There are more than 20 million rare disease groups in my country, and many patients face the embarrassment that they cannot afford medicines and treat their diseases for a long time. The last day of February every year is the International Rare Disease Day. On this occasion, the Illness Challenge Foundation and the Research Center for Health Economics and Medical Security of Nankai University jointly released the “Research Report on Inclusive Insurance Participating in Rare Disease Multi-level Security” (hereinafter referred to as “Report”), at the “Report” conference, guests from policy research, public welfare, insurance, pharmaceutical industry and other fields conducted in-depth discussions on improving the multi-level protection of rare diseases and how commercial insurance can participate in rare disease protection.
It is understood that the rare disease group is facing problems such as insufficient medical insurance coverage and high diagnosis and treatment costs, while the inclusive commercial supplementary health insurance (referred to as “inclusive insurance”) has a wide coverage of the disease-carrying population and the insured amount. high and low premiums. Some inclusive insurances that are more friendly to rare diseases, together with national and local rare disease protection policies, have become an important part of the multi-level protection of rare diseases, especially high-value rare diseases. In order to study how commercial insurance can fully supplement the shortage of rare disease payment, the Illness Challenge Foundation, together with Professor Zhu Minglai and his research team from the Center for Health Economics and Medical Security of Nankai University, jointly researched and released the “Report”. After a comprehensive review of 151 products across the country, an in-depth analysis and cost calculation of the rare disease protection content of inclusive insurance were conducted, aiming to build a rare disease “friendly” inclusive insurance evaluation index system and design for future inclusive insurance. Provide reference for rare disease protection, and make suggestions for decision-makers, commercial insurance institutions, and participants.
Guo Jinchuan, the chief author of the “Report” and the Information Research Director of the Pain Challenge Foundation, said that the “Report” has collected 151 inclusive insurance products on the market, covering 27 provinces and cities, and 4 nationwide Among them, 62 items cover the protection responsibility for rare diseases, and different reimbursement ratios are guaranteed through modes such as medical insurance catalogues, non-lists, special drug guarantees, and special guarantees for rare diseases. On the whole, inclusive insurance for rare diseases still has deficiencies in terms of protection strength, coverage, claim threshold, continuity, policy connection and medical treatment in other places, and needs to be further improved.
Professor Zhu Minglai, the chief author of the “Report” and director of the Center for Health Economics and Medical Security of Nankai University, elaborated on the results of this research in terms of cost analysis and evaluation indicators. He analyzed insurance practices and took Gaucher disease and other rare diseases with expensive drugs as an example. Due to the small number of patients, the average insurance cost borne by the insured is relatively low, and the impact on product sustainability is relatively weak; Even if people with a history of pre-existing diseases are allowed to participate in the insurance, taking “Beijing Inclusive Health Insurance” as an example, through actuarial technology in the design of insurance products, it can supplement the protection of rare disease groups, and at the same time, the cost pressure is small. Therefore, he believes that it is feasible for inclusive insurance to protect rare disease groups, and it can effectively use the law of large numbers to balance operational risks and effectively play the role of supplementary protection for rare diseases.
On this basis, the “Report” proposes a rare disease “friendly” inclusive insurance evaluation index system, which initially has two dimensions of security and sustainability, and has 23 more detailed indicators. After the calculation of 62 types of inclusive insurance covering rare diseases, a total of 35 types were rated as superior; this index system has important reference significance for future insurance design. Based on the above research, the “Report” puts forward suggestions such as giving priority to ensuring the stability of projects, optimizing protection responsibilities, improving the level of protection for rare diseases outside the medical insurance catalogue, removing restrictions on medical treatment in other places, and strengthening cooperation with pharmaceutical companies.
In addition, at the press conference, a number of guests from industry research, finance, insurance, big data management and other fields discussed the prospect of commercial insurance to protect rare diseases. Professor Su Fang, director of the Institute of Finance and Insurance of Shanghai University of Finance and Economics, conducted a theoretical analysis on the participation of inclusive insurance in multi-level protection of major and serious diseases; Liu Junshuai, member of the National Rare Disease Diagnosis and Protection Expert Committee, shared his rare participation in the combination of social security and commercial insurance. Thoughts on disease protection; Ma Tao, secretary general of the Illness Challenge Foundation, introduced the experience and innovative attempts of charitable forces participating in rare disease protection. Ma Tao said that not long ago, the negotiation and update of the National Medical Insurance Catalogue has increasingly shown the importance of rare disease groups. He expects to gather more forces from insurance, public welfare, pharmaceutical companies and other fields in the future to cooperate with the country’s various The guarantee policy escorts the rare disease group seeking medical treatment and medicine, so that the rare disease group has the confidence to move towards a better future. (Shi Xuan)
[Editor in charge: Li Ran]