Cancer screening, rare disease coverage? In fact, it is a fine accounting problem
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At the just-concluded NPC and CPPCC sessions, deputies to the National People's Congress (NPC) suggested that cancer screening be included in medical insurance and that efforts be made to increase the early stage of cancer screening. The proposal quickly aroused heated debate. Early tumor screening is of great significance for the early detection and treatment of tumors and is worth popularizing. But whether it should be covered by Medicare and paid for by Medicare is not a simple question.
According to Yu Jinming, if cancer patients can be detected and treated early, the treatment cost can be greatly reduced and the survival rate can be improved. If the disease progression is advanced due to early misdiagnosis and mistreatment, no amount of manpower, material and financial resources can be spent to remedy it. Therefore, he suggested that early cancer screening should be included in health insurance, and more efforts should be made to promote it.
At present, the vast majority of cancers, mainly malignancies, are still incurable (at least for advanced patients), and once the cancer has reached an advanced stage, the patient will suffer greatly. Early diagnosis and early treatment is of great significance for cancer treatment, which has been recognized by the medical community. According to a program of early diagnosis and treatment of cancer previously implemented by the National Health Commission in some regions, the case detection rate and the 5-year survival rate of patients were both higher than the baseline value. It is of great significance to promote early cancer screening in high-risk groups.
However, the cost of cancer screening is not cheap. The above programs have taken 13 years to screen 3.8 million high-risk groups, for which the central government has invested nearly 1.87 billion yuan, nearly 500 yuan per person on average.
And that's just the cost of screening for a few cancers in a specific range. There are many types of cancer, among which lung cancer, stomach cancer, colorectal cancer, breast cancer, liver cancer, esophageal cancer and so on are among the most common cancers in China. Screening for these cancers requires different tests and screening at regular intervals. If universal screening were to take place, the total cost would be staggering.
Whether a cancer screening is to be rolled out requires careful accounting. If a kind of early cancer detection cost is very low, the accuracy is higher, and early treatment compared with the period of the cost of treatment is much lower, treatment effect is much better, or can relieve the pain of the patients, early found early treatment of overall medical costs to save more than the cost of universal screening or not too big difference, Then early screening for this type of cancer could be considered for coverage. But if the cost of early screening is high and the accuracy is not high enough, and the difference between early treatment and late treatment is not large enough to cover the cost of screening, then it may not be covered. Of course, with the development of medicine, the cost and accuracy of screening are constantly changing and can be adjusted dynamically.
In fact, in addition to cancer screening, other delegates called for the treatment of rare diseases to be covered by health insurance. The treatment of rare diseases requires a huge cost, which is often difficult for ordinary people to afford. But can Medicare afford to treat rare diseases? At present, the design principle of China's basic medical insurance system is still based on "basic insurance", that is, to cover part of the treatment costs of some common diseases. If Medicare is required to cover the cost of treating more illnesses, premiums for enrollees tend to rise, or the level of coverage may fall.
Look at this principle as a minimalist model. In A group of insured persons, the medical insurance covers the cost of disease A, the incidence of disease A is 1% per year, and the cost of treatment is 10,000 yuan per case, not taking into account the operating costs of the insurance, etc., and only 100 yuan per person per year is charged. But one day one of the enrollees developed the rare disease B, which affects only one in 10,000 people a year but costs a million yuan to treat. If the medical insurance is required to cover the treatment cost of B, then the insurance premium of 200 yuan per person is needed to guarantee the payment, which means the rate increases by 100%. However, the incidence of rare diseases is very low and there are many types of rare diseases. If the treatment of rare diseases such as C and D is included in the coverage of medical insurance, the medical insurance premium may increase by N times. Although the algorithm and model of health care in reality are not so simple, the principle is basically the same.
As a matter of fact, the premium standard of medical insurance for urban and rural residents in China has been rising in recent years, which is related to the expanding coverage and proportion of medical insurance. In 2019, the standard for individual contributions will be 250 yuan per person, and it will be raised to 280 yuan in 2020. This is the standard after fiscal subsidies bear the bulk of the premiums. More than 1 billion people will be insured by medical insurance for urban and rural residents in 2020, with the income of medical insurance fund reaching 901.401 billion yuan, with an average contribution of 900 yuan and an average financial subsidy of 620 yuan, according to a statistical bulletin released by the National Medical Insurance Administration. The situation of basic medical insurance for urban workers is similar. The continuous expansion of the coverage of medical insurance will also put great financial pressure on the medical insurance fund for workers, and the payment standard of medical insurance fee will have to be raised.
The medical insurance fund still comes from the insurance premium paid by the participants including financial subsidies, which is not a pie falling from heaven. In the final analysis, it has to be calculated carefully.
