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Shandong: Chinese medicine reimbursement ratio will not be less than 85%, 1374 kinds of Chinese medicine, 892 kinds of Chinese medicine will be included in the medical insurance

Author: Release Date:2022/12/01

On October 27, Shandong Government Press Office held a conference to introduce the relevant policies and work of Shandong Medical Insurance to support the development of Chinese medicine heritage and innovation. Qiu Bingyu, the first-level inspector of Shandong Medical Insurance Bureau, introduced that in accordance with the requirements of the construction of the national demonstration zone for comprehensive reform of Chinese medicine, Shandong Medical Insurance Bureau has formulated a special action plan for medical insurance to support the construction of the demonstration zone, giving policy support in various aspects, such as medical insurance ordering, project construction, support for the development of technological innovation in Chinese medicine, price adjustment, medical insurance reimbursement, payment reform and handling services, to fully support the demonstration zone High-quality construction and innovative development of TCM industry.

Shandong supports the high-quality development of TCM medical institutions and promotes full medical insurance coverage for TCM medical institutions. Currently, 2,664 TCM medical institutions and 8,133 TCM stores are designated for medical insurance in Shandong, covering all types of TCM medical institutions and retail pharmacies such as TCM hospitals, TCM specialist clinics, TCM rehabilitation and TCM stores. Implementing the policy of total medical insurance support, giving total medical insurance support to tightly knit county medical communities led by TCM medical institutions, and implementing total payment. Shangdong comprehensively implements the compound medical insurance payment mode, and promotes the medical insurance payment mode of day treatment for TCM diseases with long treatment period, controllable risk and requiring continuous treatment, and carries out medical insurance settlement according to the reimbursement standard for inpatient or outpatient chronic diseases; the diseases with obvious TCM advantages, clear treatment paths and clear costs are included in the management of TCM advantageous diseases, which is implemented by disease type payment. To support the development of TCM advantageous disciplines, many cities such as Jinan, Weihai, Dezhou and Binzhou have introduced targeted support policies for TCM characteristic treatment items, TCM characteristic specialties and TCM characteristic medical institutions, so as to realize the key support of medical insurance payment for TCM characteristic technologies, enhance the service capacity of TCM and improve the recognition of TCM by the public.

Shangdong supportTCM treatment technology to keep righteous innovation and continuously promotes the price reform of TCM items. This year, 42 TCM items were adjusted in accordance with the principle of both upward and downward adjustments, and the prices of 27 TCM items that were lower than the national average were raised, and 15 TCM items that were significantly higher than the national prices were moderately adjusted downward. A green channel has been opened for the review of new TCM medical service price items, and new TCM appropriate technologies with precise efficacy and reflecting the characteristic advantages of TCM have been included in the scope of reimbursement in a timely manner, and the total number of TCM (including rehabilitation) items in Shandong has reached 208. The total number of TCM (including rehabilitation) projects in the province has reached 208. Taking advantage of TCM for treating untreated diseases, the cost of self-financed TCM projects such as TCM for treating untreated diseases and decoction fees that meet the regulations are allowed to be paid through the personal account of medical insurance.

Shandong supports the innovative development of Chinese medicine industry, and encourages TCM manufacturers and TCM medical institutions to develop drugs and treatment techniques for the prevention and control of major epidemics. During the prevention and control of epidemics, the five new Chinese medicine preparations for the treatment of crown pneumonia that are allowed to be transferred for use will be included in the scope of reimbursement in the first instance to further guide TCM and play an active role in the prevention and control of major epidemics. Standardizing the medical insurance payment for Chinese medicine herbal pieces and therapeutic medical institutions, and included 1,374 types of Chinese patent medicines will include 892 types of Chinese medicine herbal pieces, 3,757 Chinese medicine granule products and eligible therapeutic Chinese medicine in-hospital preparations. The inter-provincial Chinese medicine (materia medica) procurement alliance was established to address the situation of large quality differences, high price fluctuations, unstable supply and unregulated production and circulation market of Chinese medicine beverages. 21 kinds of Chinese medicine beverages with high clinical usage were preferred this year, and Shandong took the lead to explore the first single inter-provincial joint procurement of Chinese medicine beverages in the country. Shandong Provincial Medical Insurance Bureau, in conjunction with relevant departments, formulated the "Notice on Further Improving the Medical Insurance Payment for Chinese Medicine Formulas", which will implement the provincial centralized drug procurement platform listing, sunshine procurement and online transaction for all Chinese medicine formulas that meet the national and Shandong standards, and include medical insurance payment in accordance with regulations, which will effectively promote the transition of Chinese medicine formula particle drug production from corporate standards to national and provincial unified standards.

Shandong supports the popularization of Chinese medicine services to benefit the publicPersonal payment in the Chinese medicine treatment will be reduced;for the insured patients in the grassroots hospitalization using Chinese medicine treatment, the average medical insurance reimbursement ratio of the province's compliance medical costs of not less than 85%. In the province's unified abolition of the medical insurance catalog of Chinese medicine out-of-pocket personal first, to guide the masses to choose Chinese medicine treatment. Shandong will also promotes the management of "dual-channel" drugs, incorporate 62 nationally negotiated proprietary Chinese medicines into the "dual-channel" management of hospitals and pharmacies, and support the construction of intelligent shared Chinese medicine rooms to further improve the accessibility of Chinese medicine supply. Optimize medical insurance services, and timely include qualified TCM medical institutions into the scope of medical insurance designated points and cross-city and cross-province network designated points within the province, so as to maximize the demand for TCM treatment and medical insurance reimbursement services.




Source: Pharma.com

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