The "15th Five-Year" Plan for Medical Insurance outlines key areas for centralized procurement, with the winning bid price set as the standard for medical insurance payments.

Summary of Key Points

The "15th Five-Year Plan for Universal Medical Security" serves as a roadmap for healthcare reform over the next five years, focusing on two main areas: deepening the centralized volume-based procurement of medicines (referred to as "centralized procurement") and reforming medical services. By expanding the scope of centralized procurement, optimizing the rules, and making these drugs more readily available, the plan aims to provide citizens with cheaper and higher-quality medications and medical supplies while promoting coordinated development among healthcare insurance, medical services, and the pharmaceutical industry.

Detailed Interpretation

1. Expansion of Centralized Procurement Scope: More Medications and Supplies to Be Included in National Purchases

Previously, centralized procurement mainly targeted chemical drugs and certain high-value medical supplies (such as heart stents). The new plan aims to broaden this scope:

• Increase Variety: Gradually include more commonly used and overpriced traditional Chinese medicines, biologics (e.g., insulin), and medical supplies (e.g., artificial joints) in the procurement process.
• Wider Coverage: In addition to national-level procurement, local alliances (led by one province with participation from across the country) are encouraged. This approach helps avoid duplicate negotiations at different regions.
• Clear Goal: The goal is to reduce inflated drug prices through collective bargaining, thereby reducing the financial burden on patients.

2. Greater Convenience in Accessing Medications

Centralized procurement drugs were previously mainly available in public hospitals. The new plan aims to:

• Diversify Distribution Channels: Make these drugs accessible in primary healthcare institutions (community hospitals, township health centers), private hospitals, and designated retail pharmacies, so patients can purchase them closer to home.
• Faster Settlements: Explore direct payments from healthcare insurance to pharmaceutical companies, eliminating the need for hospitals to advance funds before reimbursement. This will speed up payment for manufacturers, encouraging them to produce and supply these drugs more actively and relieving financial pressure on hospitals.

3. More Reasonable Rules to Prevent Malicious Competition and Ensure Quality

Centralized procurement is not about the lowest price alone; the plan emphasizes the need for balanced rules:

• Clinical Relevance: Ensure that selected drugs are commonly used by doctors and necessary for patient treatment.
• Quality Assurance: Collaborate with regulatory authorities to strictly inspect the quality of approved drugs, preventing cut corners due to low prices.
• Prevent Price Manipulation: Stop companies from artificially lowering prices just to win bids, which could lead to supply issues or reduced quality.
• Combat Collusion: Crack down on practices where several companies conspire to inflate prices or take turns winning bids, maintaining fair competition.

4. Dual Drive of Healthcare Insurance and Medical Services

The plan combines centralized procurement with reforms in medical service pricing:

• Insurance Payment Alignment: Use the selected bid prices as the basis for insurance reimbursements, avoiding situations where patients still pay high prices despite insurance coverage.
• Coordination among Stakeholders: Promote cooperation among healthcare insurance providers, medical services, and pharmaceutical companies. For example, by reforming payment methods (e.g., based on the type of treatment) and establishing stable drug price mechanisms to prevent arbitrary price increases.

5. Normalization of Centralized Procurement

The plan aims to make centralized procurement a long-term practice, not a temporary initiative:

• Standardized and Institutionalized Processes: After the initial agreement expires, there will be a new mechanism for continuous procurement to prevent price rebounds after the program ends.
• Continuous Improvement: Efforts will focus on expanding the scope of procurement, refining rules, and ensuring effective implementation to truly benefit the public.

In Summary

Over the next five years, healthcare reform will involve more widespread national purchases of medications and medical supplies, making cheaper drugs more accessible and of higher quality. This will result in cost-saving and more convenient access to healthcare for citizens.