The Country Leads the Preparation of Consumables Procurement Documents,Involving All Cities

Strategic planning of medical heathcare insurance fund

On March 31, the National Medical Healthcare Insurance Fund Bureau issues the Opinions of the Office of the National Medical Healthcare Insurance Bureau and the General Office of the National Health Commission on Supporting Measures for the Centralized Procurement and Use of High-value Medical Consumables (Artificial Joints) (hereinafter referred to as the “opinions”).

The purpose of formulating these Opinions is to smoothly implement the successful results of centralized procurement of artificial joints organized by the state, ensure the timely supply of successful products, and promote medical institutions to standardize the use of centralized varieties and provide relevant medical services. In addition, it is to closely combine the characteristics of artificial joint procurement, distribution, use and accompanying services, give play to the strategic purchase role of the Medical Healthcare Insurance Fund, strengthen policy coordination, and make full use of measures such as network connection of centralized procurement platform, prepayment of the Medical Healthcare Insurance Fund, Medical Healthcare Insurance Fund payment policy, price adjustment of medical services, incentives and constraints of medical institutions to promote the smooth implementation of the results of centralized procurement of artificial joints.

It is observed that according to the special characteristics of the procurement, distribution, use and accompanying services of artificial joints, the Opinions regulate the implementation details and supporting measures of various volume procurement, such as the network connection, supply and distribution of selected products, the Medical Healthcare Insurance Fund payment policies, medical service price adjustment, balance retention, follow-up supervision focus and punishment measures. Last September, the National Medical Healthcare Insurance Fund Bureau organized the centralized purchase of artificial joints. The products of this centralized purchase are total hip replacement and total knee replacement for the first time, with a total of 5804 medical institutions participating. 540000 sets are intended to be purchased in the first year, accounting for 90% of the total demand of medical institutions in China, and the procurement cycle is 2 years. More than 40 enterprises participated in the quotation of centralized purchase, involving well-known machinery enterprises at home and abroad, such as Johnson &Johnson, Stryker, Zimmer Biomet, Micro Port, Double Medical , Mindray and so on. From the results of the selection, the average price of hip joint of centralized collection decreased from 35000 yuan to about 7000 yuan, and the average price of knee joint decreased from 32000 yuan to about 5000 yuan, with an average price reduction of 82%.

The medical Fnsurance Fund shall be paid 30% in advance, and the payment shall be settled at the end of the next month

According to the Opinions, local Medical Healthcare Insurance Fund departments should timely organize medical institutions to sign purchase agreements with selected enterprises. All coordinating regions shall calculate the agreed purchase amount in a timely manner according to the selected prices of the selected products, the purchased products and quantities agreed upon in the agreement between each medical institution and the enterprise. On the basis of the total budget management of the Medical Healthcare Insurance Fund, a prepayment mechanism is established. After the medical institution signs a purchase agreement with the selected enterprise, the Medical Healthcare Insurance Fund shall be prepaid to the medical institution at a rate of no less than 30% of the annual agreement purchase amount.

In terms of payment settlement, the opinions pointed out that medical institutions should settle the payment with enterprises in time, and the settlement time should not exceed the end of the next month when consumables are used. The Medical Insurance Funs Bureau shall settle accounts with medical institutions in time and allocate the Medical Healthcare Insurance Funds in time. On the premise of implementing the main responsibility of payment for goods in medical institutions, encourage the Medical Healthcare Insurance Funds to settle directly with pharmaceutical enterprises.

Taking the winning price as the medical insurance payment standard, what is the medical insurance payment standard that patients are most concerned about?

The Opinion points out that the selected products of artificial joint centralized purchase shall be paid according to the selected price including the accompanying service fee, which shall be included in the payment scope of medical insurance, and the Medical Insurance Fund shall be paid according to the specified proportion.
If the non winning artificial joint belongs to the payment scope of the Medical Insurance Fund, all localities shall take measures to gradually adjust the payment standard within two years to not exceed the maximum winning price of the products selected in the same group.
Insured patients use products whose price exceeds the payment standard of medical insurance, and the part exceeding the payment standard shall be paid by the patients themselves. All localities should give overall consideration to the setting of network price, self payment proportion of patients and medical insurance payment standard to avoid aggravating the cost burden of patients.

Balance retention and cost control

Incentive policies for medical institutions will be further improved.
According to the Opinions, with reference to the relevant practices of the state on the retention of Medical Insurance Fund balance in the centralized purchase of drugs, guide the overall planning areas to improve the rules for the retention of medical insurance fund balance.

There is no surcharge for admission and inventory

The Opinion points out that the selected products of artificial joint centralized procurement are linked to the network on each provincial pharmaceutical centralized procurement platform according to the selected prices of “including incidental service fee” and “excluding incidental service fee”, and the relevant expenses such as distribution and special surgical tools are included in the selected prices. Accompanying services include providing compliant “follow-up” services, assisting in the assembly of tools, necessary tool use guidance, surgical operation training, etc. non-surgical personnel shall be strictly restricted from entering the operating room. Medical institutions choose whether to provide accompanying services according to the actual situation, and pay according to the corresponding price. Public medical institutions will uniformly charge according to the zero difference rate of the winning price including the accompanying service fee. The cleaning and disinfection of non special power tools and related tools will be borne by the medical institutions, and the relevant expenses will be included in the medical service fee.
It is noteworthy that the opinions specifically pointed out that medical institutions and third-party institutions should not charge additional fees from the selected enterprises in the links of admission and inventory. In addition, the prices of non selected products should not be hung up.
According to the “Opinions”, if the non-selected artificial joint products contain the selected product components, they will be listed at the selected price of the components, and other components can be reasonably set based on the actual transaction price. Certain restrictions shall be imposed when hanging on the net, and relevant enterprises shall be guided to gradually adjust the price to a reasonable level.
is composed of different parts of the selected product, the total price shall not be higher than the price of the selected product of the same category of the enterprise. For hemi-hip prosthesis and unicondylar prosthesis products, you can refer to the selected price of the full set of hip joint and knee joint products, and hang the net according to the principle of matching performance and price.

Strengthening surgical norms and focusing on clinical use

After the successful results are implemented, the medical service fees will also be adjusted.

According to the “Opinions”, according to the dynamic adjustment mechanism of medical service prices, in 2022, the total price adjustment can be tilted towards artificial joint replacement-related surgical items in areas that are eligible for price adjustment after evaluation. In areas where the proportion of trans provincial patients with joint replacement is large, and the price of core projects such as “artificial joint replacement” is significantly lower than the national median price and the price of surrounding provinces, the price of relevant projects can be specially adjusted.

For projects that use intelligent systems such as surgical robots to assist surgical operation, the price adjustment method is also specified.
In addition, all localities should closely monitor the performance of the selected enterprises, including product supply, distribution, special tools and the provision of accompanying services. The selected enterprises that cannot perform well and are punished for illegal acts such as commercial bribery should be included in the medical price and bidding credit evaluation records, and be punished accordingly according to the severity.

Tracing the whole process and strictly controlling violations

According to the previously released procurement documents with quantity, if the selected enterprises and distribution enterprises fail to implement distribution in accordance with the requirements of medical institutions and laws and regulations, give up the qualification after winning the selection, fail to fulfill the supply commitment, and serious quality problems of the selected artificial joints, they will be included in the “list of violations”.
The winning enterprise will be included in the “list of violations” and will be disqualified. At the same time, according to the seriousness and objective reality, the above-mentioned enterprises will be disqualified from participating in the procurement of medical consumables in various regions of the alliance within two years from the date of being included in the “List of Violations”.

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