Looking forward to making medicine more accessible, after Shanghai’s “15 medical insurance items” were implemented in the community: the first batch of patients have already enjoyed the “dividends”

In order to guide citizens to seek medical treatment in the community and build a reasonable hierarchical diagnosis and treatment system, before the National Day, the Shanghai Municipal Medical Insurance Bureau, together with the Municipal Health Commission and the Municipal Administration of Traditional Chinese Medicine, jointly issued "Several Measures for Shanghai Medical Insurance to Further Support the Improvement of Community Health Service Capabilities". Aims to provide high-quality and accessible primary medical services to the public. How is the implementation of the New Deal after it is implemented? How to let patients enjoy the "dividends" to the greatest extent? Recently, reporters from Jiefang Daily and Shangguan News interviewed some community health service centers.

The “15 Medical Insurance Articles” involve reducing the burden of medical treatment on citizens, which has attracted considerable attention from the public. This specifically includes: moderately increasing the outpatient and emergency reimbursement ratio of primary medical institutions, increasing the reimbursement ratio for community outpatient and emergency services to 80% for current employees, and raising it to more than 85% for some retirees; increasing the actual reimbursement level for primary-level medicines, and equipping and using them in primary-level medical institutions. Class B drugs in the medical insurance catalog shall be paid with reference to Class A drugs, and the payment policy for centralized bulk purchase of drugs shall be implemented in accordance with relevant regulations.

During the long holiday, the first batch of patients at Jiangchuan Community Health Service Center in Minhang District have experienced the changes brought about by the new policy. For insured patients, the most practical preferential policy is to enjoy the reduction in drug prices. Aunt Zhang, a citizen, has been taking medicines to control blood pressure, blood sugar and improve coronary heart disease for a long time. She usually needs to dispense about 200 yuan of Class B paid medicines every month. "Based on the 10% self-payment, I need to pay 20 yuan in cash. After the introduction of favorable policies, , this part of the medicine is converted to Category A payment, so there is no need for personal responsibility. Even if it is a small amount, it is not a small sum in the long run for patients with chronic diseases. amount."

Dapuqiao Community Health Service Center in Huangpu District took into account the needs of patients and insisted on opening clinics every day during the long holiday. Zhang Jing, director of the pharmacy department, told reporters that many old patients have benefited from the policy. She gave an example: The Chinese patent medicine "Maizhiling" is used to treat varicose veins, etc., and more than 300 boxes were dispensed during the long holiday. This time, Class B drugs are paid according to the payment of Class A drugs. Patients who take a box of "Maizhiling" can pay 4 less. Yuan or so. The western medicine "Sacubitril Valsartan Sodium Tablets" is used to reduce blood pressure. More than 200 boxes were distributed during the long holiday, and patients can get a discount of 3-4 yuan per box compared with before.

According to the person in charge of the medical insurance department: In the past, when community health service centers reimbursed Class B drugs in the medical insurance catalog, patients were required to pay 10% of the total amount first, and then pay the remaining 90% according to the medical insurance reimbursement ratio; now, reimbursement of Class B drugs in the community is based on the All drugs are included in the scope of medical insurance reimbursement. Currently, there are nearly 2,000 kinds of Class B drugs commonly used in Shanghai community health service centers. According to static calculations, after the implementation of the policy, the financial burden on patients will be reduced by nearly 200 million yuan each year.

Zhang Jing said bluntly: In fact, many patients are very concerned about the policy after it is implemented, and the cost of seeing a doctor and dispensing medicines has been saved. However, some patients are not very familiar with the details. Currently, Class B drugs are paid according to Class A, and are limited to drugs in the medical insurance catalog. The centralized procurement catalog is implemented in accordance with relevant regulations. In addition, original drugs such as Lipitor do not belong to the centralized procurement drug catalog and are not included in the "bonus" scope of the policy.

Lv Qingkun, the attending physician at Jiangchuan Community Health Service Center, believes that the 15 measures to empower grassroots medical insurance have brought real benefits and convenience to insured patients. In order for a community to retain people and provide good medical care, it also needs to have “weapons in hand.” Increasing the reimbursement ratio for dispensing can play a role in promoting the implementation of hierarchical diagnosis and treatment and guiding patients with common diseases to seek treatment in the community.

Let the "dividend" be truly implemented. Many citizens have previously reported that some medicines dispensed in large hospitals are often not available in communities. After the "dividend" is implemented, how can the coverage be wider and the medicines more accessible? The reporter learned that Shanghai has launched extended prescription services since 2016. Family doctors have been contracted to provide extended prescription services, and about one million extended prescriptions can be filled every year. Some patients are not yet familiar with this "rights" of signing a contract, so they can try to request extended prescriptions from their family doctors, and the prescriptions from higher-level hospitals will be delivered to their homes through third-party logistics.

According to the "15 Medical Insurance Articles", citizens can also go to designated retail pharmacies with electronic prescriptions to purchase some medicines and enjoy the same reimbursement rate as in the community. The person in charge of medical insurance explained this: For medicines that patients need but are not yet available in the community, community doctors can also issue electronic prescriptions and purchase them at designated pharmacies nearby.

To meet the actual needs of citizens and appropriately expand the medication list, many community health service centers are exploring different approaches. The reporter learned that the Dapuqiao Community Health Service Center set up a questionnaire survey at the window, and patients suggested expanding the types of drugs. After comparison and evaluation by the hospital, a "selection channel" was opened to meet the needs. Not long ago, the center's antihypertensive drug "Kaisuda" became available upon patient request. Zhang Jing said that in the future, the center will continue to adjust and update to provide high-quality and accessible medical services to patients within its jurisdiction and keep common diseases in the community.