On August 18, the National Medical Insurance Bureau announced the “Notice on Carrying out Special Treatment of Oral Implant Medical Service Fees and Consumables Prices” (Draft for Comments)
details:
1. Standardize the charging methods for dental implant medical services and consumables
(1) Promoting the “separation of technology and consumption” in dental implant medical services in an orderly manner. Public medical institutions provide dental implant medical services, mainly adopting a separate pricing method of “service items + special consumables”. That is, the implant placement fee is priced separately from the price of the implant consumables system; the dental crown placement fee is priced separately from the price of the dental crown product; the bone graft operation fee is priced separately from the bone meal price. For the current situation that consumables are combined in the price of medical service items, when the “separation of technology and consumption” is implemented, the project price should be synchronously reduced in accordance with the method of deducting the average online purchase price of related consumables.
(2) Guide the formation of a reasonable price for dental implant crowns. Dental implant crowns are purchased online, and public medical institutions choose them independently according to clinical needs, and sell them at a “zero mark-up” rate on the actual purchase price. The Sichuan Provincial Medical Security Bureau organizes bidding for the mainstream clinical all-ceramic crowns in the province, and forms a reasonable market price through competition. Other materials refer to the price of all-ceramic crowns. The National Medical Security Administration instructs other provinces to implement price linkages, limit prices and hang on the Internet, and promote the transparency of dental crown prices. For medical institutions that manufacture dental implant crowns by themselves, the medical institutions shall independently determine the price based on material cost, processing services, etc., according to the appropriate cost recovery rate, and hang the price on the net. .
(3) Standardize and integrate the price items of dental implants. According to the basic principle of “output orientation”, integrate the medical service price items involved in oral implantation. Among them, the first-stage implantation surgery (implant placement) and the second-stage surgery (placement of the healing abutment) are combined into implant placement; dental crown placement services, including impression taking, jaw relationship recording and transfer, Abutment and crown installation, debugging and modification, etc., are combined into implant crown placement; bone graft surgery, soft tissue repair, implant repair and removal, etc., which are implemented in support of dental implants, set independent medical service price items . For complex implant surgeries such as full arch restoration implants and maxillary sinus bone grafting, differences can be reflected in the price of medical services. In order to ensure the accuracy of missing teeth restoration, medical institutions use various inspection methods such as medical imaging, digital technology, artificial intelligence, etc. to construct virtual 3D models, make lesion models or surgical guides, and set up corresponding medical service price items according to service output. . The specific guidelines for the establishment of dental implant and other missing tooth restoration medical services will be issued separately by the National Medical Security Administration.
It is clear that the cost of consumables and the cost of services are separated, and the crown is the guide to form a reasonable price. The cost of implantation services has been partially consolidated, and some of them need to be formed into independent service prices. For difficult implantation operations, the difference in value can be reflected. In general, for the cost of planting services, the original conventional projects have been partially merged and it is expected that the price will be adjusted downward. There is no one-size-fits-all for difficult planting services, which reflects the value of planting services. In addition, some digital design solutions have been added. , which can enhance the service value.
2. Strengthen the price regulation of medical services such as dental implants
(4) Do a good job in price regulation around the whole process of dental implants. Local medical security departments should focus on single conventional implantation, clarify the price control objectives of the whole process, guide centralized procurement with volume, standardize medical service price items, and strengthen the price control of dental implant medical services.
(5) Strengthen policy guidance on the price of medical services in public medical institutions. In areas where government-guided price management is implemented for oral implant projects such as implant placement fees, crown placement fees, and bone grafting fees, the medical security department will re-formulate and announce government-guided prices while standardizing the price items.
(6) Adhere to the ups and downs, and straighten out the relationship between the prices of related medical services. Implants, crowns, and bone grafts are mainly due to the strong feedback from the masses and the heavy cost burden. Among them, if the government-guided price of public medical institutions is significantly higher than the average price of private medical institutions in the region, the principle of public welfare should be adhered to, special demonstrations, and key price reductions; if the independent pricing of public medical institutions differs greatly between hospitals, the price order should be supervised and supervised. Medical institutions that were significantly higher than the average level took the initiative to pull back. Items with high technical difficulty and high risk such as zygomatic surgery and complex bone grafting are allowed to open an appropriate gap between the price of conventional dental implant surgery. The price of medical services in fixed dentures, removable dentures and other methods of restoration of missing teeth shall maintain a reasonable price parity with oral implants, and medical institutions are encouraged to provide patients with appropriate restoration services for missing teeth. For technical labor-based projects such as tooth extraction, periodontal scaling, and filling, if the historical price is low, the price can be appropriately increased.
(7) Strengthen the supervision and guidance of dental implant prices in private medical institutions. The prices of services such as dental implants in private medical institutions shall be adjusted by the market, and the pricing shall follow the principles of fairness, lawfulness, good faith and consistent quality and price, and proactively publicize the price level in obvious areas, and ensure the authenticity, timeliness, and integrity of the public information. . Private medical institutions should strictly regulate their own price behavior, and must not use false subsidies or low-price publicity and other price means to deceive and defraud patients. For private medical institutions in the region that have a high rate of collection and reporting of dental implants, a high rate of use of selected products, outstanding economic advantages in oral implant costs, and top evaluations, the local medical security bureaus will display prices and costs on their official websites. Provide medical guidance to patients.
Conventional planting service fees are mainly down, and the Medical Insurance Bureau also knows that public prices are more expensive, while private prices are already relatively low. Ordinary dental implants in public hospitals should be reduced in price with reference to private ones, but some difficult implants can still be distinguished from conventional ones. Reasonable guidance of patients can use dentures and other methods to repair missing teeth. It is also mentioned here that some traditional items such as tooth extraction can be appropriately increased in price. Strengthen the supervision of private institutions, and must not use false subsidies or low-cost publicity to attract patients. Private prices are subject to market regulation and will not be restricted.
3. Carefully organize the centralized procurement of dental implant consumables
(8) To form an inter-provincial procurement alliance for dental implant consumables. The Sichuan Provincial Medical Security Bureau led the establishment of an inter-provincial procurement alliance for dental implant consumables, and all provinces should participate. The centralized procurement of dental implant consumables adheres to the basic principle of integrating recruitment and procurement and linking volume and price. In accordance with the general idea of government organizations, alliance procurement, and platform operation, and fully considering the characteristics of dental implant consumables production, supply, and clinical use, guide Enterprises compete fairly. The specific procurement plan is formulated and implemented by the Sichuan Provincial Medical Security Bureau in conjunction with the medical security departments of the alliance provinces. The centralized procurement is based on a complete set of implant systems, including implants, restoration abutments, and accessories such as covering screws, healing abutments, transfer rods, and substitutes.
(9) Extensively mobilize medical institutions at all levels to participate. In principle, the number of medical institutions (including private individuals) participating in this centralized procurement in each overall planning area should account for more than 40% of the medical institutions providing dental implant services, or the proportion of the total reported demand in the region to the total actual use in the previous year. more than 50%. All localities extensively mobilize medical institutions with dental implant service capabilities within their jurisdictions, organize all public medical institutions (including military medical institutions) to participate in the centralized procurement of dental implant consumables, fully mobilize private medical institutions to participate, and clarify policy requirements to medical institutions, the masses Looking forward to the social responsibility of medical institutions, analyzing the changing trend of the industry pattern and patients’ medical behavior after centralized procurement, emphasizing relevant supporting and regulatory measures, etc., and guiding medical institutions to obtain development opportunities in the same frequency resonance with national advocacy and people’s expectations . If doctors from public medical institutions practice in multiple locations in private medical institutions and serve as the person in charge or the backbone of their business, the public medical institution shall urge them to participate in centralized procurement in a standardized manner. Medical institutions need to reply in writing to participate or not to participate in this collection, and to explain the reasons for not participating.
(10) Fill in the demand for implant procurement truthfully and accurately. Each province organized the public and private medical institutions participating in this centralized procurement to fill in the procurement requirements of dental implant consumables. The contents of the report include the actual purchase quantity and purchase demand of dental implant consumables of the unit in the previous year. In principle, the reported demand should not be lower than the actual purchase volume of the previous year, and at the same time, the factors that increase the demand for dental implants should be considered forward-looking, so as to ensure the accuracy and reasonableness of the reported volume, promote the better realization of the exchange of price with volume, and facilitate the selection of enterprises to ensure the supply. A differentiated price policy is implemented for public medical institutions that provide dental implant services but refuse to report the volume or the reported volume rate is less than 80% of the actual usage in the previous year. In regions, the actual charges of the above-mentioned public medical institutions shall not exceed 80% of the government-guided price; in areas where self-pricing management is implemented, the actual charges of the above-mentioned public medical institutions shall not exceed 80% of the average level of self-pricing by public medical institutions in the region.
Guide consumable manufacturers to compete fairly and enter centralized procurement, which basically includes the consumables needed for planting. All public medical institutions need to participate, and private medical institutions are mobilized to participate but not compulsory.
4. Implement comprehensive management of dental implant charges
(11) Explore the establishment of an abnormal price warning system for oral implants. Local medical security departments should establish an abnormal price warning system for oral implants on a prefecture-level basis, and list medical institutions at all levels and various types of medical institutions that report more price complaints, price significantly higher than the local average, and refuse or passively participate in the collection of dental implants. It will be included in the price abnormality warning list, and it will be publicly notified on the official website of the local medical security bureau every quarter. Medical institutions that have entered the warning list for many times during the year will be notified by the provincial medical security department; if the circumstances are serious, the National Medical Security Administration will uniformly expose them. For medical institutions listed on the price abnormality warning list, comprehensive use of monitoring and early warning, letter inquiries and interviews, reminders and warnings, cost investigations, information disclosure, public exposure and other regulatory means to promote the formation of a good market order; belong to public medical institutions, should Restrictive measures have been adopted in adjusting medical service prices and accepting declarations for new medical service price items.
(12) Continue to carry out special investigation and inspection of dental implant prices. In the start-up stage of the special governance (August 2022), in accordance with the principle of “horizontal to side, vertical to the bottom, and full coverage”, a comprehensive investigation and registration of dental implant charges and medical service prices will be carried out, laying a solid foundation for standardizing projects and prices and implementing centralized and volume-based procurement. Solid foundation. Investigate the clues of illegal charges found during the registration period and investigate and correct them in a timely manner. All localities should attach great importance to the special management of the prices and consumables of dental implants and other missing teeth restoration medical services, earnestly perform the industry-wide pharmaceutical service price management responsibilities, organize special forces, earnestly promote the implementation of various measures, and achieve full coverage of public and private medical institutions. It is necessary to implement the people-centered governance concept, strengthen the coordination of dental implant medical services and the centralized procurement of consumables, effectively reduce the inflated prices of dental implant medical services and consumables, and reduce the cost of the people.
Summary: Medical insurance promotes the centralized procurement of dental implant-related consumables, and there is no one-size-fits-all service price. The prices of dental implants and other services in private medical institutions are subject to market regulation.
1. Public dental implants are more expensive, and the price should be appropriately reduced. Public institutions generally use imported consumables. After centralized procurement, the price of domestic brands will drop. The more difficult implant surgery can reflect the higher price, and there is no limit to the death. It can still reflect its value for the more excellent experts to perform the difficult surgery. The price of general implant surgery in public hospitals will be reduced, and the price of public hospitals may be more reasonable.
2. The dental implant service has also added digital means, which can add price items. For planting, digitalization is indispensable, and this piece appropriately enhances the value. For tooth extraction items that are not related to dental implants, the historical price can be appropriately increased. Medical insurance does not want to completely limit the price of medical services. If it is reasonably high, it will be appropriately lowered, and if it is low, it can be raised.
3. The price of private institutions is not high, and it is specially stated that market regulation will be implemented and will not be restricted. However, it is necessary to strengthen supervision to avoid false propaganda. For private institutions with outstanding dental implant advantages, medical insurance provides patients with medical guidance on the official website, which reflects the support of the medical insurance bureau for good private institutions.
In the future, as the price of public hospitals drops, it is estimated that the queue phenomenon will be more serious, and the proportion of high-end dental implants will decrease. Small institutions that survive by marketing low-priced dental implants will have a harder time. Standard and excellent large-scale private institutions have a complete range of categories and will have better development.
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