Three departments issue guidance, allowing primary care facilities to issue up to 12-week medication long-term prescriptions, with new medical insurance funds tilted toward primary care

Recently, the National Healthcare Security Administration, the National Development and Reform Commission, and the National Health Commission jointly issued the “Guiding Opinions on Supporting the Development of Primary Healthcare Services through Medical Insurance” (hereinafter referred to as the “Guiding Opinions”). The core focus is on “Strengthening Primary Care, Consolidating Foundations, and Ensuring Basic Services” through policy innovations in medical insurance payments, price management, and drug security, building a comprehensive policy system to support the development of primary healthcare services.

The “Guiding Opinions” propose optimizing the total payment policy for tightly integrated county-level medical communities and exploring outpatient chronic disease payments based on per capita. They aim to coordinate the total expenditure of employee and resident medical insurance, achieving full coverage of outpatient, hospitalization, and local and cross-region medical expenses within the county, promoting the integration of county medical resources.

Remaining funds are increasingly directed to primary care, incentivizing medical communities to shift resources and services downward. Strengthening the linkage between per capita payments and family doctor contract services, encouraging outpatient medical insurance funds for contracted residents to be paid per capita to primary healthcare institutions or family doctor teams, and guiding primary medical staff to proactively provide services such as chronic disease follow-up, medication guidance, and health monitoring through institutional policies.

Allow primary care providers to issue long-term prescriptions with a maximum of 12 weeks’ medication, and clarify that long-term prescriptions are not included in average cost assessments, enabling primary doctors to develop reasonable treatment plans based on patient conditions.

The “Guiding Opinions” state that the reimbursement ratio for general outpatient expenses within the scope of employee medical insurance should not be less than 50%, and outpatient pooling for resident medical insurance should mainly rely on primary healthcare institutions, with a reimbursement ratio within policy scope of no less than 50%. These measures not only economically guide the public to prefer primary care but also significantly improve the convenience of medical services.

For primary healthcare institutions, increased medical insurance funds allocated to grassroots levels, the sinking of remaining funds, and the shortening of monthly settlement periods to within 20 working days will effectively ease cash flow pressures; unified drug lists for counties, townships, and villages, along with comprehensive procurement of medicines at the grassroots level, will greatly alleviate the problem of drug shortages.

Source: CCTV News

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