PKU Covered by Critical Illness Insurance of NCMS
The National Health and Family Planning Commission (NHFPC) recently issued its Notice on Advancing Several Items on the Agenda of New Rural Cooperative Medical Scheme, requiring the comprehensive use of New Rural Cooperative Medical Scheme (NCMS) funds to purchase critical illness insurance. Besides the existing insurance of 20 critical diseases such as childhood leukemia, end-stage renal disease, severe mental illness, AIDS/HIV opportunistic infections, and lung cancer, childhood phenylketonuria (PKU) and hypospadias will also be included in the coverage of critical illnesses.
According to the Notice, in 2014, the revenue collection and benefit package of NCMS will be further improved. Subsidies for NCMS by fiscal authorities at all levels will be raised to 320 yuan, and individual contributions across the country will average about 90 yuan. Local governments should adjust and optimize the compensation plan, reimbursing more than 75% of inpatient costs and as high as nearly 50% of outpatient expenses under the NCMS coverage.
The Notice requires the introduction of commercial insurance institutions to provide critical illness insurance for the city or province as a whole where governments should play a leading role based on market operations, with the aim of breaking even or profiting little in order to benefit the people. To this end, local governments should establish and improve the bidding mechanism and regulate the operation of critical illness insurance. The basic protection provided by the NCMS, critical illness insurance, medical aid and disease emergency relief systems should complement each other, thus forming synergy in providing a "one-stop" service for the public.
Improving the policy concerning general diagnosis and treatment charges, the general diagnosis and treatment rate charged by rural doctors will be increased by 1 yuan and no less than 5 yuan in total, and the increase will be paid out of NCMS funds. For public hospitals undergoing healthcare reform, the adjusted price for treatment, operation, nursing and others reflecting the value of technical services offered by medical personnel will be covered by NCMS with a higher reimbursement rate, coverage and reimbursement rates for pharmaceuticals, checks and tests by high-value medical appliances and large medical equipment should be kept at a stable level and under control. Day surgery should be included in in-patient reimbursements. The NHFPC will formulate reimbursement policies that will encourage the use of essential drugs and cheap drugs, guide medical institutions and personnel in taking the initiative to reduce costs, optimize drug prescriptions, and reduce the burden on patients caused by drug costs. Eligible village clinics will be included as NCMS-designated medical institutions; so will non-public hospitals in accordance with the implementation of NCMS regulations. On the basis of standard operations, the NHFPC will start a pilot adding health facilities of nursing homes to the list of NCMS-designated medical institutions.
The NCMS will play a guiding role in the formation of a diagnosis and treatment model featuring a first option at the community-level health facilities, two-way referrals of patients, separate treatment of acute and chronic diseases and coordination among different levels of facilities. We will widen the gap of reimbursement rates between different levels of medical institutions, and guide patients to seek diagnosis and treatment at different levels of facilities in an orderly manner.
The NHFPC will speed up the development of NCMS information platforms at the provincial level and get them connected with the National NCMS information platform. In 2014, the NHFPC will try to increase the number of provinces with interconnected NCMS platforms to around 15. By such means as utilizing NCMS information platforms, independent consultations and entrusting commercial insurance institutions with their handling, better-off regions should start piloting reimbursement for farmers seeing doctors at places or provinces other than where they are enrolled as a member of the NCMS.
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