Jiaxing, Zhejiang Province began emergency vaccination of the new crown vaccine and clarified the price of the vaccine for the first time, bringing the issue of the cost of the new crown vaccine to the forefront. The National Medical Insurance Administration reiterated that preventive vaccines are not included in the scope of medical insurance payment, and the cost of vaccines and vaccinations should be resolved through public health service funding channels.
Different from the requirements of the National Medical Insurance Administration, the second-class vaccines have been included in the payment scope of personal accounts in the reform plans for medical insurance personal accounts issued by some localities. Wang Zhen, director of the Public Economics Research Office of the Chinese Academy of Social Sciences, told Yicai that the funds in the medical insurance personal account also belong to the medical insurance fund and cannot be used to pay for vaccines and vaccinations. After the establishment of the medical insurance treatment list system in the next step, these local regulations will be banned.
Liao Zangyi, a researcher at the Medical Service Governance Research Center of Tsinghua University, said in an interview with China Business News that vaccines belong to the scope of public health. If the government declares that it is included in the scope of public health and becomes a public health service, it can be covered by finance, but financial capacity needs to be considered.
The National Medical Insurance Administration stated that in the next step, by the relevant requirements of the “Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System”, we will do a good job in serving the anti-epidemic work, and jointly study the cost of the new crown vaccine with relevant departments.
The current emergency vaccination of the new crown vaccine is 200 yuan per dose
On the 15th, the “Relevant Instructions for New Crown Vaccination” issued by the Center for Disease Control and Prevention of Jiaxing City, Zhejiang Province stated that Jiaxing City has carried out new crown vaccination among key protection objects in the early stage, and will gradually carry out general object vaccination in the future.
Not only Jiaxing, but Zhejiang Province has launched emergency vaccination against the new crown epidemic at the provincial level. The 55th press conference on the prevention and control of the new crown pneumonia epidemic in Zhejiang Province announced that Zhejiang Province has determined priority for key groups, priority for epidemic areas, safe vaccination, and informed and voluntary principles, and divides emergency vaccination objects into key guaranteed objects, key recommended objects and general object.
Among them, the key protection objects cover four categories of workers including medical care, health and epidemic prevention, port quarantine and border inspection, and centralized isolation and medical observation. The general target refers to other people who are voluntarily vaccinated.
Jiaxing CDC also announced the price of the new crown vaccine for the first time. Two doses of vaccination are required, with an interval of 14 to 28 days (recommended 28 days). This price is lower than the level previously rumored in the industry.
Jiaxing CDC said that the new crown vaccine currently used for emergency vaccination in Jiaxing City is ordered by the provincial department from Beijing Kexing Zhongwei Biotechnology Co., Ltd., and distributed to designated vaccination units step by step. The vaccine has not been officially registered and marketed and has been approved for emergency vaccination by law.
The statement issued by Jiaxing CDC did not clearly raise the issue of whether the cost of the vaccine is self-paid. From the statement of the document, the voluntary vaccination should be a self-paid vaccine. Liao Zangyi believes that the epidemic is a public health event. If the vaccine is not included in the national immunization plan, it needs to be paid for by itself. If the local finance is rich, the local government finance can bear part of the subsidy responsibility.
Vaccine costs are not covered by medical insurance
Previously, the deputies to the National People’s Congress were very concerned about the cost of the new crown vaccine. During the two sessions this year, some people’s congress representatives put forward a “suggestion on including the vaccination of the new crown pneumonia vaccine into the full reimbursement of medical insurance”. In response to this suggestion, the National Medical Insurance Administration stated that disease prevention and control items such as vaccines and vaccination costs should be resolved through public health service funding channels.
There are two legal bases for this reply. One is the “Vaccine Administration Law of the People’s Republic of China” implemented on December 1, 2019. my country divides vaccines into immunization program vaccines and non-immunization program vaccines. Among them, the immunization planning vaccine is organized by the State Council’s health department in charge of the State Council in conjunction with the State Council’s financial department and other organizations to conduct centralized bidding or unified negotiation. Second, Article 30 of the “Social Insurance Law of the People’s Republic of China” clearly stipulates that medical expenses that should be borne by public health are not included in the payment scope of the basic medical insurance fund.
The “Interim Measures for Medication Management of Basic Medical Insurance” just announced in July this year also pointed out that preventive vaccines are not included in the scope of medical insurance payment.
Wang Zhen said that vaccines belong to the scope of public health coverage and have nothing to do with medical insurance. Funds required for vaccines should be paid for by public health funds. The cost of vaccines is already included in the public health funds allocated by the fiscal year. If medical insurance reimburses the cost of vaccines again, it is equivalent to paying for one thing twice.
Liao Zangyi said that the public hopes that medical insurance will reimburse the cost of the new crown vaccine may be because medical insurance and financial support during the treatment of the new crown have caused the public to rely on the path of medical insurance reimbursement. In fact, medical insurance funds and vaccine expenses are two types of funds with completely different natures. Medical insurance reimbursement is for outpatient or inpatient treatment, which reflects the third-party payment responsibility for the resulting disease risk, and not all expenses can be reimbursed.
In addition to legal principles, whether the medical insurance fund can afford the cost of the new crown vaccine is also a question. In the reply of the National Medical Insurance Administration, the current level of financing for basic medical insurance in my country, especially for urban and rural residents medical insurance, is relatively low. In 2019, the per capita financing of urban and rural residents medical insurance is only about 800 yuan. With the large number of people vaccinated this time, the total cost is high, obviously beyond the affordability of the medical insurance fund, and the medical insurance cannot expand the scope of payment to non-therapeutic items such as vaccines.
Yicai also learned from Jiaxing that the Jiaxing medical insurance department has not participated in the policy formulation of emergency vaccination of the new crown vaccine, and this work is mainly the responsibility of the disease control department.
The list of medical insurance benefits delineates the boundaries between medical insurance and public health
Although the state has repeatedly stated that non-therapeutic and preventive items such as Class II vaccines are not included in the scope of medical insurance fund payment, because medical insurance is managed locally, local governments have a certain degree of autonomy in medical insurance policies. In the previous reform of local medical insurance personal account family mutual aid, Hangzhou, Shenzhen, Sichuan, Fujian, and other places proposed that personal account funds can be used for the cost of preventive immunization type II vaccines.
As early as 2017, Hangzhou stipulated that the scope of payment of personal account funds over the years includes the expenses for preventive immunization vaccines other than the national expanded immunization program that occurred in the local overall planning area. The funds of the personal accounts over the years can be transferred to the children through the family mutual aid method to purchase the second-class vaccines.
In 2019, based on the original payment scope, the funds in the individual accounts of the basic medical insurance for urban employees in Sichuan Province can be expanded to pay for the unplanned immunizations of the employees themselves, their spouses, parents, and children of both husband and wife who seek medical treatment at designated medical institutions in the overall planning area. Expenses for medical services that need to be borne by individuals.
The “Fujian Provincial Basic Medical Insurance Family Mutual Aid Account Use Management Measures (Trial)”, which has been implemented since July 1 this year, stipulates that the funds in the individual medical insurance accounts of employees in Fujian Province can be “shared by families”, and the scope of family mutual aid payment includes vaccination and preventive immunization. The cost of the second type of vaccine.
Wang Zhen said that both the pooling fund and the personal account fund belong to the medical insurance fund, and should not be used to pay for vaccines. After the medical insurance treatment list is issued, these local regulations will be banned.
In July 2019, the National Medical Insurance Administration announced the “Opinions on Establishing a Management System for the List of Medical Insurance Benefits (Draft for Comment)”, which clearly stated that the medical insurance fund should not pay the expenses that should be borne by public health, and proposed that local governments should not formulate individual or the Family Account Policy.
This consultation draft also proposes that, by the requirements of eliminating increments and regulating stock, localities should not introduce policies and measures beyond the scope of authorization of the list in principle. For the policies and measures introduced in the past that do not conform to the list, in principle, the clean-up and regulation will be completed within three years.
On the 15th, the National Medical Insurance Bureau said in response to proposal No. 8854 of the Third Session of the Thirteenth National People’s Congress that the National Medical Insurance Bureau is currently researching and formulating a list of medical security benefits by the requirements of the “Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical Security System”. reform plan. In the next step in the process of document formulation, the National Medical Insurance Administration will also focus on listening to opinions from all quarters to ensure that policy measures are scientific and reasonable.
