Several Measures of Shandong Province on Strengthening Medical Insurance Support for the Development of Traditional Chinese Medicine (TCM)
Several Measures on Strengthening Medical Security Support for the Development of Traditional Chinese Medicine
Lu Yi Bao Fa [2020] No. 58
To the Healthcare Security Administration, Bureau of Industry and Information Technology, Finance Bureau, Health Commission, and Market Supervision Administration of each city:
To thoroughly implement the Opinions of the Central Committee of the Communist Party of China and the State Council on Promoting the Inheritance, Innovation, and Development of Traditional Chinese Medicine (TCM), fully leverage the supportive role of medical security, promote the integrated high-quality development of TCM undertakings and industries in our province, accelerate the establishment of the Qilu TCM inheritance and innovation system, and enhance the level of medical security for the people of our province, in accordance with the deployment requirements of the Provincial Party Committee and the Provincial People’s Government for advancing the construction of a strong TCM province, the following policy measures are hereby formulated to support the development of TCM through medical security.
I. Support the Development of Traditional Chinese Medicine Institutions
(1) Timely inclusion of traditional Chinese medicine (TCM) institutions in the designated medical insurance network. Support the development of TCM clinics, outpatient departments, and specialized hospitals with distinctive features, and encourage chain operations. Regional planning for healthcare resources should appropriately favor TCM medical institutions, and all eligible TCM medical institutions at various levels and types, as well as retail pharmacies selling traditional Chinese medicines, shall be promptly included in the designated medical insurance management system.
(2) Enhance the service capabilities of TCM hospitals designated for medical insurance. Accelerate the implementation of cross-regional networked settlement for medical insurance at designated TCM hospitals, and promptly include TCM-designated hospitals at all levels in the national network for cross-regional inpatient settlement and the provincial network for cross-regional outpatient settlement of chronic diseases, thereby strengthening the regional reach of TCM medical institutions.
(3) The overall medical insurance budget shall be skewed in favor of traditional Chinese medicine (TCM) medical institutions. Efforts shall be made to enhance the scientific rigor and rationality of the overall medical insurance budget, with appropriate preference given to TCM medical institutions in setting total quota indicators, particularly those whose revenue is primarily derived from TCM diagnosis and treatment services. In regions implementing Diagnosis-Related Groups (DRG)-based payment and Disease-Specific Point Value-based payment systems, the institutional tiering coefficients for TCM medical institutions shall be appropriately increased to fully reflect the unique characteristics and advantages of TCM services. Reasonable compensation shall be provided by the medical insurance fund for increases in pharmaceutical and medical expenses resulting from major policy adjustments or increased service volume.
(4) Increase the reimbursement rate for traditional Chinese medicine (TCM) services. Further leverage the advantages of TCM’s distinctive services by appropriately raising the reimbursement ratio for medical expenses incurred by insured individuals undergoing TCM treatment. Strengthen support for TCM services at primary healthcare institutions; for insured patients hospitalized at township health centers and community health service centers who receive TCM treatment, the medical insurance reimbursement rate for eligible medical expenses shall be no less than 85%.
II. Promoting the Development of the Traditional Chinese Medicine Industry
(5) Support the innovative development of proprietary Chinese medicines. Strengthen quality control of proprietary Chinese medicines, promote the application of modern information technology in the production of traditional Chinese medicine (TCM), and enhance the level of intelligent manufacturing. Deepen the “Quality Shandong Medicine” initiative, strive to build demonstration enterprises for TCM, and leverage the positive leading role of brands. Make full use of the dynamic adjustment mechanisms of the National Reimbursement Drug List and the National Essential Medicines List to support the inclusion of more proprietary Chinese medicines from our province in these lists, thereby promoting the innovative development of our province’s proprietary Chinese medicines and marine-derived TCM products.
(6) Promoting the development of the traditional Chinese medicine (TCM) decoction pieces industry. Improve the standard system for TCM decoction pieces, promote the scaled and high-quality development of TCM decoction piece manufacturers, and facilitate premium pricing for high-quality TCM decoction pieces. TCM decoction pieces that comply with national standards or Shandong Provincial local standards shall be promptly included in the scope of medical insurance fund reimbursement in accordance with prescribed procedures.
(7) Promote the pilot production of traditional Chinese medicine (TCM) formula granules. Accelerate the research and pilot work on TCM formula granules in our province, standardize pilot research, production, and clinical use, support enterprises from other provinces to invest and develop in Shandong, and expedite the inclusion of TCM formula granules produced by the pilot enterprises designated by our province into the medical insurance fund payment scope in accordance with relevant requirements.
(8) Leverage the advantages of traditional Chinese medicine (TCM) preparations in hospitals. Enhance the R&D capabilities for hospital TCM preparations, optimize the registration and filing management of TCM preparations in medical institutions, and timely include therapeutic hospital TCM preparations approved by provincial drug regulatory authorities into the coverage of basic medical insurance funds in accordance with regulations. Improve the mechanism for the allocated use of TCM preparations among medical institutions, standardize the allocated use of clinically urgent TCM preparations within hospital consortia, and promote the development of hospital TCM preparations.
III. Support the Development of Traditional Chinese Medicine Diagnostic and Therapeutic Technologies
(9) Promote the reform of pricing for Traditional Chinese Medicine (TCM) medical services. Guided by clinical value and focusing on TCM’s advantageous and distinctive services, rationalize price ratios and optimize the pricing structure. Further liberalize the pricing of TCM medical services that are subject to sufficient market competition and cater to strong personalized demands. When adjusting medical service prices, give priority to reflecting the technical and labor value of TCM practitioners in the pricing of TCM medical services, thereby incentivizing medical personnel to actively provide TCM diagnosis and treatment services.
(10) Encourage the inheritance and innovation of traditional Chinese medicine (TCM) diagnostic and therapeutic techniques. Improve the priority review system, accelerate the approval of new TCM medical service pricing items, and establish a green channel for reviewing new TCM medical service pricing items that fill gaps in the diagnosis and treatment of major diseases or address unmet needs in diagnostic and therapeutic services, thereby supporting theoretical and technological innovations in TCM. Include TCM-specific advantageous treatments such as therapeutic acupuncture and tuina massage, as well as appropriate new technologies like auricular point combination therapy, TCM constitution identification, and pulse wave diagram diagnosis, within the scope of basic medical insurance fund reimbursement to promote the widespread adoption of appropriate TCM technologies.
IV. Improve the medical insurance payment methods suited to the characteristics of traditional Chinese medicine
(11) Promote diagnosis-related group (DRG) payment for TCM-dominant conditions. Timely include TCM-dominant conditions with clear therapeutic pathways and well-defined costs into the DRG payment system, reasonably determine payment standards, and fully reflect the value of traditional Chinese medicine services.
(12) Establish health insurance payment methods adapted to the characteristics of traditional Chinese medicine (TCM) at the primary care level. Set up comprehensive TCM service zones in township health centers and community health service centers, and improve technical standards related to TCM. Encourage capitation-based payments for general outpatient pooling and certain chronic disease categories, thereby guiding primary healthcare institutions to provide appropriate TCM services.
(13) Explore the implementation of medical insurance payment for Traditional Chinese Medicine (TCM) day-care services. Select certain cities to conduct pilot programs, and explore the establishment of day-care centers within qualified TCM medical institutions. Reimburse eligible TCM treatment costs in accordance with policies for outpatient chronic diseases or hospitalization, summarize best practices in a timely manner, and promote these models province-wide.
V. Support for Innovation in Traditional Chinese Medicine Service Models
(14) Promote the integrated development of traditional Chinese medicine (TCM) and the combined medical-elderly care industry. Actively advance pilot programs for long-term care insurance, support the development of medical-elderly care institutions featuring TCM-based health and elderly care services, promptly include eligible institutions in the designated management scope for long-term care insurance, promote the establishment of a TCM-integrated medical-elderly care service network, enhance service capabilities, and facilitate the construction of a demonstration province for integrated medical and elderly care.
(15) Support the healthy development of “Internet + Traditional Chinese Medicine (TCM).” Innovate service models for chronic disease management in TCM and advance the establishment of specialized chronic disease care zones. Timely review and approve pricing items for “Internet +” TCM medical services, include those meeting regulatory requirements within the scope of basic medical insurance fund reimbursement, promote the integrated development of “Internet + medical insurance + healthcare + pharmaceuticals,” and enhance the accessibility of TCM medical resources and overall service efficiency.
(16) Support the integrated online and offline distribution of traditional Chinese medicine (TCM). Promote “smart TCM pharmacies” to enhance pharmaceutical services for TCM decoction pieces and proprietary Chinese medicines, achieving integrated development in procurement and storage, prescription circulation, medical insurance settlement, dispensing and decoction, centralized distribution, and quality management. This will improve the accessibility of TCM services and provide greater convenience to the public.
VI. Support the Integrated Development of Production, Supply, and Marketing of Traditional Chinese Medicinal Materials
(17) Support the development of online trading platforms for Chinese herbal medicines. Establish an internationally oriented online trading platform for Chinese herbal medicines to achieve price linkage and the interconnection, sharing, and joint utilization of transaction information, thereby creating a central online hub for the trade of authentic regional herbs. This will foster a circulation system for Chinese herbal medicines that is enterprise-led, market-oriented, and integrates production, supply, sales, finance, and consumption. Support platforms in conducting trading activities in accordance with laws and regulations, encourage information sharing and fair, impartial transactions among manufacturers, distributors, and medical institutions, and establish a regionally coordinated price system and pricing standards. These efforts will drive and promote the integrated development of production, supply, and sales of Chinese herbal medicines in our province.
(18) Support the establishment of procurement alliances for Chinese herbal medicines. Establish cross-provincial and cross-regional procurement alliances for Chinese herbal medicines to jointly formulate procurement policies, share procurement outcomes, standardize procurement practices, expand regional procurement cooperation, and promote the development of the province’s Chinese herbal medicine industry toward branding, standardization, and intensification.
VII. Improving the Efficiency of Medical Insurance Fund Utilization in Traditional Chinese Medicine Institutions
(19) Innovate health insurance fund supervision models tailored to the characteristics of Traditional Chinese Medicine (TCM). Comprehensively enhance the informatization level of TCM institutions, promote intelligent health insurance monitoring, and further improve the rule base and knowledge base for such monitoring. Extend supervision to the service providers of medical and pharmaceutical institutions as well as physicians and pharmacists, establish a province-wide unified intelligent monitoring system, and achieve full-process supervision encompassing pre-event reminders, in-event warnings, and post-event audits. This will standardize the service conduct of designated TCM institutions and improve the efficiency of fund utilization.
(20) Enhance the self-management capabilities of designated TCM medical institutions under the medical insurance program. Accelerate the improvement of the assessment and evaluation system for designated TCM medical institutions to align with the global budget management of medical insurance funds, and gradually establish an evaluation mechanism and a mechanism for adjusting the global budget of medical insurance funds aimed at achieving greater health benefits at lower costs. This will promote strengthened self-management among TCM medical institutions, improve clinical efficacy, reduce service costs, and enhance service quality.
This document shall take effect as of October 17, 2020, and remain valid until October 16, 2025.
Shandong Provincial Healthcare Security Administration, Shandong Provincial Department of Industry and Information Technology, Shandong Provincial Department of Finance
Shandong Provincial Health Commission, Shandong Provincial Medical Products Administration
September 16, 2020