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Read in Chinese
Speakers:
Mr. Zhang Ke, commissioner of the National Healthcare Security Administration (NHSA)
Ms. Li Tao, deputy commissioner of the NHSA
Mr. Yan Qinghui, deputy commissioner 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:
Sept. 10, 2024
Xing Huina:
Ladies and gentlemen, good morning. Welcome to this press conference held by the State Council Information Office (SCIO) as part of the series "Promoting High-Quality Development." Today, we have invited Mr. Zhang Ke, commissioner of the National Healthcare Security Administration (NHSA), to brief you on relevant developments and answer your questions. Ms. Li Tao and Mr. Yan Qinghui, both deputy commissioners of the NHSA, are also present today.
Now, I'll invite Mr. Zhang to give his introduction.
Zhang Ke:
Ladies and gentlemen, friends from the media, good morning. First, I would like to thank you all for your long-standing interest in, understanding and support for the development of the health care sector.
General Secretary Xi Jinping profoundly stated that the fundamental goal of establishing China's basic medical insurance system is to relieve people of worries about diseases and health care services. Since the 20th National Congress of the Communist Party of China (CPC), the CPC Central Committee with Comrade Xi Jinping at its core has adhered to a people-centered development philosophy. It has attached great importance to ensuring and improving people's livelihoods, continuously strengthened overall leadership and planning of medical security work, and established the world's largest medical security network. The NHSA has resolutely implemented the major decisions and plans of the CPC Central Committee. We have vigorously promoted the experience of medical reform in the city of Sanming, strengthened the top-level design of the medical insurance system, and promoted the coordinated development and governance of medical services, medical insurance, and pharmaceuticals. We have expanded medical insurance coverage, raised its protection standards, improved our management and services, so as to continuously enhance people's sense of gain.
We remain committed to institutional development, as well as regulating and improving the medical insurance system. We have established a robust three-tiered basic medical security system encompassing basic medical insurance, major disease insurance, and medical assistance. We've formulated a list of medical insurance benefits, unified the national medical insurance drug catalog, and promoted standardized medical insurance system, policies and coverage nationwide. We've steadily enhanced the capacity for financing basic medical insurance, improved long-term mechanisms for medical insurance coverage, with coverage of basic medical insurance reaching 95% of the population, maintaining a stable scale of fund revenue and expenditure. We have done everything within our capacity to scientifically determine the coverage and standards of medical insurance schemes. The reimbursement rates for hospitalization expenses covered by related policies remain at around 80% for urban employees' medical insurance and 70% for rural and non-working urban residents' medical insurance.
We continue to prioritize people's needs by improving the quality of health care protections. We have consolidated and improved inpatient coverage, ensured outpatient care for chronic and special diseases. Outpatient expenditures are covered by funds under unified management in the basic medical insurance system for urban employees. A mechanism has been established to guarantee outpatient medicines for treating high blood pressure and diabetes for rural and non-working urban residents. We've aligned basic medical insurance schemes for rural residents and non-working urban residents, integrated maternity insurance and basic medical insurance for urban employees, enhanced the general support capacity of unified accounts, and improved the level of benefits and security for insured groups. We have sped up the completion of the medical insurance and medical assistance system against fatal and serious diseases, and establishedlong-term mechanisms to prevent people from falling back into poverty due to illness. To address the aging population, we've steadily advanced pilot programs on long-term care insurance, which cover 49 cities and 180 million people. We have also implemented measures to boost the birth rate. Already, 20 provinces and the Xinjiang Production and Construction Corps have included assisted reproductive technologies (ART), such as in vitro fertilization (IVF), in medical insurance coverage.
We remain committed to deepening reforms to enhance public health and welfare. We have institutionalized and regularized bulk government procurement of medicines and medical consumables. We have organized nine rounds of national centralized procurement of medicines and four rounds of national centralized procurement for high-value medical consumables. At the same time, we have guided and promoted centralized procurement at the local government level for drugs not included in national centralized procurement. We have deepened medical service reforms, and established a dynamic adjustment mechanism to better reflect medical workers' contributions. We have innovated catalog access negotiations, resulting in 3,088 medicines now listed. This encompasses commonly used drugs and those for special and rare diseases. We continue to include newly developed and effective drugs that were previously unaffordable in the catalog. We have deepened reform on medical insurance payment models, encouraging medical institutions to optimize their revenue structures and regulate diagnosis and treatment practices.
We're committed to leveraging digital and intelligent technologies to enhance operational management. We have built a unified national medical insurance information platform to achieve the standardized management of medical insurance data. We have carried out regulation of drug prices listed for public reviews, intensified the monitoring and handling of pharmaceutical price risks, and promoted the monitoring and comparison of drug prices in designated pharmacies. As a result, drug prices have become more transparent, making it more convenient for the public to make choices. We have intensified the supervision of medical insurance funds through ongoing unannounced inspections and targeted actions. We've stepped up the application of intelligent monitoring and big data, promoted the use of drug traceability codes, and established and improved whistleblowing reward mechanisms. We publicly exposed representative cases involving legal violations, standardized the use of medical insurance funds, and protected the money that people rely on to pay their medical bills.
We adhere to a service-oriented approach to optimize medical insurance public services. We have improved the management and service system, included eligible village clinics in the medical insurance settlement network, and provided people with convenient access to medical insurance services. We have developed an online medical insurance service network and mobile app, promoted medical insurance codes and mobile payments, and facilitated online and mobile filing. We've strengthened the direct settlement of medical expenses incurred outside of a patient's home province, enabling cross-provincial direct settlement at the county level for general outpatient expenses and five outpatient chronic and special diseases such as hypertension and diabetes. We are gradually expanding the scope of diseases eligible for cross-provincial direct settlement. We have bolstered one-stop government services in relation to medical insurance and optimized the procedures for medical insurance access, transfer and renewal, benefit claims, and settlement of medical expenses. These improvements make it easier for people seeking medical treatment and purchasing medications.
On the new journey in the new era, the NHSA will thoroughly implement the guiding principles of the third plenary session of the 20th CPC Central Committee. We will unswervingly implement the important instructions and directives of General Secretary Xi Jinping regarding the health care sector, striving to promote the high-quality development of medical insurance. These efforts aim to contribute to building a great country and achieving national rejuvenation.
That's all for my introduction. Thank you.
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Xing Huina:
Thank you, Mr. Zhang. The floor is now open for questions. Please raise your hand if you have a question. Please identify the media outlet you represent before raising your question.
Economic Daily:
We know that the third plenary session of the 20th CPC Central Committee proposed improving the social security system. The public is keenly interested in the development of the medical security system. We have noticed that the NHSA recently proposed to improve the "1+3+N" multi-level medical security system. Could you brief us on the relevant work arrangements? Thank you.
Zhang Ke:
I will answer the question. Health care coverage is a crucial aspect of social security for the people, and they have high expectations for its continuous improvement and development. Our basic medical security system primarily covers three aspects. First is urban employee medical insurance and resident medical insurance that we are all very familiar with, which is included in basic medical insurance. Second, we have medical assistance for people in challenging circumstances. In 2023, we provided assistance to 80.2 million people facing difficulties. People are concerned about how those who have severe diseases but are extremely poor or have no income can apply for medical insurance. You can rest assured that our country cares much about their insurance coverage, providing either full or partial subsidies to help them enroll in medical insurance. Third, we have major disease insurance, a less familiar term. Many friends have asked me whether they should purchase major disease insurance and where to purchase it? Actually, people covered by resident medical insurance do not need to buy major disease insurance, which is included in the basic medical insurance framework. By enrolling in medical insurance for rural and non-working urban residents, one automatically gains access to major disease insurance. The reason people sometimes don't notice it is because we now have a one-stop settlement system. Once the personal expenditure exceeds a certain amount during medical treatment, especially hospitalization, the major disease insurance will be triggered to save more out-of-pocket costs. If we examine hospital discharge settlement slips, we will find the specific amount covered by major disease insurance. These are the three layers of protection within our basic medical security system.
However, the three layers of protection still fall short of meeting the people's growing health care needs, manifesting in three key aspects. First, due to funding constraints, many expensive drugs are difficult to cover under basic medical insurance. This limitation conflicts with the unlimited nature of people's needs. Second, the basic medical insurance system is relatively uniform. This uniformity is in conflict with the varying levels of economic and social development across the country, as well as differences in disease patterns across different regions. Third, the rules and catalog of basic insurance are quite fixed and are not able to be adjusted frequently. It's difficult to include every new drug or technology as soon as it's developed. This also conflicts with fast development and changes in pharmaceuticals, medical devices and technologies.
How to solve these contradictions? According to the deployment of the CPC Central Committee and the State Council, we have been tasked with building a multi-level medical security system, which in recent years has been clearly required by the CPC Central Committee. In addition to basic medical insurance, what else does this multi-level system include? Primarily, it includes the following aspects: Huiminbao, an insurance with government support; other commercial health insurances, charities, mutual aid through trade unions as well as other funds. The participation of these forces not only meets people's diverse and changing health care security needs but also complements the basic medical insurance system. This composes the relationship of "3" and "N," which means three-tiered protection of basic medical security system and various supplementary sources.
The "1" in the system refers to the NHSA's promotion of digital and intelligent technologies to provide a basic information platform, ensuring the effective operation of a multi-level medical security system. The platform features the following aspects: "one person, one file," meaning that everyone has a personal health record; "one drug, one code," meaning that every medicine box will have a tracking code, enabling future traceability of each medicine box to ensure that the public has access to safe drugs. It also contains "one claim, one settlement" and "one invoice, one verification." Commercial insurance companies and philanthropic institutions are concerned about whether they can find right recipients and get authentic invoices. The NHSA through big data tech services can provide these necessary conditions for participating organizations in this multi-level medical scheme. On the basis of digitalization, we can cooperate and strive to effectively meet people's increasing needs for health care security.
That's all for my response to the question about building a multi-level medical security system based on "1" and coordinated by "3+N."
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Farmers' Daily:
At the beginning of this year, the NHSA released major tasks concerning the one-stop government services in medical insurance. Can you tell us about the current progress made with these tasks? Thank you.
Zhang Ke:
Let us invite Mr. Yan to answer the question.
Yan Qinghui:
Thank you for your question. Since this year, the NHSA has implemented guiding principles from the State Council's relevant documents and has emphasized the integration of one-stop government services principle in all aspects of health care security work, effectively handling every matter to provide heartwarming services for enterprises and residents. Currently, the time for handling major tasks has been shortened with streamlined procedures and flexible forms. The insured population, pharmaceutical companies and medical institutions are all experiencing an enhanced sense of fulfillment from medical insurance services.
On the one hand, insured residents are experiencing improved services. Newborns can now be enrolled in medical insurance immediately upon birth, rather than waiting for household registration. Previously, newborns' households had to be registered before newborns could be enrolled in medical insurance, and medical expenses had to be paid out-of-pocket and then reimbursed at medical insurance windows later. Now, through data sharing, local medical departments can enroll newborns in the medical insurance system with just a birth certificate. The average time needed for enrollment and payment has been reduced to 6.4 working days from 28.7 working days at the beginning of the year. Medical expenses can now be directly reimbursed upon newborns' discharge from the hospital. Individual medical insurance accounts for urban employees have changed from individual ownership to family sharing. Through an online application, employees can add their parents, children, spouses and other close relatives to their accounts for shared use of their personal account funds. Currently, local governments are advancing work in this regard. From January to July of this year, the amount of individual medical insurance accounts shared among family members reached 22.7 billion yuan. It is projected that by the end of this year, individual accounts will be able to be shared among family members within the provincial-level administrative area where insurance is registered, and efforts will be made next year to promote cross-provincial practice. Particularly, on-the-spot settlement of cross-provincial medical expenses of outpatient services now covers 10 kinds of chronic and special diseases from the previous five. Taking varying diseases across different regions into consideration and to better meet people's needs for convenient cross-region medical services, we have included five diseases, namely chronic obstructive pulmonary disease, viral hepatitis, coronary heart disease, rheumatoid arthritis and ankylosing spondylitis, on top of the previous five kinds of diseases. By the end of this year, every district and county across China is planned to have at least one medical institution capable of cross-provincial on-the-spot settlement of medical expenses for these new types of diseases. In addition, we have shortened the average claim period for employee maternity benefits to be within 10 working days.
Second, we have taken more solid measures in medical security to facilitate the development of the pharmaceutical industry. In order to effectively address the concerns of pharmaceutical companies on some time-consuming procedures, such as coding medicines and publishing online notifications of centrally procured drugs, we have canceled the public notification procedure during the medicine coding process, while accepting complaints and appeals on a regular basis, so as to reduce the turnaround time for coding medicines covered by medical insurance from one month to one week. We have guided localities to unify the tendering and procurement information systems as well as product information standards, formulating a standardized service directory. We have also streamlined the operational procedures for centrally procured medical products to go through online public notification, reducing the turnaround time for such applications to fewer than 15 working days. In order to relieve the financial burden on medical institutions, we have taken timely settlement of eligible medical expenses as a prerequisite while streamlining the whole process. As a result, more than 90% of regions under unified management nationwide have realized monthly settlement of medical bills. We have also continued to implement the pre-payment mechanism. Medical insurance funds are prepaid to designated medical institutions at the beginning of each year to facilitate their development, with appropriate preference given to institutions that ensure better implementation of medical insurance policies.
That is all from me. Thank you.
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National Business Daily:
The third plenary session of the 20th CPC Central Committee proposed supporting coordinated development and management of medical services, medical insurance and pharmaceuticals, as well as further reform of medical insurance payment models. We noticed that the NHSA recently released a new version of the DRG/DIP classification plan. What measures will the administration take to implement these requirements and further enhance its capabilities for pursuing high-quality development? Thank you.
Zhang Ke:
Thank you. I would like to invite Ms. Li to answer this question.
Li Tao:
Thank you for your question. The NHSA has resolutely implemented the decisions and arrangements of the CPC Central Committee and the State Council, and continued to reform medical insurance payment models. In recent years, in terms of hospitalization expenses, we have accelerated the promotion of the DRG/DIP payment methods, which are diversified, compound medical insurance payment models featuring predominantly bundled payments based on disease types and diagnosis-related groups. By the end of 2023, the program had already covered all regions under unified management nationwide, generally bringing changes in four aspects. First, the medical insurance payment model has been switched from treatment-based to ones that are based on disease types and diagnosis-related groups. Second, medical insurance settlement has been switched from post-paid to pre-paid. Third, audit approach has been switched from manual audit to one that is based on the application of big data. Fourth, the provision of medical services has been switched from extensive management to precise management. We have fully implemented management mechanisms such as global budget, evaluation and oversight, as well as allowing medical institutions to keep the surplus of allocated funds and share the overspend. By doing so, we have standardized hospitals' diagnosis and treatment, ensured rational drug use, improved efficiency, and controlled costs, thereby alleviating the overall burden of medical treatment for insured patients, reducing time spent, as well as supporting coordinated development and management of medical services, medical insurance and pharmaceuticals.
Meanwhile, the reform of medical insurance payment models is a phased process in which progress is continuously being made. Recently, we have focused on problems reflected by both medical institutions and the public concerning imprecise classification plans and limited length of hospitalization. We released version 2.0 of the classification plan to further improve the technical standards and supporting policies for medical insurance payments based on disease types and diagnosis-related groups, with priorities on establishing new mechanisms concerning separate discussion for special cases, pre-payment, opinion soliciting and feedback, consultation and negotiation, as well as data working groups. Take separate discussion for special cases as an example. For special cases that involve extended hospitalization, high medical expenses and frequent use of new medicines, medical consumables and technologies, as well as complex, severe and critical symptoms, we have ensured that medical institutions can decide for themselves whether to apply for separate discussions. The medical insurance departments will then review those cases, and consult with medical institutions to adjust the charging standards, so as to better satisfy the demands of clinic treatment and medicine use, as well as relieve the burden of high medical expenses on patients.
Next, the NHSA will be more conscious of pressing concerns of the people, and continue to reform medical insurance payment models. First, we will establish a dynamic adjustment mechanism of DRG/DIP payment, which pays hospitalization expenses based on disease types and diagnosis-related groups. By doing so, we will better satisfy patients and clinical needs, as well as improve payment efficiency of medical insurance funds in a more scientific and precise manner. Second, we will improve the diversified, compound payment system, and explore payment models in line with the characteristics of medical services such as outpatient care and close-knit medical communities. Third, we will strengthen coordination and interplay with the National Health Commission and other relevant departments, as well as support coordinated governance of medical services, medical insurance and pharmaceuticals, so as to effectively protect the people's right to health. Thank you.
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China Review News:
Recently, the NHSA has exposed many cases involving medical insurance fraud. How will health care security departments tighten oversight of medical insurance funds and protect the medical insurance coffers? Thank you.
Yan Qinghui:
Thank you for your question. Since the 18th CPC National Congress, the CPC Central Committee with Comrade Xi Jinping at its core has attached great importance to the supervision of medical insurance funds, and issued a series of decisions and plans. The third plenary session of the 20th CPC Central Committee also proposed tightening oversight of medical insurance funds. Since the start of this year, the NHSA has focused its efforts in three areas:
First, we have carried out strict inspections and severe crackdowns. We have stepped up efforts in conducting checks, including regular annual checks that are publicly announced, as well as special checks that start without prior notice or announcement, forgo any form of work report, escort or official hospitality, and go directly to the site at the community level. So far, we have inspected 432 designated medical institutions in 30 provinces. By the end of this year, the number is expected to exceed the total of the previous five years, greatly expanding inspection coverage. Localities have intensified efforts in cracking down on medical insurance fraud. A number of institutions suspected of wrongdoing were forced to terminate contracts and were transferred to the public security department. Compared with previous years, we have paid more attention this year to the role of big data technology. So far, we have identified and recovered nearly 60 million yuan of medical insurance funds through big-data screening involving "glycated hemoglobin." Another nearly 14 million yuan has been recovered through big data screening involving "diagnosis, treatments, examinations and drug use restricted to one gender." Through these efforts, we have realized a targeted crackdown based on the integration of on-site inspections and big data technology.
Second, we stay committed to maintaining a balance between leniency and strictness. We've effectively utilized self-examination and self-correction. Before the NHSA's unannounced inspections began, we organized designated medical institutions nationwide to conduct self-examinations and corrections based on a checklist of issues. This has encouraged medical institutions to more consciously regulate their services. To date, designated medical institutions at various levels have returned approximately 3 billion yuan in medical insurance funds. We've also effectively used guidance interviews, meeting with non-compliant pharmacies to urge rectification, and publicly reported these issues so that designated pharmacies could better regulate their practices. Additionally, we've leveraged public exposure. The NHSA's official WeChat account has exposed fraudulent practices by some medical institutions, including illegal and irregular activities such as excessive glycated hemoglobin testing and confusion of gender-specific examinations. This approach has strengthened the deterrent effect.
Third, we stay committed to addressing both symptoms and root causes. We're exploring a management system for medical insurance payment qualifications, using a points deduction system similar to that for driving licenses to hold responsible parties accountable. This aims to warn and educate medical personnel to consciously follow treatment norms and self-regulate their prescribing practices. We're improving the social supervision mechanism for medical insurance funds to better engage all sectors in fund supervision. Guidelines for this are currently open for public comment. We've also improved the whistleblower reward mechanism. Since 2022, a total of 2,422 rewards have been issued nationwide, totaling 3.68 million yuan, including rewards of over 100,000 yuan for three individuals and rewards of 50,000 to 100,000 yuan for eight individuals. We hope the media present here can help promote and guide society-wide participation in this reporting and reward system.
Moving forward, we will earnestly implement the decisions and arrangements of the CPC Central Committee and the State Council, and resolutely shoulder the political responsibility of safeguarding the security of medical insurance funds. We will never allow the public's money for medical treatment or life-saving care to become easy targets for exploitation. Thank you.
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The Poster News APP:
Sanming city's medical reform program has emerged as an important model for national medical reform, providing valuable insights for further improvements. Could you please outline the main approaches and results of implementing Sanming's medical reform model in the medical insurance sector? Thank you.
Zhang Ke:
Thank you for your question. I'll answer it. The NHSA has consistently implemented the CPC Central Committee and the State Council's decisions and plans on promoting Sanming's medical reform experience. We've vigorously advanced its institutional achievements, incorporating its pioneering, innovative and locally adaptive spirit into all aspects of medical insurance work. First, I'd like to report that the NHSA's establishment itself reflects the implementation of Sanming's reform experience. Previously, we didn't have an independent medical insurance bureau. It was due to Sanming's successful model that the CPC Central Committee decided to establish dedicated health care security administrations at all levels nationwide. We are now stepping up efforts to advance the following reforms.
First, we're conducting centralized bulk procurement for drugs and medical supplies in a solid way. Drawing on Sanming's approach to cutting off improper interests in the pharmaceutical supply chain, the NHSA has actively promoted reforms in drug bidding and procurement systems. We've established a routine, standardized process for centralized bulk procurement. Nationally, we've organized nine batches of drug procurement and four batches of high-value medical supplies procurement. Provinces are also conducting centralized procurement either independently or in alliances. This has significantly reduced prices of commonly used drugs and medical supplies, creating favorable conditions for supply-side reform in medical services.
Second, we're gradually improving the medical service pricing mechanism. Driven by centralized procurement, we've achieved a more profound and higher-quality structural reform of medical services. The savings from centralized procurement are first used to deliver reform benefits to the public. They also create space for new drugs and diagnostic procedures that reflect new quality productive forces to enter clinical application, and create conditions for adjusting medical service prices. Since 2021, we've guided provinces to dynamically adjust medical service prices, conducted pilot reforms, and explored new pricing mechanisms that align with economic and social development, better reflect the government's role, ensure full participation of medical institutions, and reasonably represent the value of technical services. Since the reform, prices for technical procedures like surgeries and traditional Chinese medicine have increased in an orderly manner, while prices for exams and tests like CT scans have decreased reasonably. The pace of price adjustments matches economic and social development.
Third, we're continuously promoting efficient payment mechanisms. We've implemented a three-year action plan for payment reform, fostering a multi-component payment system primarily based on diagnosis-related groups (DRG). By the end of 2023, over 90% of coordinated areas nationwide had adopted DRG/DIP payment reforms. Results from the 2022 national performance evaluations of tertiary public hospitals showed a 0.7 percentage point increase in the proportion of revenue from medical services compared to the previous year.
To further implement General Secretary Xi Jinping's important instructions on Sanming's medical reform model and to further promote these experiences in the national medical insurance sector, the NHSA issued a notice in May of this year to further promote Sanming's medical reform experience and continuously advance innovation in medical insurance work. It requires local authorities to deeply understand the essence of Sanming's reforms and calls for exploring original and differentiated reform measures suited to local conditions and deepening the establishment of a multi-tiered medical security system. Following the document's release, local authorities have actively implemented these requirements. Some provinces have further detailed their own implementation plans based on the national document. For example, Guangxi Zhuang autonomous region has specifically developed task lists, measure lists, and responsibility lists for promoting Sanming's medical reform experience and advancing innovation in medical insurance work.
Next, the NHSA will guide the health care security departments at all levels to resolutely apply the important instructions of General Secretary Xi Jinping, take actions in line with local conditions, deepen the health care insurance reform, continuously enhance policies, management and services, foster greater synergy between the medical insurance system, medical treatment and medications, and deepen their reform and development while continuously improving health care insurance management services, so as to give our people a growing sense of fulfillment, happiness and security. Thank you.
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CCTV:
As we know, China's unified national health care insurance platform has been built and put into use. How do the health care insurance departments use this platform to provide people with more convenient and efficient services? Thank you.
Zhang Ke:
I'd like to invite Ms. Li to answer this question.
Li Tao:
Thank you for your question. Health care insurance settlement has become more convenient thanks to the use of this platform, which has seen daily volume exceeding 28 million settlements and the average response time of the hospitalization expenses settlement system being only 0.8 second, effectively reducing the time people spend waiting in line at hospitals. The application of medical insurance code has also become more popular. A total of 1.17 billion people in China have activated the code, ushering in a "code era" for medical insurance services. People can use their cellphones or other electronic devices to activate medical insurance codes for medical services as well as reimbursement of medical costs without carrying physical cards.
The unified national health care insurance platform has made services even more optimized. We have continued to improve the NHSA's website and app and set up family accounts, providing the public with convenient health care insurance services online or in short distances. At present, the real-name users of the NHSA's website and app have exceeded 400 million, with the number of users of family accounts exceeding 158 million, greatly improving the efficiency of health care insurance transactions. We have started to provide inter-provincial health care insurance services, enabling people to register online for receiving medical services outside of home jurisdiction, sometimes even in different provinces, and realizing on-the-spot settlements of related medical bills. Other medical insurance services such as information changes, inquiries, and account transfers and continuations are also available across provinces.
The unified national health care insurance platform has provided stronger guarantees. The platform can unify and sort different policies in various regions and each coordination area, and meet the needs of medical insurance settlement and reimbursement in each coordination area. It can carry out intelligent approval of funds, using big data monitoring and analysis to conduct fund approval and reimbursement, and timely identify abnormal situations, so as to accurately crack down on fraudulent practices and insurance swindle. It can also promote the standardized coding of medicines and medical consumables, realize "bidding, procurement and settlement with one code," and enable mutual recognition, circulation and sharing of health care insurance data nationwide, so that information on national medical insurance settlements and prices of medicines and medical consumables can be interconnected and more transparent.
The unified national health care insurance platform has also brought our services closer to the public. We promoted the digitalization of the entire process of medical insurance handling services, saved people's legwork through data sharing, made more medical insurance related administrative services available online, built 15-minute health care insurance service circles, and enabled the public to enjoy high frequency services, such as health care insurance information inquiries and registration for receiving medical services outside of home jurisdiction, nearby in their towns (sub-districts), villages and communities. Thank you.
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Cover News:
The third plenary session of the 20th CPC Central Committee proposed improving the mechanism to support the development of innovative drugs and medical devices. How is the NHSA promoting the clinical application of new technologies, equipment and consumables? Thank you.
Yan Qinghui:
Thank you for your question. The NHSA has always supported the innovation of medical technology and promoted the high-quality development of health care services by improving its pricing policies. The NHSA has organized experts to speed up the compilation of national standards for medical service price items. In accordance with the principle of successively releasing in batches once each is mature, it has currently issued nine batches of approval guidelines for obstetrics, nursing and other areas, and standardized the medical service price items of related disciplines, highlighting a medical service-oriented approach.
In view of the feedback from medical institutions and related enterprises hoping to speed up the price approvals of new technology, equipment and consumables, the NHSA has guided all provinces to further smooth channels for increasing medical service price items. Green channels have been opened and approvals have been accelerated for major innovation projects that optimize diagnostic and treatment plans for major diseases or fill gaps in the treatment of them. For improvement-oriented innovation projects, we refined the existing price items and met the reasonable charging demands in a balanced manner. Concerning other new price items, we accelerated the approval procedures, and fully met the reasonable charging needs of new technologies, equipment and consumables at different innovation levels. Since 2022, more than 1,000 new price items have been added each year in each province, and a number of high-quality innovative technologies, equipment and consumables have been put into clinical application, allowing innovative medical technologies to better benefit the people.
Next, the NHSA will earnestly implement the spirit of the third plenary session of the 20th CPC Central Committee, accelerate the compilation of national standards for medical service price items, continue to guide all provincial health care insurance departments to enhance the management of new items based on clinical value and innovation quality, speed up the handling of applications for adding items if they involve major innovative technologies such as medical equipment that gain priority review and approval by the National Medical Products Administration, as well as promote the development of new quality productive forces in the medical field. At the same time, we will also strengthen the quality control of innovation to prevent low-quality and fake innovation from disrupting the market environment or squeezing the medical insurance funds. We also hope that relevant enterprises will effectively improve their innovation quality, ensure proper disclosure of information on the prices of high-value medical consumables involved in new price items, and accept public supervision and peer review. Thank you.
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The Paper:
In recent years, China's medical insurance system has expanded coverage to include more drugs for chronic and rare diseases. Notably, the inclusion of some extremely expensive drugs has significantly reduced the financial burden on patients. This process has also led to widely publicized negotiations for lower drug prices. Could you talk about the current state of the national medical insurance drug catalog? What are the plans for future developments in this area? Thank you.
Zhang Ke:
Thank you for your questions. Ms. Li will answer this question.
Li Tao:
Thank you for your question. The medical insurance drug catalog defines the range of medications eligible for reimbursement through medical insurance funds. It primarily includes Western medicines, Chinese patent medicines and prepared ready-for-use traditional Chinese medicines. Since its establishment, the NHSA has adhered to the principle of doing everything within our means and has continuously advanced reforms and improved management of the medical insurance drug catalog.
First, we've maintained dynamic adjustments, updating the catalog annually and promptly adding eligible new and improved drugs. This has significantly enhanced both the quantity and quality of medicines in the catalog. Over the past six years, we added 744 new medicines to the catalog. The number of Western medicines and Chinese patent medicines has increased from 2,535 in 2017 to 3,088 today. Simultaneously, the quality of medicines in the catalog has markedly improved. Many drugs based on new therapeutic mechanisms and new targeted drugs have been included, particularly in areas such as treatment of cancer, rare diseases and chronic conditions like hypertension and diabetes. This has achieved a closer match between the drugs covered by the national medical insurance system and clinical demand.
We have also leveraged the advantages of group purchasing through the medical insurance system to guide new drug prices toward reasonable levels. By implementing strategic purchases based on the integrated drug needs of more than 1.3 billion insured individuals, we've improved the mechanism for medical insurance access negotiations. As a result, many previously expensive drugs have become more affordable, significantly reducing the medical burden on the public. In the six years since the establishment of the NHSA, negotiated drug prices have benefited 720 million insured patients. Factoring in price reductions from negotiations and reimbursements from the national medical insurance system, the financial burden on the public has been eased by over 700 billion yuan.
At the same time, we have also strengthened incentives and guidance to drive innovative development in the pharmaceutical industry. While maintaining a focus on basic needs, we have developed preferential policies for innovative drugs that cover the entire process from enterprise declaration to review, calculation and negotiation. In recent years, many innovative drugs have been included in the catalog the same year they received approval. This rapid inclusion in the medical insurance system, coupled with swift market launches and clinical applications, has enabled enterprises to obtain reasonable returns on innovation. This has created a virtuous cycle of reinvestment and further research and development. The medical insurance system has played an important role in driving the development of new quality productive forces in the pharmaceutical sector.
Moving forward, we will further improve the mechanism for adjusting the national medical insurance drug catalog. While adhering to the principle of meeting people's basic needs, we'll strive to include more, better and newer medicines in the catalog. At the same time, we will also focus on studying and refining the multi-tiered medical security system with Chinese characteristics. This includes broadening payment channels for innovative drugs, aiming to continually meet people's expectations for a better life.
That's all from me. Thank you.
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Xing Huina:
You may continue to raise your hands for questions. We have time for two more reporters.
Chengdu.cn:
In recent years, centralized procurement of medicines and medical equipment has gradually gained recognition and acceptance. What achievements have been made in this area? Looking ahead, what adjustments are planned for centralized procurement to both lower medical costs for people and promote development in the biomedical industry? Thank you.
Yan Qinghui:
Thank you for your questions. The achievements of centralized procurement can be understood from three aspects.
First, it has lowered medical costs for people and improved the accessibility and quality of medicines. For example, the annual cost of antiviral medicines for hepatitis B, such as Entecavir and Tenofovir, was as high as 4,000 to 5,000 yuan before centralized procurement. After centralized procurement, the annual cost dropped to about 100 to 200 yuan. Clinical studies by medical institutions have shown that the rate of antiviral treatment and standard treatment for hepatitis B patients have increased significantly. Another example is insulin. Since the implementation of centralized procurement, its price has been greatly reduced. Consequently, the use of third-generation insulin, which has better clinical performance, has increased from 58% before centralized procurement to over 70% now.
Second, it has advanced the healthy and high-quality development of the pharmaceutical industry. Centralized procurement has reshaped the ecology of China's pharmaceutical industry and changed its development approach. Before centralized procurement, pharmaceutical enterprises focused on sales channel competition, paying less attention to quality and research and development. Centralized procurement provides a platform for fair and transparent competition, allowing good products to quickly enter the market. Public inquiries into price regulation of thoracic aortic stents and other medical consumables show that price cuts for some pharmaceutical products mainly came from compressing circulation costs, with minimal impact on the actual revenue of production and R&D enterprises. Meanwhile, the expenses saved can be redirected toward innovation, encouraging more enterprises to shift their focus to quality improvement, large-scale production and innovation.
Third, it has contributed to ensuring that public hospitals and medical institutions truly serve the public interest. Centralized procurement has eliminated hidden kickbacks in the distribution of medicines and consumables, leading to more standardized prescribing practices among medical staff. For example, the antibacterial use density (AUD), a key indicator measuring antibiotic consumption in areas prone to drug abuse, has declined from 37.8 in 2018 to 33.8 in 2022. Supporting policies for centralized procurement also focus on increasing legitimate and transparent income for medical institutions and staff. The policies require that medical insurance funds saved through centralized procurement are partially retained by medical institutions after assessment, with a considerable portion funding staff salary reforms. Some regions have also launched pilot projects for pharmaceutical service fees, recognizing the value of technical services provided by physicians and pharmacists. These measures have created conditions for high-quality development in medical institutions, enabling them to truly serve the public interest.
Next, the health care security authorities will vigorously expand the scope and improve the quality of centralized medicine procurement. We will continue to broaden the scope of centralized procurement, including launching new batches of national-organized drug and high-value medical consumables procurement. High-value medical consumables such as cochlear implants will be included in the procurement program. We will strengthen regional coordination, with a focus on guiding localities to advance centralized procurement for traditional Chinese medicines, TCM decoction pieces, and in vitro diagnostic reagents through alliances. We will proceed smoothly with follow-up procurement, enhance the refined management of procurement execution, and collaborate with relevant departments to reinforce management measures for the use, supply and monitoring of selected products. We will ensure that the selected products are promptly delivered to hospitals and prioritized for use. Additionally, we will take measures to hold selected enterprises accountable for ensuring product quality and supply. Thank you.
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Xing Huina:
One last question, please.
Tide News:
The third plenary session of the 20th CPC Central Committee outlined the need to improve the fertility support policy system and incentive mechanisms, and to promote the development of a fertility-friendly society. Could you please share some of the successful experiences and practices of the health care security system in building a fertility-friendly society? And what new policies can we expect in the future? Thank you.
Zhang Ke:
Thank you for your questions. The population issue is crucial for the sustainable development of the Chinese nation. The NHSA is committed to implementing the strategic decisions and deployments of the CPC Central Committee and the State Council. We are focusing on effectively managing basic medical insurance and maternity insurance, actively exploring ways to improve policies and measures for maternity insurance, and aligning these efforts with relevant economic and social policies to jointly build a supportive policy system for childbearing.
On the one hand, we continue to leverage the protection function of maternity insurance. While maternity insurance is a separate insurance program, it is now implemented in conjunction with basic medical insurance for employees. This helps reduce the burden of maternity medical expenses for insured female employees, balance the labor costs of employers, and promote fair employment opportunities for women. Maternity insurance covers both employers and employees, ensuring coverage for maternity medical expenses and maternity allowance during the mandated maternity leave period. In recent years, the protective function of maternity insurance has continued to be fully utilized. In 2023, 249 million people were covered by maternity insurance nationwide, with the expenditure of the maternity insurance fund reaching 117.7 billion yuan. The average maternity allowance for insured female employees was 26,000 yuan. To clarify, the maternity allowance is essentially the wage during maternity leave. We often hear discussions about whether maternity leave wages should be paid by the husband's employer or the wife's employer. In fact, neither is correct, because maternity leave wages are paid by medical insurance, specifically maternity insurance. Currently, there are two methods for distributing maternity leave wages, or maternity allowances. One method is to pay it directly to the female employee, and the other is to pay it to the employee's company, which then distributes it to the employee. Recently, we have also consulted with the All-China Women's Federation (ACWF) to gather their input. Going forward, we will explore ways to distribute maternity allowances (maternity leave wages) more directly to female employees. Of course, we acknowledge that some regions have local regulations that require allowances to be paid to the company first, which then pays the employee. We will encourage relevant regions to conduct careful research on this matter.
On the other hand, in response to the national population strategy and requirements, we are implementing multiple measures to improve and enforce proactive fertility support policies. This primarily involves expanding and consolidating maternity insurance coverage. We support certain regions in exploring flexible approaches, allowing self-employed individuals to participate in maternity insurance alongside employee medical insurance. We have already guided provinces such as Jiangxi, Zhejiang and Guizhou as well as Tianjin to carry out these explorations across their regions, and the results have been very positive. At the same time, we are standardizing and regulating the pricing of assisted reproductive medical services and promoting the inclusion of assisted reproductive technology projects in medical insurance coverage. We are guiding provinces to consider factors such as the capacity of medical insurance funds and the regulations on assisted reproductive technologies, gradually including suitable assisted reproductive technology projects in the scope of medical insurance fund payments through proper procedures. This aims to help resolve the issues faced by families who wish to have children but are unable or unwilling to do so. Currently, 20 provinces, autonomous regions and municipalities, including Beijing, Guangxi, Inner Mongolia and Gansu, as well as the Xinjiang Production and Construction Corps, have included assisted reproductive medical services in medical insurance reimbursement. By the end of this year, more provinces are expected to include these services in medical insurance reimbursement. Recognizing that childbirth can be a significant physical and emotional experience, we have expanded our offerings to include pain management options, doula delivery and family companionship during labor. These services aim to meet the diverse needs of mothers and improve the childbirth experience. Additionally, we continue to enhance the administrative services for maternity insurance, requiring localities to implement the standards for minimum application materials, simplest procedures, shortest processing time and highest service quality. We have streamlined the process and clarified that enjoying maternity insurance benefits no longer requires providing unnecessary additional documents such as a birth permit, maternity service certificate or marriage certificate, to facilitate access to benefits for the insured.
Building on Mr. Yan's introduction, new mothers often have a significant concern right after childbirth. Some babies may need to be placed in an incubator or undergo surgery immediately after birth, while the mother has not yet left her hospital bed. How can we ensure that the newborns receive timely and effective treatment? We have implemented a seamless newborn enrollment process, which allows parents to use a cellphone from the bedside to enroll the baby in insurance and obtain reimbursement immediately. This ensures better coverage and protection for the baby's medical expenses and treatment. These measures create more favorable conditions and more convenient services for proactive fertility policies.
Next, we will continue to guide various regions in effectively managing maternity insurance and basic medical insurance. We will continue to improve and refine the maternity insurance system, enhance its protective functions, expand its coverage and steadily increase the level of coverage for insured individuals' maternity medical expenses. At the same time, we will strengthen coordination between departments, promote the establishment of a policy system for fertility support, and work together to foster long-term balanced population development. Thank you.
Xing Huina:
Due to time constraints, today's press conference is hereby concluded. Thank you to the three speakers and friends from the media. Goodbye.
Translated and edited by Yan Bin, Huang Shan, Liu Jianing, Li Xiao, Wang Qian, Mi Xingang, Wang Wei, Zhang Tingting, Liu Sitong, Xu Kailin, Wang Yanfang, Liu Caiyi, Li Huiru, David Ball, Jay Birbeck, and Rochelle Beiersdorfer. In case of any discrepancy between the English and Chinese texts, the Chinese version is deemed to prevail.
