Summary of the Key Points from this Press Conference
The press conference held by the State Council Information Office regarding the launch of the 14th Five-Year Plan for medical insurance did not consist of empty slogans; instead, it presented concrete policies aimed at addressing the real issues faced by ordinary people in accessing healthcare and the bottlenecks in the medical industry. On one hand, these measures aim to reduce the burden on citizens by addressing long-standing problems such as the high cost of innovative medicines, the difficulties in enrolling in insurance for those in flexible employment, and the high costs of caring for disabled elderly people. On the other hand, they seek to encourage innovation in the medical sector by providing incentives for pharmaceutical companies and medical technology companies to develop new drugs and cutting-edge medical technologies. The ultimate goal is to create a win-win situation where patients benefit, hospitals can develop, and the industry gains momentum.
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Detailed Breakdown and Interpretation
1. Dual-track reimbursement for innovative drugs: No more waiting for years for price reductions
Many people will remember the news about the 700,000-yuan drug for a rare disease being included in the medical insurance coverage. Since the medical insurance system began to dynamically adjust its drug list in 2018, a total of 949 drugs have been added to the reimbursement list, including 199 innovative drugs that were previously unaffordable for the general public. Now, the annual update of the medical insurance drug list has been established as a long-term practice. The focus will be on areas such as oncology, chronic diseases, rare diseases, and pediatric medications, with eligible new drugs being quickly included in the insurance coverage. This will prevent the situation where a life-saving drug takes five to six years to be reimbursable after its launch.
To make things even more convenient, a "buffer insurance" mechanism has been introduced. For newly launched drugs that are highly innovative and have proven clinical effectiveness but have not yet gone through the medical insurance negotiation process, they will be added to the recommended list for commercial health insurance. This allows commercial insurance to cover part of the cost, freeing patients from having to pay the full amount out of pocket, essentially creating a fast-track for drug reimbursement.
2. Accelerated adoption of cutting-edge technologies like surgical robots and brain-computer interfaces
We have often heard about powerful domestic surgical robots and brain-computer interface devices that have been approved for use but have not been widely adopted in hospitals due to the lack of corresponding medical insurance reimbursement options. The newly introduced "medical service price pre-approval system" aims to solve this issue. Before a new technology or device undergoes clinical testing or national innovation approval, the medical insurance authorities will engage with companies and hospitals to establish pricing rules in advance, creating a green channel for approval. Once approved, hospitals can charge patients according to the set standards across the country. This has already unified the reimbursement rates for over 200 new technologies, such as surgical robots and brain-computer interfaces, preventing arbitrary pricing differences between regions. As a result, patients can access more advanced medical technologies more quickly, hospitals can generate reasonable revenue from these technologies, and research and development companies can quickly recoup their investments and pursue further innovation.
3. Full liberation for flexible employment workers in enrolling in medical insurance
There are hundreds of millions of people in flexible employment across the country, including delivery riders, online car-hailing drivers, and freelancers. They have faced many difficulties in enrolling in medical insurance. For example, delivery riders without a Shanghai residence could not enroll in the local employee medical insurance and had to rely on the resident insurance from their hometown, resulting in lower reimbursement rates. Now, all major cities have abolished the household registration requirement for flexible employment workers to enroll in medical insurance. They can enroll directly in the local employee insurance and enjoy the same reimbursement benefits as local employees. Additionally, the years of resident insurance they have paid will be credited towards the employee insurance requirements, with the option to convert them monthly. For instance, nine years of resident insurance can be equivalent to three years of employee insurance, allowing them to meet the minimum requirement after paying for another 22 years and enjoying medical insurance benefits upon retirement, without any loss of their previous contributions.
4. National coverage of long-term care insurance by 2028
Many people are unaware that China's medical insurance system includes a "long-term care insurance" that covers the costs of caregivers and home-based care for disabled or semi-disabled individuals. For example, the monthly cost of hiring a caregiver for a disabled elderly person can be significantly reduced by this insurance. Currently, this insurance is only available in a few pilot cities, and the assessment criteria for disability vary from place to place. The new plan sets a clear timeline for nationwide coverage by the end of 2028, expanding coverage from insured employees to all urban and rural residents. A unified national standard for disability assessment will ensure that eligible individuals can apply for benefits anywhere in the country without the need to repeatedly provide proof. This will greatly reduce the financial burden on families caring for disabled loved ones and eliminate the need for children to quit their jobs to care for them full-time.