Summary of the News in Plain Language
Recently, the Tianjin Medical Insurance Bureau introduced a new regulation. The most significant aspect of this change is that all transaction data related to using one's medical insurance personal account to purchase medication will now be included in the official drug price monitoring system. In the past, when checking whether drug prices were excessive, the authorities mainly looked at the purchase prices listed by hospitals and the public prices displayed by pharmacies, both online and offline. This made it easy for merchants to manipulate prices through tactics such as using “dual pricing” or swapping products. With this new regulation, Tianjin has extended its supervision to the final payment stage for consumers, integrating the actual transaction prices from hospitals, offline pharmacies, e-commerce platforms, and personal account transactions for cross-referencing. This is essentially like obtaining a detailed receipt of every purchase, making it impossible to hide any price discrepancies.
This is not a temporary measure specific to Tianjin; it represents the next step in the nationwide reform of medical insurance personal accounts. Previously, the adjustment was made to ensure that the money contributed by employers no longer goes into personal accounts but is instead pooled into a common fund for mutual reimbursement of outpatient expenses. Now, the focus has shifted to strictly controlling how the money in these personal accounts is spent. The reform has evolved from simply determining which items can be paid for using the account to also assessing whether the products purchased are worth the price and whether there are any price markups. It is very likely that other provinces across the country will follow Tianjin’s lead.
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Detailed Explanation of the Changes
1. What were the loopholes in previous drug price supervision, and how are they being addressed?
Many people may not be aware that there was a significant blind spot in previous drug price monitoring: the official data available only reflected the prices that merchants were willing to make public, not the actual prices paid by consumers. For example, although medical insurance required consistent prices both online and offline, some merchants used two separate systems. The price displayed to customers could be 10 yuan, but when the payment was made using the medical insurance account, the system would automatically show a price of 20 yuan, with the difference going to the pharmacy. Even more problematic was the practice of some pharmacies allowing customers to use their accounts to buy items like laundry detergent or health supplements, and then changing the product description in the backend to something like a cold medicine or fever reducer during the transaction. With the new regulation, Tianjin has directly accessed the real transaction data, bypassing the manipulated information provided by merchants and obtaining a clear record of each purchase, including the date, amount paid, and specific product purchased.
2. What does “vertical and horizontal comparison” mean, and how does it work?
The “vertical and horizontal” monitoring system being established by Tianjin is easy to understand:
- Vertical comparison (national price comparison): If the same cold medicine is available for 12 yuan in other provinces, and a pharmacy in Tianjin sells it for 25 yuan, the system will automatically issue a warning without the need for manual verification.
- Horizontal comparison (cross-channel verification): If the same medicine costs 15 yuan in hospitals, 16 yuan online, and 17 yuan in offline pharmacies, and you pay 30 yuan, the system can immediately identify that the pharmacy is overcharging.
This system can also trace the transaction data back to the manufacturers. If the prices at multiple outlets are significantly higher than the national average, medical insurance can investigate the manufacturers to determine if there is any malicious price gouging, rather than just punishing the selling outlets.
3. Many people think the money in their personal accounts is their own; however, this is not the case.
There has been confusion about the nature of the money in personal medical insurance accounts. This money was never intended to be freely disposable personal savings. It is part of a medical insurance fund and can only be used for medical expenses. In the past, a portion of the money contributed by employers was placed in personal accounts as a transitional measure due to limited insurance coverage. Over the years, this has become increasingly problematic. Young people with good health may have thousands in their accounts that they cannot spend, while elderly people who frequently need medical care may run out of funds. A significant amount of money remains unused in these accounts. During the reform, some experts suggested abolishing personal accounts and putting all the money into a public fund for outpatient reimbursement. However, to gain broader acceptance, the current system was adopted, where only the portion contributed by individuals goes into personal accounts.
4. What benefits will ordinary people enjoy after the new regulation takes effect?
There are several direct benefits for consumers:
- Medications will be cheaper: Pharmacies that overcharged will be penalized, making it more cost-effective to use medical insurance for purchases.
- Consumers will no longer be deceived by deceptive sales tactics: The system will alert users if their transaction records show purchases of non-medical items at high prices.
- Outpatient reimbursement funds will be more sufficient: With fewer misappropriations, more funds will be available for outpatient reimbursement, potentially leading to higher reimbursement rates and limits in the future.
5. Tianjin is not an isolated case; nationwide regulation is the trend.
Tianjin’s initiative is part of a broader national effort. It is rumored that the National Medical Insurance Administration is promoting a second round of multi-channel price comparison monitoring. Once Tianjin’s system is fully implemented and the warning mechanism is in place, other provinces are likely to adopt similar measures. Future medical insurance supervision will cover the entire chain, from drug production to final payment, ensuring that the medical insurance funds are used where they are most needed and returning any undue deductions to the insured.