Cross-Region Healthcare Insurance Settlement Opens a New Window

2019-09-03 17:44

Following the new policy of interprovincial"roaming" for healthcare insurance, another document aimed at facilitating insured individuals seeking medical treatment was recently officially released by the Ministry of Human Resources and Social Security.

Analysts believe that this move is a continuation of a series of supporting policies for the new healthcare reform. It marks an important step from a regional health insurance market to a national one,helping to break down regional boundaries. However, due to several technical issues that need to be addressed before the policy can be implemented, the short-term impact on the pharmaceutical industry is expected to be limited.

Breaking Regional Boundaries

"This is a pro-people policy of the nation, primarily aimed at facilitating medical treatment for the insured population, but it won't have a significant short-term impact on the pharmaceutical industry," stated Gan Rongfu, Senior Advisor of Operational Management at China National Pharmaceutical Group Corporation (Sinopharm). This viewpoint is based on several considerations: Firstly, medical needs are essential and regardless of reimbursement availability, people will seek medical care when they are ill; secondly, there are still many technical issues to be addressed before the policy is fully implemented."

The " guidelines " mainly target individuals relocated after retirement, and do not apply to all insured individuals.Therefore, reimbursement for medical treatment in different locations has notbeen completely liberalized. "In reality, the actual conditions don't permit full liberalization, as once it's allowed, all insured individuals at the grassroots level will flock to large hospitals in big cities for medical treatment, which would strain the medical resources of these major hospital seven further."

In accordance with the recent key implementation plan of healthcare reform, the " guidelines " introduced this time require eligible regions to enhance coordination levels, implement city (or prefecture)-level coordination, unify policies, standards, management, and settlement methods of basic medical insurance within the same coordinated area. This includes adopting unified settlement processes and reducing out-of-area medical settlement cases.

Meanwhile, the " guidelines " also provide explanations for the settlement methods of several typical situations, including medical expenses incurred by insured individuals during short-term business trips, educational training, or vacation, as well as medical expenses resulting from local medical conditions requiring referrals during such periods. It also addresses the settlement methods for retired individuals with long-term residence in a different location seeking medical treatment in their place ofresidence and individuals permanently working in a different location seekingmedical treatment in their work location.

Generally speaking, the construction of the medical insurance system is often regarded as a significant driving force for markete xpansion and industry growth. As policies for continued insurance coverage,cross-regional healthcare, and seamless expense settlement services are gradually introduced and implemented, they also contribute to raising the actual level of medical security. The resulting increase in payment capacity from this enhanced security level will promote a stronger willingness to seek medical treatment and drive growth in medical expenses.

However, there is not just one expert with a cautious view. An expert from the Chinese Community Health Association also told reporters that the release of the "guidelines" is certainly a good thing, but it is currently unclear how long the period is from the issuance of the"guidelines" to their implementation. "I think the problem and difficulty are not small. I don't know what the feasible policies are.Cross-regional medical insurance settlement exists between certain areas and specific locations, but to implement it as a unified policy nationwide, I still hope to see detailed supporting policies," the expert said.