Xu Guangjian: a list of the charging standards for nucleic acid detection in various parts of the country

 Xu Guangjian: a list of the charging standards for nucleic acid detection in various parts of the country

Xu Guangjian

In novel coronavirus pneumonia, the detection of nucleic acid has become a hot topic of public concern recently. The general trend is that with the continuous improvement of nucleic acid detection ability, the appointment of nucleic acid detection is becoming more and more convenient, and the situation of difficult appointment and slow results in the past has obviously improved. At the same time, we have also noticed that the charging standard or the price of nucleic acid testing is gradually decreasing, and there is a trend of steady decline. However, there is not a small gap in charges between different medical institutions or testing institutions in the same city, which needs further adjustment and improvement.

1u3001 Charge standard of nucleic acid detection based on cost

First of all, the pricing of nucleic acid testing should be based on the principle of supply and demand. In the early stage of the outbreak, the research and development of nucleic acid detection reagents is in the exploratory stage, and the number of manufacturers approved by the state is very few, and the production capacity of the kits is limited, and the supply is in short supply. At this stage, nucleic acid detection is only for the key population in the epidemic area, and it is not spread out in a large scale. The cost of nucleic acid detection is borne by the government, and the personnel receiving the test do not need to pay any fees.

With the increase of kit manufacturers, Chinas nucleic acid detection capacity has been greatly improved. In addition to Wuhan, Beijing and other cities that carry out large-scale detection, residents all over the country can accept nucleic acid testing through local designated medical institutions when necessary. At this stage, the personnel who do not belong to the scope of due inspection and due inspection need to pay the testing fee according to the regulations. In principle, the pricing of nucleic acid testing is determined by the provincial price department or medical insurance department according to the sum of the procurement cost of nucleic acid detection kit and the human cost of testing service personnel. Many regions in China have issued policies to encourage their medical institutions to purchase online through public resource trading platform, so as to improve the fairness, fairness and openness of the procurement process. For example, Hubei Province, as a key area for epidemic prevention and control in China, started centralized procurement of new coronavirus detection reagents in April 2020. According to the results published on its official website, the bid winning prices of four manufacturers of new coronavirus nucleic acid detection reagents are 16.78 yuan, 19.998 yuan, 23.90 yuan and 24.99 yuan respectively, that is to say, under normal circumstances, the procurement cost of nucleic acid kits does not exceed 25 yuan. In the latest joint procurement action between Beijing, Tianjin and Hebei, prices hit a new low. The lowest price of the new crown nucleic acid detection reagent group is 12 yuan / person provided by Shenzhen united medical, and the lowest price of the new crown antibody detection reagent group is 5.8 yuan / person supplied by boassez. Because the novel coronavirus pneumonia is highly infectious, the working conditions of the testing staff are higher and the intensity is larger. There is still a certain psychological pressure. The cost of manpower needs to be compensated through reasonable charges. In addition, the cost of sample transportation and safety protection varies from place to place, and the laboratory conditions vary greatly. These comprehensive costs need to be compensated by reasonable charges. However, at present, there is no public information about the detailed evaluation rules of this part of the cost. In other words, the current pricing can only be judged by cross regional comparison.

2u3001 A brief review of pricing policy for nucleic acid testing

For the nature of nucleic acid testing charges, some regions have given clear provisions. On May 21, 2020, the Beijing Municipal Development and Reform Commission proposed in the reply letter to the Beijing Health Commission that the new coronavirus nucleic acid detection fee, as an administrative institution type charge, should be managed by two lines of revenue and expenditure. The full amount of the fee income should be turned over to the national treasury at the same level and included in the financial budget management at the same level. In addition, the municipal and district centers for Disease Control and prevention are required to do a good job in publicizing the charges in accordance with the relevant regulations, and accept the supervision of the financial, development and reform, audit, market supervision and other departments and the society. In June 25th, novel coronavirus novel coronavirus related policies were issued jointly by the four departments of the Beijing health insurance bureau, including the health insurance bureau, the Wei Jian Committee, the Finance Bureau and the Bureau of social affairs. The specific criteria for adjusting the new coronavirus nucleic acid detection price were reduced to 120 yuan from 180 yuan per person, and the highest price was not allowed to float. There is no limit to the degree.

Hubei Province has made great efforts to reduce the burden of patients in formulating and adjusting the charging standards for nucleic acid testing. On April 26, Hubei Province temporarily added the new coronavirus nucleic acid detection and antibody detection medical service items, and set a ceiling price, with the maximum price of nucleic acid detection of 180 yuan / time and antibody detection of 50 yuan / item. After that, we should take active measures to reduce the cost. At the beginning of May, the cost of nucleic acid and antibody detection reagents in relevant hospitals was investigated. On May 15, after reporting to the provincial government, the provincial medical insurance bureau and the Provincial Health Commission jointly issued a document to reduce the price of new coronavirus related detection items, adjusting the maximum price of nucleic acid detection items from 180 yuan / time to 132 yuan / time, and the maximum price limit of antibody detection items from 50 yuan / item to 40 yuan / item.

According to the provincial policy documents available, the openness of nucleic acid testing policies in different provinces is not the same, and there are obvious differences in the provisions of charging standards. By sorting out the relevant policy texts, the pricing information of nucleic acid detection in provinces and municipalities directly under the central government in the current public information is sorted out. The details are shown in the table below.

First of all, there are differences between provinces in terms of charging standards. As the main responsibility of nucleic acid detection is the provincial government, therefore, at this stage in the province where there are multiple charging standards, the price of the province can be unified through centralized procurement and unified pricing, so as to avoid unnecessary confusion to the society.

Secondly, from the published data, there is a big difference in nucleic acid testing fees among different provinces. At present, the price difference among different provinces in China is mainly due to the purchase of test kits in provinces and autonomous regions. In the future, it is necessary to improve the content of the public information of charging standards, improve the standardization of information display, and improve the accessibility of information, so that residents can easily obtain clear charging information and understand consumption. At the same time, we should open up complaint channels, timely understand the demands of the masses and give positive feedback to improve the credibility of the government.

Third, many provinces implement the price ceiling policy, which allows medical institutions to timely lower the test fee standard according to the change of cost, and also allows different regions or different medical institutions in the province to determine the charging standard according to the maximum price, which reflects better policy flexibility.

3u3001 The policy of medical insurance to cover the cost of nucleic acid detection is constantly improved

In June 19, 2020, novel coronavirus pneumonia was developed and the local medical insurance funds should be considered comprehensively. The nucleic acid, antibody detection items and related consumables for new crown virus will be included in the provincial medical insurance treatment project catalogue and the payment conditions will be determined simultaneously. Encourage the provincial and regional health insurance departments to actively explore the centralized procurement of new coronavirus detection reagents, and promote the price to return to a reasonable level through competition. In addition, the pricing scope is also clearly defined, requiring all consumables of nucleic acid testing to be included in the medical service price item; in vitro diagnostic kit is charged according to zero margin in addition to the medical service price item. This policy puts forward the working requirements and principles for the procurement, charging and reimbursement of nucleic acid testing in all provinces.

At present, many provinces or municipalities directly under the central government have included the cost of nucleic acid testing into the scope of medical insurance, and the residents worries are relieved through the system design. On April 14, 2020, Tianjin Medical Insurance Bureau and Tianjin Health Commission announced that the expenses of nucleic acid detection for people within the scope of payment should be fully reimbursed by medical insurance. In May 14, 2020, the novel coronavirus pneumonia virus detection project and medical insurance reimbursement policy were unified by Sichuan medical insurance bureau. The cost of nucleic acid detection was managed by a category a diagnosis and treatment project, that is, the proportion of personal first payment was not set, and the payment was directly based on the basic medical insurance policy in the area. From May 19, 2020, Beijing Municipal Bureau of medical security, Municipal Bureau of Finance and other relevant departments will include the people who should be fully examined stipulated by the state and the city into the scope of protection. If the insured personnel carry out nucleic acid testing in designated medical institutions of medical insurance, they will be reimbursed according to the regulations, and the part of personal burden will be borne by the urban two-level finance. On June 30, 2020, Shanghai will bring the new coronavirus detection project into the list of medical insurance diagnosis and treatment projects of this city. If the insured people in the city are tested in the designated medical institutions, they will be paid according to the provisions of the basic medical insurance of the city. For example, Zhejiang has taken the lead to include the cost of nucleic acid and serum antibody testing required for students to go to fever clinic into the scope of medical insurance payment, and will be extended to all insured objects from April 30, 2020.

The identification of virus infectors by nucleic acid detection is an effective measure to achieve accurate prevention and control, and is also the starting point of the prevention and control chain. The continuous improvement of nucleic acid detection ability provides favorable conditions for expanding the detection range. The promotion of nucleic acid detection needs to strengthen regulation and optimize the implementation effect through institutionalized policy tools. The future work should focus on three aspects.

Second, optimize the procurement and testing links to reduce costs. Centralized procurement of public resources can give full play to the buyers advantages, improve the fairness, fairness and openness of procurement through standardized operation, and ensure the use efficiency of funds. In the future, qualified regions should realize the online procurement of nucleic acid reagents based on provinces, and realize the optimal allocation of resources through the power of the market. In addition, we should continue to strengthen the training of personnel skills, reasonably arrange the division of labor, reduce the labor cost as much as possible, and improve the detection efficiency. As long as the two pronged approach is adopted, the testing cost can be further reduced and the residents sense of real gain can be brought.

Third, the government and employers work together to ease the pressure on residents to pay. Although some provinces have issued documents to include nucleic acid testing into the scope of medical insurance reimbursement, some areas with weak medical insurance fund foundation still face greater payment pressure. The government in these areas should issue policies to attribute the payment responsibility of nucleic acid testing for work reasons to the employer, form a scientific and reasonable payment structure, and reduce the burden of residents.

Fourth, the most important thing is that medical institutions or testing institutions should always put the quality of nucleic acid testing in the first place, and at the same time reduce the charging standard as far as possible to reduce the economic burden of the tested personnel, but also pay more attention to continuously improving the quality of nucleic acid testing. The relevant departments should do a good job in publicity and education, improve the publics ability to identify regular nucleic acid detection channels, and be cautious of being deceived; for illegal acts, they must be severely punished according to law to maintain the order of epidemic prevention and control.

This article is the exclusive contribution of Netease Research Bureau and does not constitute investment decision.

Produced by Netease Research Bureau (wechat official number: wyyjj163)

Netease Research Bureau is a financial and professional think tank created by Netease News. It integrates the original multimedia matrix of NetEase Finance and economics, relies on the wisdom of hundreds of top economists at home and abroad, conducts rational and objective analysis and interpretation on hot topics of economics, and creates a leading financial think tank with attitude. Welcome to contribute (contribution email: [email protected] uff09u3002

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