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Latest clarification: cancel hospital settlement authority


01

The medical insurance fund is settled directly, and the enterprise supervises the collection


Recently, the Information Office of the Xingtai Municipal Government of Hebei Province held a press conference on the centralized procurement of drugs and medical consumables in the city, and the issue of payment collection was mentioned many times.

 

(Source: Great Wall. com)

It is reported that in order to deal with the persistent problem of medical institutions defaulting on enterprise payment for goods and solve the last "one kilometer" problem of centralized purchase, Xingtai Medical Insurance Bureau, together with the Finance Bureau and the Health and Health Commission, formulated the Implementation Opinions on the Use of Revolving Funds for Centralized Purchase of Drugs and Medical Consumables in Xingtai City to standardize the use of funds and the payment and collection methods of selected drugs, and took the lead in exploring the implementation of direct settlement between medical insurance agencies and distribution enterprises in the province, It fundamentally solved the problem of medical institutions defaulting on the payment of medical enterprises.

In addition, a two-way evaluation system for distribution enterprises and payment collection units has been established.

Guo Hongbin, a member of the Party Leadership Group and deputy director of Xingtai Medical Security Bureau, said that distribution and payment collection are two important links in the centralized procurement of drugs and medical consumables. The municipal medical insurance bureau innovates the mechanism and takes the lead in implementing the two-way evaluation system in the whole province, that is, the medical security department and medical institutions evaluate the distribution of medical consumables of the distribution enterprises, and the distribution enterprises evaluate the payment collection of the medical security departments at all levels.

Yang Xingbing, a fourth-level researcher of Xingtai Medical Security Bureau, said that according to the survey, the payment for non-centralized purchase of medical consumables in Xingtai City is generally more than 6 months, and even more than a year for many medical institutions to collect the payment, so that the hospital has occupied the working capital of the production enterprises for free, and the most direct and effective way for the production enterprises to reduce the sales costs is to raise the price.

In Xingtai City, centralized procurement adopts the direct settlement method of medical insurance handling and distribution enterprises, and the average payment collection is 30 days, which greatly improves the capital turnover rate.

By the end of 2022, Xingtai City has implemented the centralized procurement of 11 batches of 337 varieties of drugs and 14 batches of 41 types of medical consumables organized by the state and the province. The average price of drugs has been reduced by 59%, the maximum price of single product has been reduced by 98.7%, the average price of consumables has been reduced by 74%, the maximum price of single product has been reduced by 99.21%, and the annual burden of patients' drug costs can be reduced by more than 600 million yuan.

02

The state clearly states that it is necessary to ensure payment collection


The issue of "triangle debt" involved many parties and was difficult to solve for a long time. However, with the promotion of the volume procurement policy, the national level is paying close attention to the collection of consumables.

In February last year, the Information Office of the State Council held a regular briefing on the progress of deepening the reform of centralized procurement of drugs and high-value medical consumables. Chen Jinfu, former deputy director of the National Health Insurance Bureau, said that the backlog of payment for goods in the pharmaceutical industry, especially in the field of consumables, is a big problem. A large proportion of drugs have not been collected for more than half a year and consumables have not been collected for more than one year.

At the meeting, it was proposed that medical institutions must ensure payment collection when purchasing drugs. In order to solve the shortage of funds in medical institutions, the medical insurance fund paid 30% in advance, and explored the direct settlement with drug distribution enterprises and drug supply enterprises on the bidding and purchase platform, so that the platform can serve enterprises and reduce operating costs.

Some places are allowed to further expand the share of medical insurance advances. At the same time, in the bidding rules, more and more strict requirements are made on the repayment of medical institutions, and software systems are developed to monitor the progress of drug payments.

It is noteworthy that the establishment and improvement of the national unified medical insurance information platform is expected to further promote the supervision of the whole process of consumables bidding, procurement, payment and use.

According to the National Health Insurance Bureau, the national unified medical security information platform was basically completed in May last year. The medical insurance information platform covers 14 subsystems, such as payment method, bidding and purchase of drugs and medical consumables, and has been implemented and applied in succession. The new platform has played an important role in the fields of payment mode reform, intelligent supervision of medical insurance, centralized drug procurement, and drug price monitoring.

Recently, a document issued by the National Medical Insurance Bureau's Medical Price and Bidding Procurement Guidance Center circulated in the industry. The document mentioned that it is necessary to focus on improving the four functions of the national unified medical centralized procurement platform, improve the settlement and payment functions, and support the provision of online settlement services for payment of goods. Guide all regions to carry out bidding procurement, transaction settlement and other handling work relying on the bidding and finance subsystem.

03

Intensive issuance of documents in multiple places, and the "clearing plan" for payment collection was launched


According to CyberBlue, many hospitals still have difficulties in collecting money. In some areas, the collection cycle of non-centralized consumables has reached one or two years, and some hospitals even longer. In terms of the collection policy, the reform models vary from place to place.

For example, Shandong Province proposed to establish a unified drug and equipment settlement supervision platform across the province, and complete the development of online monitoring functions for direct settlement of medical insurance funds for purchased drugs and consumables with quantity, and self-settlement of medical institutions and pharmaceutical enterprises for purchased drugs and consumables without quantity. By the end of 2021, relying on the regulatory platform, the State and Shandong Province will organize the direct settlement of the payment for the purchase of drugs and consumables in a centralized way. In 2025, the direct settlement of medical insurance funds and pharmaceutical enterprises will be fully implemented.

In October last year, the Shandong Provincial Medical Insurance Bureau issued the Notice on Further Strengthening the Supervision of Centralized Pharmaceutical Purchase, which further pointed out that public medical institutions at all levels should fully implement the direct settlement of medical insurance funds and pharmaceutical enterprises for the centralized purchase of pharmaceutical products with a certain amount, and resolutely put an end to the default of pharmaceutical enterprises. All localities should achieve the goal of clearing medical institutions that have not carried out the direct settlement between the medical insurance fund for centralized purchase of drugs and pharmaceutical enterprises as soon as possible.

The scope of direct settlement of the payment for drugs and instruments in Fujian Province has been continuously expanded, and policies have been issued to refine the settlement and payment process.

In December of last year, the Fujian Provincial Health Insurance Bureau and the Fujian Provincial Department of Finance issued the Interim Measures for the Administration of the Unified Settlement and Payment of Medical Security Payment for Drugs and Devices in Fujian Province, which pointed out that the medical security fund centers and drug and device payment settlement agencies or departments in the overall planning areas should carry out the relevant business of drug and device payment settlement according to the division of responsibilities and entrust the provincial medical insurance information platform.

The settlement department settles the payment for the drugs and instruments on behalf of the medical institution to the drug and instrument distribution (supply) enterprise, and the relevant expenses are deducted from the medical insurance settlement payment. The remaining part is paid by the settlement department to the medical institution. If the medical insurance settlement payment payable is insufficient to offset the payment for the drugs and instruments that have been paid on behalf of the medical institution, the insufficient part is recovered from the medical institution.

The settlement department shall pay the supply enterprise for the drugs and instruments of the medical institutions in the overall planning area through the payment system before the 15th of each month.

Jiangxi Province proposes to implement direct settlement for drugs and medical consumables purchased in a centralized way.

According to the Implementation Opinions on Promoting the Normalization and Institutionalization of Centralized Purchasing of Drugs and Medical Consumables issued by the General Office of the People's Government of Jiangxi Province in December last year, the purchase payment of selected drugs and medical consumables shall be settled directly between the medical insurance fund and pharmaceutical enterprises, and the working capital system shall be established and improved, Specifically, the medical security department will directly settle the purchase payment of the selected drugs and medical consumables with the drug and medical consumables supply enterprises (manufacturing enterprises or distribution enterprises) through the custody account of the amount of the turnover fund. Establish and improve the online payment settlement system of the platform, improve the platform function settings, orderly promote online settlement, and improve the payment settlement efficiency.

In addition to the above regions, Tianjin, Liaoning and other places have also introduced direct settlement policies for medical insurance funds and enterprises.

Nationwide, the policy of direct settlement is being gradually promoted, and the collection problem in regions where direct settlement has been carried out has improved. It is expected that after the establishment of the unified platform, the supervision of the whole process of consumables will be completed. Under the expansion of direct settlement, the pain point of "triangle debt" will gradually disintegrate.

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