National Healthcare Security Administration and National Health Commission Jointly Issue Guidelines to Include Internet Medical Services in Health Insurance Coverage

On March 2, the National Healthcare Security Administration and the National Health Commission jointly issued the “Guiding Opinions on Promoting ‘Internet+’ Healthcare Insurance Services During the Prevention and Control of COVID-19,” which clarified relevant matters regarding the inclusion of internet-based diagnosis and treatment services—recently a subject of significant public attention—into healthcare insurance reimbursement.

During the pandemic, internet healthcare demonstrated significant value. Major platforms and physical hospitals successively launched online fever clinics, later expanding online consultations to other departments. These services first helped alleviate public panic amid the epidemic, then guided patients to seek medical care online, thereby avoiding cross-infection risks associated with in-person hospital visits, while also ensuring follow-up consultations and medication access for patients with chronic diseases. VCBeat previously reported in “Approval Completed in 11 Minutes: How Internet Diagnosis and Treatment Services Support Epidemic Prevention and Control Needs Amid the National Health Commission’s Push for Vigorous Development” provides a detailed review.

Subsequently, Jiangsu, Shanghai, Zhejiang, and other regions incorporated internet diagnosis and treatment services into medical insurance reimbursement schemes and expedited the upgrading of their information systems. In key epidemic areas, Wuhan not only enabled online reimbursement and settlement for online consultations at three public hospitals but also included WeDoctor Internet General Hospital in its medical insurance coverage, making it the first platform-based internet hospital in the locality to be covered by medical insurance.

VCBeat in "Wuhan and Over 10 Other Cities Urgently Enable Medical Insurance Coverage for Online Consultations, Breaking the Biggest Bottleneck in Internet Healthcare During the Pandemic” provides a systematic summary,The integration of medical insurance has further completed the closed loop of online consultation, prescription, settlement, and drug delivery, which not only facilitates patients but also marks another step forward for internet healthcare as a whole.

The joint issuance of the aforementioned “Opinions” by the National Healthcare Security Administration and the National Health Commission serves as further encouragement for local explorations and practices.

To resolutely implement the decisions and arrangements made by the CPC Central Committee and the State Council on strengthening the prevention and control of the novel coronavirus pneumonia (COVID-19) epidemic, facilitate medical treatment and medication purchase for insured individuals, and reduce the risks of crowd gathering and cross-infection, and in accordance with the spirit of documents such as the “Opinions of the General Office of the State Council on Promoting the Development of ‘Internet + Healthcare’” (Guo Ban Fa [2018] No. 26), the following guiding opinions are hereby proposed on the provision of “Internet +” medical insurance services during the epidemic period:

Designated medical insurance institutions that have been approved by the health administrative authorities to establish internet hospitals or to conduct internet-based diagnosis and treatment activities may, on a voluntary basis, sign supplementary agreements with the medical insurance handling agencies in their pooling areas. Upon such agreement, the “Internet+” follow-up consultation services they provide to insured individuals for common and chronic diseases shall be included in the scope of reimbursement from the medical insurance fund.

In accordance with the provisions of the "Guiding Opinions of the National Healthcare Security Administration on Improving Price and Medical Insurance Payment Policies for 'Internet+' Medical Services" (Yi Bao Fa [2019] No. 47), relevant price and payment policies shall be implemented. For follow-up consultation services provided via "Internet+" by designated non-public medical institutions, settlement shall be made with reference to the price and payment policies applicable to designated public medical institutions.

Implement the medical insurance reimbursement policy for "long-term prescriptions." Actively promote the implementation of outpatient medication coverage mechanisms for urban and rural residents with hypertension and diabetes. Insured individuals may obtain medications at their designated medical institutions or designated retail pharmacies using prescriptions issued online by designated medical institutions. Explore and advance direct settlement for medication dispensing at designated retail pharmacies, with costs borne respectively by individuals and the medical insurance fund in accordance with the medical insurance policies and standards prescribed by the pooling regions, thereby supporting epidemic prevention and control efforts. Encourage designated medical and pharmaceutical institutions to innovate delivery methods, under the premise of ensuring patient medication safety, so as to reduce crowd gatherings and the risk of cross-infection.

When signing supplementary agreements with designated medical institutions providing "Internet+" medical services, the medical insurance handling agencies in the pooled regions shall clearly specify the scope, eligibility criteria, fee and settlement standards, payment methods, global budget management, supervision of medical practices, and prescription review standards for "Internet+" medical services covered by medical insurance. In principle, unified management shall be implemented for both online and offline medical services. Medical insurance handling agencies shall coordinate closely with designated pharmaceutical and medical institutions to ensure seamless integration and enable online medical insurance settlement for compliant "Internet+" medical services and online prescription drug fees.

Enable cardless access to online medical insurance services through the use of the electronic medical insurance certificate. Provinces that have already activated the electronic medical insurance certificate for online medical insurance services should continue to promote its application and adoption. Provinces that have not yet activated the electronic medical insurance certificate shall carry out their work in accordance with the requirements set forth in the “Notice of the General Office of the National Healthcare Security Administration on Comprehensively Promoting the Application of the Electronic Medical Insurance Certificate” (Yi Bao Ban [2020] No. 10). For provinces where conditions for activation are not yet met, maintain the stability of existing information systems and avoid redundant or fragmented development. Concurrently, strengthen cybersecurity measures for data related to online medical insurance services to prevent data breaches.

In accordance with the characteristics of “Internet+” medical services, implement real-name registration for online medical consultations, and establish supporting systems for online prescription review and supervision mechanisms for medical service practices. This ensures the rationality of diagnosis, treatment, and medication, prevents fabricated medical services, and safeguards the security of medical insurance funds. Designated medical and pharmaceutical institutions shall create and properly maintain electronic medical records, online electronic prescriptions, and medication purchase records for patients. They must ensure full traceability across the entire process of diagnosis and treatment, prescribing, transactions, and delivery, achieve comprehensive monitoring of information flows, fund flows, and logistics, and enable patients to query their medical record data online, including examination and test results, diagnostic and treatment plans, prescriptions, and medical orders.

We must strengthen public awareness campaigns on “Internet+” medical insurance services, uphold correct public opinion guidance, and provide accurate interpretations of relevant policies. Necessary telephone and online consultation services should be provided to promptly address public inquiries. During the epidemic period, we must effectively carry out tasks such as system launch, application improvement, situation reporting, and evaluation and summary. Successful experiences and best practices should be promptly summarized and promoted, gradually expanding to eligible designated medical institutions and regions, so as to better deliver high-quality services to the insured population.

Source: Official Website of the National Healthcare Security Administration