the basis of summarizing and extracting the experience of the trial program, we will study and improve the overall goals and long-term plans for institutional development. A unified and systematic orientation, frame, policy, and standard will be set to regulate management and operation so as to form a long-term care insurance system with Chinese characteristics. Thank you.

Xing Huina:

Today's briefing is hereby concluded. Thanks to all the speakers and friends from the press. Goodbye, everyone.

Translated and edited by Zhu Bochen, Wang Qian, Guo Yiming, Zhou Jing, Cui Can, Liu Sitong, Yan Bin, Yuan Fang, Liu Caiyi, Liu Sitong, Yan Xiaoqing, Huang Shan, Lin Liyao, Wang Yanfang, Li Huiru, Tom Arnsten, and Jay Birbeck. In case of any discrepancy between the English and Chinese texts, the Chinese version is deemed to prevail.