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Medical Insurance Bureau: Bypassing hospitals to settle accounts directly with medical device companies
Release time:
2025-03-12 09:41
The unavoidable problem of payment collection
Direct settlement with medical consumable manufacturers and distributors
Recently, the Shenzhen Medical Insurance Bureau released the "Shenzhen Implementation Plan for the Reform of High-Value Medical Consumables Governance" (hereinafter referred to as the "Reform Plan").
The Reform Plan clearly requires strengthening centralized settlement management. Following the principles of uniformity, standardization, and efficiency, a centralized settlement mechanism for transaction funds will be established. A centralized settlement supervisory account will be set up on the Shenzhen Sunshine Platform to achieve full process supervision of trading activities.
Explore the possibility of the medical insurance fund settling accounts directly with medical consumable manufacturers and distributors through a centralized settlement supervisory account.
It is understood that, recently, the Guangdong Provincial Medical Insurance Bureau also issued the "Drugsand Group Purchasing of Medical ConsumablesPurchasing> again for public comment," which clearly indicates the need to reform the payment settlement mechanism.
The above-mentioned draft for comments shows that it is necessary to strengthen payment settlement, prepaying medical institutions at least 30% of the purchase amount; actively promoting the direct settlement of funds between the medical insurance fund and pharmaceutical manufacturers or distributors, improving payment collection efficiency.
In addition, on March 5, the State Council issued the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System," which also clearly stated that it is necessary to promote direct settlement between the medical insurance fund andPharmaceuticalEnterprisesdirectly, and improve the mechanism for coordinating medical insurance payment standards and centralized purchasing prices.
Some industry insiders analyzed that this is a way for medical insurance to improve the efficiency of medical institution billing, and medical institutions will lose the right to settle payments directly with enterprises.
Improving the payment collection efficiency for medical equipment enterprises is conducive to increasing the enthusiasm of enterprises to participate in volume-based procurement. Because the price of volume-based procurement is relatively low, the gross profit margin of enterprises is also particularly low, and coupled with the fact that payments are collected only after half a year or even a year or two, enterprises will incur a large amount of financial costs, resulting in great pressure, which is not conducive to the further development of volume-based procurement.
A batch of consumables, focusing on governance
In addition to settlement matters, the above-mentioned Shenzhen Reform Plan also requires clarification of the scope of key governance. Referencing the national and Guangdong provincial key governance lists for medical consumables, conduct baseline surveys of medical consumable use in public medical institutions,
and include medical consumables that directly affect the human body, have strict safety requirements, are used in large quantities clinically, have relatively high prices, and have a heavy burden on the masses in the governance scope of high-value medical consumables, and include high-value medical consumables with relatively high unit Price and resource consumption ratio in the key governance list.
On January 14 this year, the Medical Administration and Management Bureau of the National Health Commission issued the "Notice of the General Office of the National HealthHealthCommission on Issuing the First Batch of National Key Governance Lists for High-Value Medical Consumables," announcing the national high-value consumable governance list.
At the same time, it is required that provincial health and health administrative departments, on the basis of the list, appropriately increase the varieties according to local conditions to form provincial lists, and guide medical institutions within their jurisdictions to formulate medical institution lists.
Local health and health administrative departments at all levels and medical institutions of all types and levels must strictly implement the relevant requirements of the "Management Measures for Medical Consumables in Medical Institutions (Trial)", strengthen the management of medical consumables, and carry out relevant work in accordance with the requirements of the reform work for the governance of high-value medical consumables.
As early as July 31, 2019, the State Council issued the "Reform Plan for the Governance of High-Value Medical Consumables," which clearly requires strengthening the standardized management of high-value medical consumables, clarifying the scope of governance, and taking high-value medical consumables with relatively high unit Price and resource consumption ratios as key governance objects.
In addition, on November 18, 2019, the State Council website issued the "Notice of the Leading Group for Deepening Medical and Health System Reform of the State Council on Further Promoting the Experience of Deepening Medical and Health System Reform in Fujian Province and Sanming City," which also clearly stated that in 2020, all localities should, in accordance with the national key governance list for high-value medical consumables and relevant work requirements, increase the efforts to govern consumable use.
At the same time, it emphasized that the 11 comprehensive medical reform pilot provinces must ensure that they achieve phased results.
Attachment: The first batch of national key governance lists for high-value medical consumables
Medical insurance, medical devices
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