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hot discussion! 104 medical institutions voluntarily withdraw from medical insurance. what do you think?

2024-09-30

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author of this article: z_popeye

a large number of designated institutions have taken the initiative to unbundle medical insurance.

on september 29, the xing'an league medical security bureau issued an announcement. as of that day, 100 medical institutions in the xing'an league had their medical insurance service agreements suspended or terminated due to violations, and 104 medical institutions voluntarily withdrew from the medical insurance service agreement.

screenshot of the official account of xing'an league medical security bureau

xing'an league voluntarily withdraws from the list of medical institutions providing medical insurance services (partially) source: xing'an league medical security bureau official account

at a time when medical insurance management is becoming increasingly strict, it has become a trend for private companies to proactively unbundle medical insurance.

private sector bids farewell to medical insurance "position"

in september, various places in the inner mongolia autonomous region issued notices on the termination of medical insurance service agreements by a large number of designated medical institutions:

on september 11, tongliao city notified 76 medical institutions to terminate their medical insurance service agreements;

on september 12, ordos city notified 7 companies, all of which actively applied to terminate their medical insurance agreements;

on september 29, manzhouli city reported that 52 medical institutions had voluntarily proposed and been approved for lifting;

on september 18, urad front banner notified 12 companies;

on september 12, chifeng city reported 57...

not only that, on september 27, the xinjiang medical security bureau also announced that it would terminate the medical insurance service agreements of more than 160 designated medical institutions.

list of medical institutions that have terminated their medical insurance service agreements in the xinjiang autonomous region since 2024. source: xinjiang medical security bureau

last month, the news that taikang shenhua hospital in taikang county, zhoukou, henan, was "unbundling medical insurance" caused heated discussion. at that time, some people called it "the first hospital in the country to actively unbundle medical insurance." (click on the link to view dingxiangyuan’s previous articles: "hot discussion! a hospital in henan voluntarily withdraws from medical insurance. how should we treat it?")

although this statement is not accurate, taikang shenhua hospital is not the first hospital to actively apply to terminate the medical insurance agreement. but similar comments also reflect that most people, even doctors, are very unfamiliar with the idea that hospitals can withdraw from medical insurance.

but after just one month, the peopleunbundling medical insurance has become a trend - whether this unbundling is active or passive.

since the release of the "2024 special rectification work plan for medical insurance fund violations and violations" in april this year, strict medical insurance inspections of medical institutions have been ongoing.

among them, the most recent example is wuxi hongqiao hospital.

source: wuxi medical insurance official account

from the media's widespread reports that "doctors reported real-name hospital insurance fraud" to the national medical insurance bureau sending unannounced inspection teams to directly station in the hospital, and then the hospital's closure, the legal representative, president, etc. have been subject to criminal coercive measures by the public security organs, which lasted only 3 days. .

the processing speed is fast and the methods are vigorous and resolute, which shows the determination of medical insurance to crack down on violations.for other private hospitals, such cases are nothing less than a constant warning bell.

when big-brand private hospitals with larger scales and brighter brands can differentiate themselves by specialties and focus on commercial insurance coverage,it has become inevitable for small private companies that cannot keep up with technology and cannot play with the rules to bid farewell to the "position" of medical insurance.

lifting medical insurance, including retail pharmacies

it is worth noting that in the recently announced list of medical insurance agreement cancellations, in addition to private hospitals, there are also a large number of medical insurance designated pharmacies.

in january this year, the national medical insurance administration issued the "notice on promoting fair, honest, transparent and balanced inter-provincial prices for drugs with the same generic name and brand name", proposing that pharmaceutical purchasing agencies will basically eliminate "four identical drugs" by the end of march 2024 ( refers to the unfair high prices and discriminatory high prices between provinces for drugs with the same generic name, brand, dosage form, and specifications.

source: screenshot from the national medical insurance administration

this document started "the most stringent drug price control in history", and the hurricane soon spread from pharmaceutical companies to retail pharmacies.

in june, the special campaign "online stores, check drug prices, compare data, and focus on governance" was officially launched, and the "instant price delivery" of the online drug sales platform was introduced for comparison. if the price is significantly higher than the "instant price", especially if it involves payment from the medical insurance fund, pharmaceutical companies and designated pharmacies should be urged to adjust drug prices to a reasonable level.

pharmaceutical retail stocks fell in response, and the era of "the same drug cost 13.8 yuan in a hospital and 140 yuan in a pharmacy, a price difference of 10 times" was completely over.(click to view dingxiangyuan’s previous articles: “the hospital is 13.8 yuan, the pharmacy is 140 yuan, the price difference of the same medicine is 10 times? the national medical insurance administration has taken action!”)

source: financial associated press

at almost the same time, the well-known listed chain drugstore yixintang pharmaceutical was interviewed by the national medical insurance administration, pointing out that some of its stores had exchanged drugs, overprescribed drugs, and performed medical insurance settlements and drug purchase and sales records for designated retail stores that had suspended medical insurance settlements. problems such as mismatch and irregular prescription drug sales have caused losses to the medical insurance fund.

taking inner mongolia as an example again, in april this year, inner mongolia reported the verification and processing results of 40 designated retail pharmacies with questionable data, and 9 of them were punished for recovering illegal expenses; 1 was punished for recovering illegal expenses and the medical insurance agreement was terminated. the company shall not apply for medical insurance designated treatment within the year; one company will be required to recover illegal expenses and terminate the medical insurance agreement, and shall not apply for medical insurance designated treatment within three years.

the pressure faced by retail pharmacies to lower drug prices and focus on typical cases may not be less than that of private hospitals.

drug price comparison systems launched in many places source: shenzhen medical insurance bureau

on september 27, the national medical insurance administration, the national health commission, and the state food and drug administration jointly released the "guiding opinions on establishing a medical insurance payment qualification management system for relevant personnel in designated medical institutions", and a "driver's license-style score" for medical personnel was released. (click to view dingxiangyuan's previous articles: "the doctor's medical insurance driver's license is here! if you have deducted 12 points, you will not be able to use medical insurance for one year")

from hospitals to pharmacies, from institutions to individuals, it is not difficult to see that the supervision of medical insurance has covered the entire industry, and is becoming more and more detailed and strict.

in the future, it is likely that private hospitals and retail pharmacies will continue to take the initiative to cancel medical insurance. under such a trend, those who are still covered by medical insurance, whether they are organizations or individuals, need to be alert.