Major Progress: Draft Policy on Internet Healthcare Pricing Finalized, Provinces to Define Local医保 Reimbursement Scope

On July 31, the official website of the National Healthcare Security Administration publicly released its response to proposals on internet-based healthcare submitted by some deputies to the Second Session of the 13th National People’s Congress. The response primarily addressed two aspects: pricing for internet-based healthcare services and the inclusion of such services in the scope of medical insurance reimbursement.

The National Healthcare Security Administration stated in its response: "To improve and refine the pricing and payment policies for 'Internet+' medical services, relevant strategic approaches have been developed based on extensive research. The primary considerations are to adapt to the development of 'Internet+ Healthcare,' support the positive role of 'Internet+' medical services, and improve and refine policies in accordance with the principles of 'deepening administrative streamlining, delegating power, improving regulation, and upgrading services; implementing classified management; encouraging innovation; and promoting coordinated online and offline development.'"

First, we must adhere to the combination of market determination, government regulation, and social co-governance, placing equal emphasis on stimulating the vitality of the medical market and guiding the provision of appropriate services;

Second, adhere to classified management. In accordance with the operational and developmental patterns of “Internet+,” formulate practical pricing and payment policies tailored to different service providers, target populations, and content.

Third, encourage innovation. Provide a more flexible development environment for new technologies and models that leverage “Internet+” to significantly improve cost-efficiency and better meet multi-tiered healthcare needs;

4. Coordinated development. Fair pricing and reimbursement policies shall be implemented for both online and offline medical services to promote their coordinated development and ensure equitable cost sharing.

In accordance with the division of authority between the central and local governments in the management of medical service prices, the national level is responsible for specifying standards such as the principles for establishing “Internet+” medical services, service names, service content, pricing units, and pricing descriptions, and for guiding provinces in their work on medical service price items. Each province is responsible for establishing medical service price items applicable to its region and for formulating and adjusting item prices, based on advancements in medical technology and local conditions, in compliance with the nationally prescribed principles for project establishment.

Currently, the National Healthcare Security Administration has prepared a draft in accordance with this approach. It will be officially released after soliciting feedback from all relevant parties and making revisions and improvements.

Regarding the inclusion of internet healthcare fees in medical insurance, the National Healthcare Security Administration responded: At the national level, medical service items are managed using an exclusionary approach, and internet diagnosis and treatment services have not been excluded. On this basis, each province formulates its own specific scope of medical service items eligible for reimbursement. With the development of internet healthcare, the National Healthcare Security Administration has strengthened guidance to local authorities, supporting local medical insurance departments in including qualified internet diagnosis and treatment services within the scope of medical insurance coverage, contingent upon the financial sustainability of their insurance funds.

According to preliminary statistics, provinces including Jiangsu, Guizhou, Gansu, and Sichuan have introduced policies on telemedicine pricing and reimbursement across their entire jurisdictions or in selected areas, incorporating eligible diagnostic and treatment services into the scope of medical insurance coverage.

The National Healthcare Security Administration stated that it will continue to implement the relevant regulations of the State Council, collaborate with the National Health Commission and other related departments to jointly promote the development of “Internet + Medical Health,” issue policy documents on pricing for “Internet +” medical services and healthcare insurance reimbursement as soon as possible, and provide guidance and oversight to ensure effective implementation across all regions.

In June this year, the State Council issued the "Key Tasks for Deepening the Reform of the Medical and Health Care System in 2019," which explicitly required the formulation of policy documents on pricing for internet-based medical consultations and their coverage by medical insurance payments. This task was assigned to the National Healthcare Security Administration, with a deadline for completion by the end of September 2019. In other words, the relevant policies are expected to be released within two months at the latest.