Can the new crown vaccine be included in medical insurance reimbursement? Response from the National Health Insurance Administration

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 The official website of the National Medical Security Administration recently announced the “Reply to Recommendation No. 9354 of the Third Session of the Thirteenth National People’s Congress”, in response to the suggestion of “inoculation of the new coronary pneumonia vaccine to be fully reimbursed by the medical insurance” proposed by the representatives of the National People’s Congress, the National Medical Insurance The bureau responded that the relevant state regulations clearly stated that “prophylactic vaccines are not included in the scope of medical insurance payment.” In addition, the number of people vaccinated this time is large, and the total cost is high, which obviously exceeds the affordability of the medical insurance fund.

 According to the National Medical Security Administration, since the outbreak of the epidemic, by the deployment requirements of the Party Central Committee and the State Council, the “two guarantees” policy has been studied and issued promptly in conjunction with relevant departments to ensure that patients will not be affected by the cost of medical treatment and that the hospital will not be affected by payment policies. . All confirmed and suspected patients will be treated first and then settled, and special funds will be allocated to medical institutions that undertake the task of creating new coronary pneumonia, to relieve the financial pressure of medical institutions, and settle settlements with medical institutions promptly. As of July 19, 2020, there have been 135,500 medical insurance settlements for confirmed and suspected patients with new coronary pneumonia nationwide, involving medical expenses of 1.847 billion yuan and medical insurance payments of 1.232 billion yuan, with a payment ratio of 67%. The remaining part of the government is subsidized according to regulations, which solves the worries of patients and medical institutions, and lays a solid foundation for defeating the epidemic.

 According to the “Vaccine Administration Law of the People’s Republic of China” implemented on December 1, 2019, my country divides vaccines into immunization planning vaccines and non-immunization planning vaccines. Among them, the immunization planning vaccine is organized by the State Council’s health department in charge of the State Council in conjunction with the State Council’s financial department and other organizations to conduct centralized bidding or unified negotiation. At the same time, Article 30 of the “Social Insurance Law of the People’s Republic of China” stipulates that medical expenses that should be borne by public health are not included in the payment scope of the basic medical insurance fund. In addition, the “Interim Measures for the Administration of Medication for Basic Medical Insurance” announced in July 2020 pointed out that preventive vaccines are not included in the scope of medical insurance payments. Therefore, disease prevention and control projects such as vaccines and vaccination costs should be solved through public health service funding channels.

 In addition, the National Medical Security Administration stated that the current level of financing for basic medical insurance in my country, especially for urban and rural residents medical insurance, is relatively low. In 2019, the per capita financing of urban and rural residents medical insurance is only about 800 yuan. However, the number of people vaccinated this time is large, and the total cost is high, which obviously exceeds the affordability of the medical insurance fund. Judging from the overall development of the medical insurance system at this stage, the demand for disease treatment of the masses, the level of financing of medical insurance funds, and the ability to resist risks, the current basic medical insurance system is still based on providing basic disease treatment guarantees for the masses, focusing on meeting the basic medical needs of the masses, and also There is no ability to expand payments to non-therapeutic items such as vaccines.

 The National Medical Security Administration revealed that in the next step, by the relevant requirements of 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”, it will do a good job in serving the anti-epidemic work, and jointly study the cost of the new crown vaccine with relevant departments.

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By Michael Caine

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