Following the U.S. Model: After Guizhou's Breakthrough, Sichuan's Telemedicine Quietly Surges with Policy and Pricing Frameworks

As a typical representative of the integration of healthcare and technology, telemedicine has long been hindered by the lack of policy and health insurance support in the internet healthcare industry."Difficulties" in the Industry.

For a long time, employers and health plan sponsors have sought to include telemedicine in their insurance coverage, but insurers have been reluctant to do so.Paying for telemedicine. Taking the United States as an example, the earliest regulation established specifically for telemedicine was the Balanced Budget Act of 1997,Authorize certain parts of Medicare to reimburse telemedicine services in rural areas lacking healthcare professionals, and may requireExtremely stringent, with the minimum reimbursement rate being as low as 10%.

Until the 2010 Affordable Care Act, which transformed the multi-party game among consumers, the government, insurance companies, and healthcare enterprises in the U.S. healthcare systemThis situation has been elevated to a new level, laying a solid market foundation for the development of telemedicine in the United States. Subsequently, through measures including the "Tele-The introduction of key regulations such as the “Healthcare Reimbursement Act,” the “Telemedicine Reimbursement Act,” and the “Telemedicine Affordability Act” has enabled the U.S.Telemedicine in China has truly entered a period of explosive growth. Currently, approximately 32 states in the United States have integrated telemedicine services into routine medical care.Certain components of the project require private insurance institutions to reimburse remote physicians for patient consultation fees.

Telemedicine in China has long occupied an awkward position, to the extent that it could be described as existing in name only; however, with the development in the United StatesPrecedents have been set, and the National Health and Family Planning Commission is also keeping pace with the times by continuously improving its policies.

In August 2016, telemedicine in China first saw the light of day in Guizhou Province. The provincial government decided to include telemedicine services in the basicThe scope of payment from the medical insurance fund, effective as of August 1, 2016, shall be implemented on a trial basis for one year.

In accordance with the "Notice on Issues Concerning the Inclusion of Telemedicine Services in the Basic Medical Insurance Fund Payment" issued by the Guizhou Provincial Department of Human Resources and Social SecurityZhi》, the services covered under the basic medical insurance fund payment scope include: remote single-specialty consultation, remote multidisciplinary consultation, and remote traditional Chinese medicineNine items, including TCM syndrome differentiation and treatment consultations and synchronized remote pathology consultations.

Meanwhile, pricing for telemedicine services was established.

Furthermore, the "Opinion Table on Basic Medical Insurance Fund Payment for Telemedicine Service Items in Guizhou Province" explicitly requires that telemedicine services be billed per individual service item actually performed, with no duplicate charging for multiple items; no additional fees shall be charged for remote diagnostic services. Each session of remote multidisciplinary consultation and remote Traditional Chinese Medicine (TCM) syndrome differentiation and treatment consultation shall, in principle, not exceed one hour. In special circumstances where the duration exceeds this limit, an additional 10% fee shall be charged for every 10 minutes of overtime, with the cumulative overtime duration not exceeding 60 minutes and the cumulative additional amount not exceeding 60% of the maximum price cap. The preparation time for remote consultations shall not be included in the consultation time.

With policy support, Guizhou Province’s telemedicine system has also made significant progress.It is reported that this year’s Government Work Report of Guizhou Province explicitly proposes to achieve county-level and aboveFull coverage of telemedicine in public hospitals.Currently, 199 public hospitals at or above the county level in Guizhou ProvinceHospitals have established in-house telemedicine working bodies, management systems, and work processes, and have initially built a telemedicine professional team of over 4,000 members.Technical Team.Starting from November 1, all 199 public hospitals at the provincial, municipal, and county levels in Guizhou Province have been fully connected to the telemedicine network system, andSynchronize connectivity with high-quality medical resources at the national level and from other provinces.

In contrast to Guizhou’s high-profile initiatives, the actions of the Sichuan Provincial Health and Family Planning Commission appeared somewhat low-key. In October 2016, Sichuan Province successively issued the “Notice onNotice on Setting Prices for Internet Medical Service Items” and “Guiding Opinions on Accelerating the Development of ‘Internet + Healthcare’ Services.”

According to the “Notice on Setting Prices for Internet-based Medical Services,” Sichuan Province aims to integrate regional medical resources and effectively extend and amplify the service capacity of medical institutions, thereby promoting the downward flow of high-quality medical resources. Meanwhile, the “Price List for Internet-based Medical Services Provided by Provincial Public Medical Institutions in Sichuan Province” has been formulated, implementing government-guided pricing for remote consultation, remote diagnosis, and remote examination services, while market-adjusted pricing applies to remote monitoring and other categories.

For internet-based medical service projects, the following telemedicine services are provided:

1. Remote Consultation Services: Remote Single-Specialty Consultation, Remote Multidisciplinary Consultation, Remote Imaging Consultation.

2. Remote Diagnosis: Remote ECG Diagnosis, Remote Imaging Diagnosis, Remote Laboratory Diagnosis, Remote Pathology Diagnosis.

3. Remote Consultation Category: Online Outpatient Clinic.

4. Remote Monitoring and Others: Remote Fetal Heart Rate Monitoring, Remote ECG Monitoring, Remote Blood Pressure Monitoring, Remote Blood Glucose Monitoring, and OthersInternet Healthcare Project.

(Items 2, 3, and 4 are all subject to market-adjusted pricing, with fees determined independently by medical institutions.)

Half a month after the release of the Notice on Pricing Internet-based Medical Services, the Sichuan Provincial Health and Family Planning Commission issued the Guiding Opinions on Accelerating the Development of “Internet Plus” Healthcare Services. Sichuan Province explicitly stated its commitment to adopting an open and inclusive “Internet Plus” mindset to actively build an ecosystem for “Internet Plus” healthcare services that offers greater convenience, more standardized management, and more efficient resource utilization.

By leveraging “Internet+” to integrate healthcare resources, we are reshaping service models for health management, medical consultations, and medication procurement. This approach continuously expands the breadth and depth of integration between the internet and healthcare services, optimizing the allocation of medical resources, enriching internet-based healthcare applications, and strengthening the synergy between online and offline services, thereby achieving comprehensive healthcare coverage across the entire patient journey—pre-diagnosis, during diagnosis, and post-diagnosis.

and formulated two key tasks based on this:

I. Strengthen the Foundation of "Internet + Healthcare" Services.

Leveraging the Sichuan Provincial E-Government Extranet and the E-Government Cloud Platform, we have integrated three major databases—the national population database, electronic health records (EHRs), and electronic medical records (EMRs)—to fully establish an interconnected provincial, municipal, and county-level population health information platform. We have improved and vigorously promoted technical service standards for data exchange, collaborative sharing, and security protection, thereby supporting new models of networked medical and health services that span across institutions, regions, and departments.

II. Establish an Internet + Medical Health Service Platform.

Secondary and tertiary medical institutions shall accelerate the establishment of their own online platforms for public convenience, or leverage qualified third-party service platforms, to provide support for physicians’ online diagnosis and treatment and patients’ online medical consultations.

By the end of 2017, leveraging the Sichuan Provincial Population Health Information Platform as the carrier and the Resident Health Card as the link, we aim to initially establish a networked, intelligent, convenient, and collaborative “Internet+ Healthcare” ecosystem. By 2020, various Internet-based healthcare applications will be widely adopted, and the development and application of “Internet+ Healthcare” services will reach a leading level nationwide.