医保医用耗材分类优化
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历史首次实现全国编码统一!7类医保医用耗材分类优化,助力价格纠偏
Mei Ri Jing Ji Xin Wen· 2025-09-15 14:09
Core Viewpoint - The National Medical Insurance Administration (NMIA) has optimized the classification of medical consumables, enhancing the standardization and precision of medical insurance management in China [1][5]. Group 1: Classification Optimization - The optimization focuses on seven categories of medical consumables, including vascular intervention stents and balloons, non-vascular intervention stents and balloons, anastomosis devices, artificial organs, and implantable cardiac rhythm management devices [1][5]. - The new classification aims to objectively reflect the functional characteristics of various consumables, addressing issues related to identification, differentiation, and management [1][3]. Group 2: Coding and Price Monitoring - The classification is based on the registration information from the medical device regulatory authority, grouping consumables with similar clinical uses and structures under the same category [2]. - The introduction of unified coding for medical consumables allows for precise price monitoring, helping to identify and correct unfair pricing practices [2][4]. Group 3: Support for Innovation and Clinical Needs - The revised classification supports innovation by adding new categories for products already registered with the regulatory authority but lacking appropriate classification in the medical insurance database [4]. - The optimization aligns with clinical needs, facilitating better management and application of medical consumables, particularly in areas with significant differences in clinical use and insurance payment values [4][3]. Group 4: Implementation and Impact - This revision marks the first nationwide implementation of unified coding for medical consumables, with the new database already operational in regions like Shanghai [5]. - The optimization is expected to enhance data-driven decision-making in medical insurance management, addressing questions related to affordability and value [3].
我国已完成7类医保医用耗材分类优化工作
Yang Shi Xin Wen· 2025-09-15 01:16
Core Viewpoint - The National Healthcare Security Administration (NHSA) of China has completed the classification optimization of seven categories of medical consumables, aiming to address issues related to identification, differentiation, and management, thereby enhancing the standardization and precision of medical insurance management [1][2]. Group 1: Classification Optimization - The classification optimization includes seven categories of medical consumables: vascular interventional stents, vascular interventional balloons, non-vascular interventional stents, non-vascular interventional balloons, surgical staplers, artificial organs, and implantable cardiac rhythm management devices [1]. - The optimization addresses the long-standing issue of inconsistent naming standards for medical consumables, which has complicated precise payment and fund supervision in medical insurance [1]. Group 2: Innovation and Industry Development - The classification adjustment supports innovation, exemplified by the separate categorization of leadless cardiac pacemakers, which represent a revolutionary technology in cardiac pacing, offering advantages such as minimally invasive implantation without incisions or leads [1]. - This adjustment provides more options for patients with traditional pacemakers who face complications such as multiple infections or lack of upper vena cava access [1]. Group 3: Implementation and Standardization - Under the guidance of the NHSA, regions like Shanghai have already implemented a new database for the seven categories of medical consumables, with other provinces accelerating their application of the new database [2]. - The establishment of a unified coding system for medical consumables is expected to standardize medical insurance business coding, data norms, and service processes, facilitating code-based bidding, procurement, and settlement [2].