Why is the cost of PET-CT examination not included in medical insurance? Response from the National Medical Insurance Administration

2023-10-25

According to the official website of the National Medical Insurance Bureau, in its response to Recommendation No. 3342 of the First Session of the 14th National People's Congress, the National Medical Insurance Bureau stated that the examination fees for medical items such as PET-CT are generally high, and it needs to be fully demonstrated to include them in the national medical insurance, especially in the Class A reimbursement directory. According to the Notice on Issuing Opinions on the Management of Basic Medical Insurance Diagnosis and Treatment Projects, Scope of Medical Service Facilities, and Payment Standards for Urban Employees jointly formulated by the original Ministry of Labor and Social Security (Labor and Social Security Ministry [1999] No. 22), inspection and treatment projects conducted using large medical equipment such as positron emission tomography (PET) and electron beam CT are not within the scope of basic medical insurance payment. The National Medical Insurance Administration stated that China's basic medical insurance payment management adheres to the development concept of putting the people at the center and the functional positioning of "basic insurance", effectively ensuring the reasonable treatment needs of insured personnel. It is necessary to do our best and act according to our abilities. Considering that China is still in the primary stage of socialism and the overall level of medical insurance financing is not high, the per capita funding level of medical insurance for urban and rural residents in 2022 is only 960 yuan, and the guarantee capacity is very limited. The basic medical insurance system is mainly based on providing basic medical security for the people. The cost of medical examination such as PET-CT is generally high, and its inclusion in the national medical insurance, especially in the category A reimbursement directory, still needs to be fully demonstrated. Next, with the development of China's economy and society, medical insurance, finance and other departments will timely summarize, evaluate, adjust and improve the existing management methods for basic medical insurance diagnosis and treatment projects based on the affordability of medical insurance funds and the progress of clinical medical technology. Qualified medical projects will be included in the medical insurance payment scope according to procedures, further reducing the burden of medical expenses on the public. Reporter: Qiao Yeqiong (Xinhua News Agency)

Edit:GuoGuo    Responsible editor:FangZhiYou

Source:people.cn

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