Lei Jufang: Increase Public Awareness of Bottom-Line Medical Insurance Coverage for Serious Illnesses

　　At the 2017 National People's Congress and Chinese People's Political Consultative Conference, Lei Jufang, a member of the National Committee of the Chinese People's Political Consultative Conference and Chairwoman of Qizheng Tibetan Medicine, submitted a proposal focusing on strengthening public awareness campaigns for the country’s catastrophic illness medical insurance coverage and bottom-line assistance program. In her proposal, she pointed out that “after decades of hard work, one single illness can plunge you back to the days before liberation,” and “people with illnesses dare not go to the hospital, and even if they do go, they fear the high costs.” In 2015, the General Office of the State Council forwarded documents issued by the Ministry of Civil Affairs and other departments, outlining measures to further improve the catastrophic illness medical assistance system. The documents clearly stated that in the future, regardless of whether individuals are recipients of minimum living guarantees or low-income households, anyone suffering from a serious illness whose medical expenses exceed their family’s ability to pay will be eligible to apply for catastrophic illness assistance. Most impoverished rural residents live in areas with relatively limited transportation and information access, and many are unaware of the medical assistance policies provided by the central government and local governments. Given this situation, we recommend improving and intensifying publicity efforts aimed at promoting the country’s catastrophic illness medical insurance coverage and bottom-line assistance program.

　　The following is the original text of the proposal submitted by Lei Jufang, a member of the National Committee of the Chinese People's Political Consultative Conference and Chairperson of Qizheng Tibetan Medicine:

　　Proposal 1: A Proposal on Improving and Intensifying Public Awareness Campaigns for the National Critical Illness Medical Insurance Safety Net and Enhanced Assistance Measures

　　“After decades of hard work, a single illness can set you back to the days before liberation.” “When you’re sick, you don’t dare go to the hospital—yet once you do go, you’re afraid of the costs…” The reason people are so terrified of serious illnesses is not only the physical pain and suffering they bring, as well as the threat to their lives, but also the enormous financial burden that such illnesses place on families—a burden that is simply too heavy to bear. A serious illness has an especially profound impact on a family, whether it’s a household in an urban area or a rural one.

　　Against this backdrop, the critical illness insurance system for urban and rural residents was launched in 2012 and now covers all provinces. However, for some impoverished farmers or low-income urban residents, even after receiving assistance through this system, the support still falls short when they fall seriously ill. In 2015, the General Office of the State Council forwarded a document issued by the Ministry of Civil Affairs and other departments, outlining measures to further improve the critical illness medical assistance system. The document explicitly stated that, going forward, regardless of whether an individual is on minimum living security or belongs to a low-income group, anyone who suffers from a serious illness and incurs expenses exceeding their family’s ability to pay can apply for critical illness assistance. According to the document, the proportion of critical illness assistance will be no less than 70% in 2015; combined with medical insurance coverage, the reimbursement rate for families facing financial hardship due to serious illnesses could reach as high as 96% within the scope of the policy.

　　In 2016, 15 departments—including the National Health and Family Planning Commission and the State Council Office for Poverty Alleviation—jointly issued the "Guiding Opinions on Implementing the Health Poverty Alleviation Project," clearly stipulating that all impoverished rural residents would be fully covered by medical assistance programs for serious and critical illnesses. For patients who suddenly fall ill with a serious disease and temporarily lack family support, thus facing severe difficulties in meeting their basic living needs, greater efforts will be made to provide temporary relief and charitable assistance. At the same time, the document proposes establishing a coordination mechanism among various healthcare systems—including basic medical insurance, critical illness insurance, medical assistance, emergency medical assistance, and commercial health insurance—to leverage their synergistic and complementary effects, thereby creating a unified and robust safety net aimed at ensuring that impoverished patients receive all necessary medical treatment. In terms of controlling medical expenses, measures such as implementing “diagnosis and treatment first, payment later,” tiered diagnosis and treatment, and reforms in medical insurance payment methods will be adopted to keep the costs of treating serious illnesses within affordable limits for impoverished populations, effectively reducing their financial burden when seeking medical care.

　　The introduction of these policy measures has established uniform regulations covering aspects such as the objectives of medical assistance policies, fund-raising mechanisms, eligibility criteria, assistance standards, and assistance procedures. This represents a maximum possible reduction in the financial burden of medical expenses for the public, ensuring that every life is protected by a “safety net” in times of emergency. It prevents individuals from falling back into poverty or their families from collapsing overnight simply because of a serious illness. Such measures not only reflect social equity but also highlight the superiority of our institutional framework. Currently, these systems are performing relatively well in large and medium-sized cities, effectively helping many people suffering from serious illnesses and facing financial hardship to receive timely and effective medical treatment. However, there are still gaps in some smaller cities, and rural areas face even greater shortcomings and have considerable room for improvement.

　　Since most of the impoverished rural population lives in areas with relatively limited transportation and information access, many people are unaware of the medical assistance policies offered by the aforementioned national and local governments. After falling ill, they either give up treatment due to the heavy financial burden or turn to various donation platforms—some reputable, others not—that appeal to the public’s compassion and charitable donations. This not only risks delaying diagnosis and missing the optimal window for treatment but also, as information about large-scale medical fundraising campaigns spreads widely across these public welfare platforms, tends to exaggerate the vulnerability and helplessness of ordinary people facing serious illnesses, thereby undermining the government’s considerable efforts and achievements in providing comprehensive medical insurance coverage and in poverty alleviation through health initiatives.

　　In light of this, we recommend enhancing and stepping up efforts to publicize the country’s comprehensive medical insurance coverage and bottom-line assistance for serious illnesses—especially in rural, impoverished areas. By leveraging a variety of media channels and communication methods, we can ensure that residents in these rural, impoverished regions gain quick and thorough understanding of the relevant national policies and measures. This will effectively improve their access to and awareness of medical and health services, ensuring that these beneficial policies are truly implemented and play their intended role in poverty alleviation through health initiatives. We must strive to achieve universal access to basic medical and health services in impoverished areas by 2020, guaranteeing that everyone has access to necessary medical care and can live with dignity.

　　Proposal 2: A Proposal on Reflecting on the “Drug-to-Total Cost Ratio”

　　The “Guiding Opinions on the Pilot Comprehensive Reform of Public Hospitals in Urban Areas,” issued by the General Office of the State Council on May 17, 2015, proposed further expanding the pilot program for comprehensive reform of public hospitals in urban areas in 2015, with the goal of reducing the proportion of drug costs in these hospitals to around 30% overall by 2017. As a result, “drug cost ratio” has become a hot topic in the current healthcare reform, and health administrative departments across various regions have adopted it as an important indicator for evaluating hospital performance.

　　Since the implementation of the drug-to-total-revenue ratio indicator control, discussions among medical institutions almost invariably revolve around this very ratio. Localities have adopted fairly stringent measures to enforce drug-to-total-revenue ratio controls. Yet, further surveys reveal that the issue of high medical costs for the public remains unresolved. On the contrary, the drawbacks of the drug-to-total-revenue ratio indicator are gradually coming to light—and have even evolved into policy factors that exacerbate conflicts in medical treatment.

　　In some regions, local health authorities have been implementing policies in a rather rigid manner, treating general hospitals and specialized psychiatric hospitals alike. The diagnosis and treatment of mental disorders largely rely on scale-based assessments and pharmacological therapies; as a result, examination costs are relatively low, and medications constitute the primary expense for specialized psychiatric hospitals. The assessment of drug expenditure ratios will likely prompt patients currently undergoing outpatient treatment to switch to cheaper, less effective drugs with greater adverse effects, potentially even putting them at risk of having their treatment interrupted.

　　Some hospitals, in their ongoing efforts to reduce the proportion of drug-related expenses, have adopted various measures to increase non-drug revenue from medical services and other sources. At the same time, they have established a series of targeted management systems covering drug procurement, drug information disclosure, dynamic drug monitoring, and tiered management of antimicrobial agents. These comprehensive management measures include signing responsibility agreements with heads of all clinical departments to ensure integrated control over the drug expenditure ratio. Hospitals have implemented a system of assessing and monitoring the drug expenditure ratio, setting specific targets for each department—for instance, the surgical department is set at 40%, the internal medicine department at 45%, and departments such as oncology and infectious diseases—where drug-based treatments are predominant—are set at 50%. The baseline drug usage ratios for each clinical department are assessed monthly, and the drug expenditure ratio is directly linked to performance-based incentives. For departments whose drug expenditure exceeds the established baseline, their performance bonuses will be reduced by double the amount of the excess; for every 1% by which the drug expenditure ratio exceeds the target, 2% of the department’s performance bonus will be deducted. Additionally, physicians who fail to comply with the prescribed drug usage guidelines under the medical insurance regulations—and whose failure results in penalties imposed on the hospital—will have an equivalent amount deducted directly from their personal performance bonuses.

　　Without strengthening the assessment of the appropriateness of diagnosis and treatment, and without reforming the medical insurance payment system, merely mechanically monitoring the proportion of drug costs will only bring negative consequences for patients and put medical professionals in a dilemma. The proportion of drug costs should serve merely as one among many evaluation indicators and must never be imposed forcibly. Given that patient conditions, departments, and disease types differ, how could the drug cost ratio possibly remain the same? A simple logical analysis reveals that to reduce the drug cost ratio, one must either decrease the numerator or increase the denominator. Reducing the numerator means refraining from prescribing medications that shouldn't be prescribed in the first place—this approach is indeed correct—but it also risks selectively withholding even clinically necessary, high-value drugs. On the other hand, increasing the denominator by raising testing and examination fees leads to situations where CT and MRI results from top-tier hospitals in the same city are mutually unrecognized, and the root cause of this issue lies precisely in these very policies.

　　In light of this, we believe that controlling the proportion of drug costs cannot fundamentally address the issues of healthcare supply inducing demand and controlling medical expenses. On the contrary, it may only distort hospitals further, leaving patients in an increasingly dire situation where their welfare could actually decline the more they are “regulated.” Such an approach is not only unworthy of promotion; rather, it calls for deeper reflection and adjustment.

　　First, the drug-to-total-cost ratio is a macro-level requirement for hospitals. It is recommended that health authorities introduce policies to treat different diseases differently based on their specific characteristics. We should explore excluding certain special diseases—such as mental illnesses—as well as chronic conditions like hypertension and diabetes—from the drug-to-total-cost ratio assessment.

　　Second, it is recommended to shift from controlling the “proportion of drug costs” to implementing a “prescription review system.” For example, a provincial-level platform could be established to conduct prescription reviews, with a team of expert reviewers assembled. All prescriptions from public hospitals would be assigned unique numbers and uploaded to the platform, allowing for random spot checks and reviews. This approach would exert an invisible deterrent effect on practices such as excessive prescribing, duplicate prescriptions, and the overuse of ancillary drugs, thereby ensuring the rationality of prescriptions.

　　Proposal 3: A Proposal to Add Medicinal Herbs with Dual Food-and-Medicine Properties to the Catalog of the Filing System for Health Foods

　　The “medicine and food share the same origin” culture is an important component of the outstanding traditional culture of the Chinese nation. Throughout history, renowned physicians and health experts have advocated that “food therapy is better than medicinal treatment” and “dietary nourishment is superior to medicinal supplementation.” They highly推崇 dietary therapy using medicinal foods, adopting gentle approaches to regulate the body. In practice, they have created hundreds of thousands of dietary prescriptions and nutritional formulas. Many Chinese medicinal herbs that embody the “medicine and food share the same origin” principle serve both as prescription ingredients and as everyday foods. Through “food therapy,” one can not only savor delicious cuisine but also nourish the body, promote health, prevent diseases, and treat illnesses—thus highlighting the unique advantages of the “medicine and food share the same origin” approach in traditional Chinese medicine’s health preservation and wellness practices. This approach complements and enriches the strengths of modern Western health-care philosophies.

　　From June 1, 1996, to the end of 2015, among the health food products approved in China, a significant proportion—42.93%, 46.55%, and 35.79% respectively—were made by appropriately adding certain excipients to single-ingredient medicinal materials classified under the “food-as-medicine” principle. For example, propolis, grape seed extract, and ginkgo leaf extract accounted for these proportions. From 2016 to 2015, over the course of 10 years, China registered a total of 6,308 health food products. The top 10 medicinal materials used as raw ingredients under the “food-as-medicine” principle were goji berries, ganoderma lucidum, American ginseng, astragalus membranaceus, propolis, panax ginseng, kudzu root, poria cocos, epimedium, and rhodiola rosea. These figures demonstrate that “food-as-medicine” medicinal materials possess advantages in terms of safety and health-promoting functions, and they are irreplaceable as raw materials for health foods.

　　Currently, the state is strongly supporting the development of traditional Chinese medicine (TCM). In February 2016, the State Council issued the "Outline of the Development Strategy for TCM (2016-2030)," encouraging TCM institutions to fully leverage modern scientific and technological advancements—including biotechnology, bionics, and intelligent technologies—to develop a range of health foods, health products, and health-care devices. In October 2016, the CPC Central Committee and the State Council jointly released the "Healthy China 2030" Outline, which stipulates that by 2030, the leading role of TCM in preventing diseases before they occur, its synergistic role in treating major illnesses, and its pivotal role in disease rehabilitation will be fully realized. In December 2016, the National People's Congress promulgated the "Law of the People's Republic of China on Traditional Chinese Medicine," clearly defining the state’s direction for developing TCM-based health and wellness services. The law also relaxed the requirements for both applying for drug approval numbers and for medical institutions to prepare and use “compound Chinese medicinal preparations derived from time-honored classic prescriptions.” Furthermore, the registration requirements for health foods should likewise be referenced and implemented accordingly.

　　The introduction of the aforementioned policy recommendations further promotes the important role that “medicinal foods”—herbs with both medicinal and culinary uses—play in people’s health care. Relevant practitioners are eagerly anticipating that the registration and filing system for health products will bring new changes and opportunities to the industry’s development.

　　Against this backdrop, on July 1, 2016, the "Administrative Measures for the Registration and Filing of Health Food Products" were officially implemented, shifting the management model for bringing health food products to market from the previous single-registration system to a combined registration-and-filing approach. These measures have streamlined the approval process, shortened the approval cycle, and reduced the cost of application submissions, thereby fostering the development of the greater health industry.

　　On January 12, 2017, the National Medical Products Administration, together with the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine, formulated and officially released the "Catalogue of Raw Materials for Health Food (I)" and the "Catalogue of Health Functions Permitted for Health Food Claims (I)." These catalogues will take effect officially on May 1, 2017.

　　We found that the current catalog of health food registration under the filing system features a limited range of ingredients and an overly narrow scope of application. In the "Catalog of Health Food Ingredients (I)," the primary entries are nutritional supplement ingredients, including calcium, magnesium, potassium, and manganese. Similarly, in the "Catalog of Health Functions Permitted for Health Food Claims (I)," only health functions related to vitamin and mineral supplementation are currently listed. The ingredients registered in these catalogs are predominantly concentrated on nutritional supplements, vitamins, and minerals—akin to the health-care practices in Western countries, which focus on supplementing the body with vitamins and minerals. However, medicinal herbs embodying the precious essence of traditional Chinese health preservation—those with the principle of "food and medicine sharing the same origin"—are conspicuously absent from this catalog. The existing catalog is not conducive to transforming Chinese medicines, which boast resource advantages and unique health benefits, into health products that effectively meet the public’s health needs. Moreover, it will likely lead to severe product homogenization in the future health-food market, making it difficult to ensure product quality and hindering the healthy development of the industry.

　　In light of this, we believe that “medicinal and food substances with the same origin” have undergone long-term consumption and scientific evaluation, demonstrating that they meet the requirements for health-food registration in terms of safety and usage guidelines. It is urgently necessary to add these “medicinal and food substances with the same origin” to the relevant catalog, so as to fully harness the important role of traditional Chinese medicine in preventing diseases before they occur, intervening and adjusting health conditions, and promoting the health of the Chinese nation.

　　Reporting media: Sohu Finance

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