Chinese medical insurance is now seeking to advance. One of the biggest changes is the provincial medical reimbursement ratio complies with national medical insurance ratio. Liu Ye, a partner of a clinic in Hangzhou, disagreed with this action. He gave an example, if the prices of drugs bought by clinics from the market exceed the ones specified by the medical insurance system, the clinics will have to sustain losses when selling them to patients.
For this “money loss” phenomenon, Zhu Minglai, the director of the Center for Health Economics and Medical Insurance of Nankai University, explained, “After being admitted to the national medical insurance system, a clinic will be subject to limitations, such as proportion of medicines, drug specification, medical expenses, etc. All of these aspects are clearly specified.” Generally, the clinics’ independent pricing power will be relatively limited.
Their discontents are reasonable. The rate of international student health insurance (aka 留学生保险), U.S. dental insurance (aka 美国牙医保险), and U.S. vision insurance (aka 美国眼科保险) are written by colleges individually, since the policy and laws in different states are different. Another example is the U.S. travel insurance (aka 美国旅游保险). The need of having such insurance in some states are mandatory while others are not.
The surgical clinic invested and operated by Dr. Smile Medical Group did not apply for the permission. The medical insurance reimbursement systems in most cities “value inpatient treatment, belittle outpatient service”, and therefore only inpatient treatment can be reimbursed. However, a day surgery model has been used in the surgical clinic of Dr. Smile Medical Group. “We hope that patients can be treated without hospitalization. This is the future healthcare trend and may not be in line with the current policy of medical insurance reimbursement.” Zhang Qiang, the founder of Dr. Smile Medical Group, said.
In general, clinics in large cities have a pretty ambiguous attitude towards medical insurance: to be part of medical insurance can improve their operation, but without it, they can be more independent. It sheds light on a reality: nothing can be utterly perfect. For example, colleges compelling students to purchase health insurance oftentimes cover the HPV vaccine (aka hpv疫苗). Students cannot reject to buy. Schools allowing to waive health insurance (aka 替换保险) give students more freedom, yet the alternative health insurance plan students buy from a third party may not 100% cover the vaccine.
For many clinics at the grassroots level, inclusion in the national medical insurance system may be equivalent to having a “permit” for serving a large number of grassroots patients. Patients with medical insurance will choose to go to these clinics for minor illnesses treatment, and the clinics are thus enabled to serve more patients.