Medical Insurance Settlement Across Regions Opens a Window

Following the new policy of inter-provincial "roaming" for medical insurance, another document aiming to facilitate medical treatment for insured persons has been officially released to the public by the Ministry of Human Resources and Social Security recently.

  Analysts believe that this move is a continuation of a series of supporting policies for the new medical reform, and an important step from a regional medical insurance market to a national medical insurance market, which helps break regional boundaries. However, since there are still many technical issues to be addressed for the implementation of the policy, its impact on the pharmaceutical industry is limited in the short term.

  Breaking Regional Boundaries

  "This is a national policy that cares about people's well-being. It mainly facilitates medical treatment for people covered by medical insurance, but it will have little impact on the pharmaceutical industry in the short term." Gan Rongfu, consultant of the Operation Management Department of Sinopharm Group, put forward the above view mainly based on the following considerations: First, medical demand is rigid demand. Whether it can be reimbursed or not, people will definitely seek medical treatment when they are really sick; second, there are still many technical issues that have not been addressed for the implementation of the policy.

  The Opinion is mainly aimed at people such as retirees relocated to other places, and is not open to all insured persons. Therefore, reimbursement for medical treatment in different places has not been truly liberalized. "In fact, the actual conditions do not allow liberalization. Once it is liberalized, all insured people at the grass-roots level will go to large hospitals in big cities for medical treatment, which will make the medical resources of large hospitals even tighter."

  According to the requirements of the recent implementation plan of the medical reform, the Opinion issued this time requires that eligible regions raise the overall planning level and implement municipal (prefectural-level) overall planning. Within the same overall planning area, the policies, standards, management and settlement methods of basic medical insurance shall be unified, unified settlement shall be implemented, and cross-region medical settlement shall be reduced.

  At the same time, the Opinion also specifies the settlement methods for several typical situations: medical expenses incurred by insured persons during short-term business trips, study and training or vacations; medical expenses incurred when transferring to another place for treatment due to the limitation of local medical conditions; retirees who have lived in other places for a long time seeking medical treatment in their place of residence, and personnel who work permanently in other places seeking medical treatment in their place of work.

  Generally speaking, the construction of the medical insurance system is regarded as a great driving force for market expansion and industry growth. The gradual promulgation and implementation of policies on the connection of medical insurance relations, off-site medical treatment and expense settlement services will also help improve the actual level of medical security. The improvement of payment capacity brought by the improvement of security level will promote the increase of willingness to seek medical treatment and the growth of medical expenses.

  However, more than one expert holds a relatively cautious view. An expert from the Chinese Community Health Association also told reporters that the promulgation of the Opinion is certainly a good thing, but it is still unclear how long the time span will be from the promulgation of the Opinion to its implementation. "I think the problems and difficulties are not small, and I don't know what the operable policies are. Off-site medical insurance settlement exists in some regions and between some specific locations, but for the implementation of a unified policy across the country, I still hope to see detailed supporting policies." The expert said.