Since the beginning of the year, the national health insurance agency has made the project on harmonization of prices a major reform task, accelerating the preparation of a guide on the publication of prices for medical services. Since 2021, 39 sets of guidelines have been issued nationwide for the development of health-care price projects, 30 on average, and the 40th series of testing guidelines have been consulted, with the aim of harmonizing the national health-care price project “common name”. Of these, more than 180 new projects involving new technologies, forward-looking pricing of new products, covering front-line medical areas such as surgical robots, tele-surgery, brain interfaces, etc., have received extensive attention。
What is the guide to setting items on price? What will be the far-reaching implications of the development and landing of the guidelines for public access to health care, hospital operations and the development of the pharmaceutical industry
Screening of innovative technologies
Wang xiao ning, director-general of the state health insurance agency, said that the guidelines for the formulation of projects identified core elements such as the name of the price item, service output, unit of measure, etc. Price items are both the basis and the boundaries of hospital fees and a prerequisite for the realization of the value of medical technologies and services, essentially a market access system that reflects the value of the relevant technologies and services。
The chief of the medical prices division of the national health insurance board, jiang bing town, explained that the screening criteria for the incorporation of new technologies into price formulations were based on four main considerations: first-rate technological maturity, taking into account clinical needs, and assessing industrial-led effects, taking into account both the affordability of the population and the sustainability of health insurance funds。
“the price project is essentially a pass for innovative technology to access the hospital system. Re-advanced medical technology, without a corresponding fee-price line, would not actually benefit patients even if they were admitted to hospitals. Price projects are designed to give businesses a reasonable return and willingness to undertake technological innovations, while making them accessible and affordable.” jiang chang song, researcher at the national institute of health and social security of the university of medical sciences of the capital。
In the case of terminal heart failure patients, for example, artificial heart implants, the total treatment cost was over $1 million, which was difficult for ordinary families to bear. Following the implementation of the price guidelines, the health-care sector has harmonized the introduction of new assistive device price items, negotiated one-to-one prices with the enterprises concerned, squeezing the circulation chain to an unreasonable premium, reducing the overall cost of surgery to around $700,000, while ensuring reasonable profits in the production of research and development. Currently, projects in beijing, chengdu and guangdong have been integrated into health insurance, and the patient's own personal expenses can be reduced to around $200,000。
Promoting results on the ground
Price projects provide a clear reference to local planning, construction and revenue measurement for high-end medical technologies invested in heavy assets. High-end equipment for treatment of tumours is available at high cost, after only a small number of provinces were set up and innovative results were widely available。
The deputy director of the prices and recruitment department of the national health insurance agency, thong zhuang, introduced the guidelines for the price of medical services, which include additional items such as proton and ion treatment, taking into account the benefits of innovation, the costs of medical institutions and patient affordability, drawing on practical experience in shanghai, gansu and other places, and making it more accessible to such high-end medical technology by making it reasonable to set a ceiling at the cost of treatment。
“today, shanghai, zhejiang and gansu have established the prices of government guidance on a practical basis. The total process cost of proton treatment is approximately 170,000 yuan, heavy ion treatment is contained within 200,000 yuan, prices are at a low global level, and the results of technological innovations in health care are truly being promoted for the benefit of the population.” chiang chang song believes that the price anchors are clear, that the benefits of new technologies can be quantified and can be expected, and that more provinces are bold enough to plan for the construction of proton, heavy ion treatment centres without patients having to travel to the country or even abroad for treatment。
The managing director of the beijing arts and crafts inc. Said that clinical outreach was constrained by the lack of a single national fee for the development of surgical robots and high technical barriers. The national health insurance agency has established a project to harmonize prices, clarify the name of the project and the content of the service, price it on the basis of clinical contributions, and create a level playing field between national production and imported brands。
Chiang changsong, for example, has a global first-intrusion brain interface product that has been approved for listing in the country and, based on past experience, usually takes between one and two years from approval to a clear fee, but this time the national health insurance agency set up the “intrusion brain interface fee” project ahead of schedule, with multiple government guidance prices now concentrated in 6,000 to 6,600 yuan. When prices are clear, enterprises can clearly measure the r & d return cycle, and hospitals have a fee base that effectively activates r & d, production and use the full chain。
Reshaping value structures
The price-setting guide continues to reshape the value structure of medical services while harmonizing the rules. With the gradual improvement of the institutional system, our project on the price of health services is moving from decentralized management to national harmonization, with a framework of common standards for the industry. This means not only that the price system is comparable across regions, but also that it provides a solid basis for subsequent price monitoring, assessment and dynamic adjustment。
The director general of the department of market access of shenzhen presbyterian science and technology ltd., huang yansheng, said that the regulation of a uniform price system, which allows the population to receive regular treatment near primary health-care facilities, also creates a stable market environment for medical equipment enterprises, enhances the confidence of industry to continue its high-end research and development, and creates a virtuous circle of value-defeating, iterative innovation。
In addition, assistance in gradating and consolidating services at the grass-roots level has been an important focus of the price reform. The state health insurance agency, in conjunction with the cost of manpower, the needs of the population and the distribution of medical resources, provides guidance on how to optimize price systems for classification. In the case of universal basic projects, the price convergence of different levels of health-care institutions is explored, enabling them to operate properly. Price items, such as inspections, which are mainly based on equipment consumption, are directed to reducing prices appropriately in high-priced areas, reducing price gaps at different levels of hospitals and promoting rational sinking of medical resources。
In line with the trend towards forward-looking medical technology development, the health sector is breaking the traditional “marketing first, pricing later” model, putting price policy support ahead of research and development and clinical trials and reshaping the pace of clinical transformation of new technologies. According to thong, the national health insurance agency is studying the establishment of a system of pre-pricing medical services, providing policy advice ahead of the clinical trials of new technologies, promoting the rapid development of new products after approval of new technologies, accelerating the efficiency of market transformation for high-level innovative results and promoting the development of high-quality medical technologies。
