On January 4, it was learned from the Qinghai Provincial Medical Security Bureau that during the "14th Five-Year Plan" period, the bureau has been enhancing the sense of benefit and happiness among insured individuals by implementing a "combination punch" of pharmaceutical management strategies tailored to the provincial context.
Qinghai has adhered to the dynamic adjustment of the medical insurance drug list, incorporating more new and effective medicines into the reimbursement scope. A total of 387 nationally negotiated and competitively priced drugs have been included in the "dual-channel" supply guarantee, significantly improving patient access to medication.
Building upon the national list of 892 traditional Chinese medicine decoction pieces, Qinghai has added 150 Tibetan medicinal decoction pieces to its reimbursement coverage. It pioneered and continuously optimized the medical insurance catalog for Tibetan and Mongolian hospital preparations nationally, which now includes a total of 531 types, amounting to 3,200 specific preparations.
Substantial policy support has been directed towards medical services that highlight the strengths of ethnic medicine, with 499 ethnic medical diagnosis and treatment projects now covered by insurance, accounting for 88% of such items. Furthermore, 127 surgical procedures have been included in the day-surgery settlement scope, exempt from deductible lines and reimbursed under inpatient policies.
Six conditions where Chinese and Tibetan medicine show particular efficacy, such as neck stiffness and facial paralysis, have been incorporated into the day-ward settlement system. Patients admitted under this scheme are not charged for床位 fees, and nursing fees are levied at 50% of the tertiary care standard, consistently reducing the financial burden on the insured.
Through enhanced coordination with health authorities and an "integrated" management approach, village clinics have been brought into the designated medical insurance network. To date, 4,343 out of the province's 4,469 village clinics are included, achieving near-universal coverage across all administrative villages.
Concurrently, management of designated pharmaceutical institutions has been strengthened by clarifying local management responsibilities, abolishing the mutual recognition of designated institutions within the province, and enabling province-wide access upon designation at one location. A smart medical insurance supervision system has been established to shift the oversight of insurance funds forward, enabling early detection, warning, and handling of irregularities.
Significant efforts have been made to optimize the process for out-of-town medical treatment registration, expanding the channels for filing through the launch of online functions on WeChat mini-programs and the Qinghai Medical Insurance App. The requirement for intra-provincial out-of-town treatment registration has been eliminated, establishing direct settlement channels to achieve "seamless access within the province, one card usable everywhere," effectively resolving issues related to travel and upfront payments for insured individuals.
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