“none of the richest countries can afford the heavy burden of disease caused by chronic diseases; neither the more developed societies can cope alone with the serious challenges posed by ageing” is emerging as a global consensus on chronic disease prevention and control. As the ageing of our population accelerates, the incidence and burden of chronic diseases continue to rise and their prevention and control are urgent。
Recently, premier li keqiang of the state council chaired a general meeting of the state council to develop a “pharmaceutical formula” for the prevention and control of chronic diseases such as hypertension and diabetes。
The introduction of high blood pressure and diabetes outpatients into the population's health care, with a reimbursement rate of at least 50 per cent; the promotion of lower domestic pressure and lower sugar prices; and the introduction of a system of prescriptions。
Earlier, operation healthy china (2019-2030) had made it clear that our country would undertake preventive action against four major chronic diseases: cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. Among these, the goal of action to combat diabetes is to achieve a standard management rate of 60% and above and 70% and above for diabetes patients by 2022 and 2030, respectively。
“diabetic mellitus, high blood pressure patients are more likely to deal with complications caused by diseases, such as heart infarction, perceptive, ophthalmic and kidney diseases. Reducing morbidity and even mortality from complications is at the core of management of chronic diseases such as hypertension and diabetes. There is an urgent need for grass-roots hospitals, on the one hand, to raise patients ' awareness of the disease through patient education and, on the other hand, to train primary health-care staff to improve their level of care. This will increase the standard management rate for chronic diseases.” hu ming dynasty, director of the paik district people's hospital in shaanxi province, told the journalist of china operations。
300 million patients
In general, chronic diseases, also known as chronic non-communicable diseases, are long-term, self-rehabilitating and virtually incurable diseases, mainly cardiovascular diseases, metabolic diseases such as diabetes and cancer。
According to public information, our country is one of the fastest-growing countries in the world, with more than 97 million people currently suffering from diabetes and some 150 million people in the early stages of diabetes. High blood pressure is also one of the most common chronic diseases, with 270 million high blood pressure patients in the country and an annual average of 10 million new high blood pressure patients throughout the country. Of these, most diabetes patients combine hypertension。
For a large number of chronically ill people, the occurrence and development of chronic disease complications can even threaten life if conditions are not effectively controlled. According to survey data, hypertension is the most important risk factor for heart disease, brain failure, kidney disease and death, and we have more than 40 per cent of all deaths due to cardiovascular disease, with about 70 per cent of deaths in the brain and about 50 per cent of myocardial infarction closely related to hypertension. Diabetes suffer from increased blood sugar and extensive and microvascular damage, which seriously endangers the heart, brain, kidney, surrounding nerves, eyes, feet, etc。
Chronic patients are often treated at a more serious stage or when complications arise, and slow diseases cause “grave diseases”, resulting in significant medical expenses and an increased burden on patients。
To further strengthen the prevention and treatment of major chronic diseases, the relevant departments have taken a comprehensive approach to the fight against chronic diseases。
For the first time, the report on the work of the government in 2019 referred to “the prevention and treatment of common chronic diseases and the incorporation of outpatient medicines such as hypertension and diabetes into health insurance reimbursement”. In addition, at the two press conferences this year, prime minister li keqiang made it clear that 50 per cent of the cost of chronic drugs such as hypertension and diabetes would be reimbursed this year。
The army is fast. On 20 august, the national directory of essential health insurance, employment injury insurance and maternity insurance (hereinafter referred to as the national health insurance catalogue) was fully edited and published after 19 years. The new version of the national health insurance list includes 36 new chronic drugs. In addition, a number of chronically ill drugs are included in health insurance negotiated access。
On 12 september, the premier of the state council, li keqiang, presided over the council's standing committee, which decided to increase the reimbursement rate to more than 50 per cent of the more than 300 million people with high blood pressure and diabetes who participate in basic health care for urban and rural residents by integrating their outpatient medicines within the national list of basic health care. Where there are conditions, no pay lines can be set, and the top lines are set by each location. In the case of patients who have been included in the coverage of outpatient chronic diseases, the existing policy continues to ensure that the level of treatment does not decrease。
Good for people
It is noteworthy that the system of prescriptions has become another asset in the fight against chronic diseases。
The so-called prescriptions are in terms of the cyclical use of prescription drugs. In 2007, the prescription management scheme, published by the national board of health and health, stipulated that “prescriptions shall generally not exceed 7 days; in certain chronic, geriatric or exceptional cases, prescriptions may be extended as appropriate, provided that the doctor indicates the reasons”. In practice, due to various objective factors, doctors tend to prescribe prescriptions based on red wires that do not exceed 7 days of medication。
Homing dynasty told reporters: “the prescriptions for chronic diseases such as diabetes in general, hypertension are adjusted from 3 to 6 months, and chronic diseases are mostly prescribed. Previously, chronically ill people had to be registered every time they went to the hospital to prescribe medication, and every time they had to pay a registration fee. For patients in some remote areas, the cost of transportation to and from hospitals and the cost of registration are a burden, so that some chronically ill persons do not insist on taking medication.”
Indeed, at the end of 2018, the national commission for health and health, in conjunction with the national administration of chinese and chinese medicine, issued its opinions on accelerating the high quality development of pharmacological services, which explicitly sought to explore the long-term prescription of chronic diseases and encouraged the business and health insurance departments at all levels of health and health administration to develop long-term prescription policies for chronic diseases, specifying the requirements for chronic disease catalogues, drug coverage, management systems, safety advisories, etc., that could be issued for chronic patients who meet the requirements of the assessment, one for 12 weeks at a time。
Since then, slow-disease prescriptions have been introduced in several provinces, including hubei, shanxi, shanghai, guangdong, zhejiang and xi'an. For example, in zhejiang province, the system of prescriptions is applied only to 12 common chronic diseases, including hypertension, diabetes, tuberculosis, coronary heart disease and bronchial asthma. Patients with 12 common chronic diseases can be prescribed by contracted family doctors on a long-term basis, with a maximum of 12 weeks for a single prescription of chronic diseases depending on the patient's condition。
An analysis by a medical observer indicates that the application of the slow-disease prescriptions facilitates both the medication of chronic patients and, to a certain extent, their dependence。
The negative effects are clear
Chronic disease prevention and treatment, “strength battles”, must not only strengthen prevention and reduce the incidence of major diseases, but also contribute to the sustainability of health insurance funds. To this end, policies have been put in place in various regions, with a combination of policies。
For example, in zhejiang province, from 1 july of this year, 12 common chronic disease outpatient medicines, including hypertension, diabetes, have been integrated into the population's health insurance, the reimbursement rate for slow medical treatment at the primary level is not less than 60 per cent, the reimbursement rate for tuberculosis clinics is not less than 70 per cent, and the start-up line at the grass-roots level is, in principle, not more than $300。
In addition, some municipalities have different payment lines, payment rates, ceiling lines, etc. For diabetes mellitus, high blood pressure outpatient claims and compensation rates。
In some cases, reimbursement for the cost of urban outpatient clinics is based on different criteria depending on age, such as those for children under 70 years of age: $800 at the start of the payment line, $3,500 at the top; and over 70 years of age: $600 at the start of the payment line and $4,000 at the top。
Some urban clinics are classified on the basis of whether or not they are employed, for example, with a pay line of $800 for active personnel and 40 per cent for individuals, with no ceiling; while retirees, with a pay line of $500 for retirees, pay 40 per cent for individuals, with no ceiling。
At the same time, the chronic care policy implemented in some areas also covers the cost of treatment for diabetes mellitus and hypertension patients。
According to ho minh dynasty, patients with diabetes and hypertension who are treated at outpatient clinics in primary hospitals in shaanxi province are granted benefits for cases identified as chronic diseases. For example, the poor, who are identified as diabetics, receive a health insurance reimbursement subsidy for outpatient visits at level ii and below, which is limited to $2,400 per year, or 80 per cent. In the province of shaanxi, the “free medication” model has also been introduced in a small number of secondary and lower medical institutions. “slower sickness benefits, combined with out-patient health insurance reimbursement, have a significant negative effect on diabetes mellitus and hypertension.”
“drugs are available to diabetic and hypertension patients, and prices vary widely. We have calculated roughly that if the patient uses lipto, viviol, two blood resins, pressure relief pills, the cost is around $80 a week. With the introduction of the policy of reimbursement for outpatient treatment for hypertension diabetes for urban and rural residents, the out-of-pocket cost of medication for one week could be reduced to around $40, with a clear negative effect on the patient。
The above-mentioned medical community observers have also indicated that enhanced outpatient compensation may improve the efficiency of the allocation of health insurance funds。
“it has been true that there were previously some cases of hypertension and diabetes which, owing to the high rate of reimbursement for hospitalization, have taken the form of `hospital transfer' `beds'. These phenomena have increased expenditures on health insurance funds. Now that the cost of the clinic can be reimbursed, there may be some improvement in over-reimbursing.” hu ming dynasty says。
