With the development of Internet health care, the National Health Insurance Bureau has strengthened its guidance to local medical insurance departments, and supported local medical insurance departments to include qualified Internet diagnosis and treatment projects into the scope of medical insurance payment according to the fund affordability. It is the first time that medical insurance is included in the payer of internet medical insurance, which helps to expand the coverage of internet medical insurance and has historical significance. At the same time, the Internet health care into the medical insurance means that the last barrier of online payment “health insurance card” is about to break.
Previously, both medical services based on light consultation and Internet diagnosis and treatment based on return visit of common and chronic diseases were paid through self payment or commercial insurance. Only patients in some provinces (such as Guizhou) with deep poverty can be reimbursed for remote consultation, remote diagnosis and other expenses according to routine medical services, and the reimbursement ratio is between 70% and 85%.
First of all, Internet medicine can effectively improve the efficiency of medical resource allocation. On the basis of physical hospitals, medical institutions use Internet technology to provide safe and appropriate medical services and realize online and offline integration of medical treatment process. Taking the diagnosis and treatment of chronic diseases as an example, patients with chronic diseases can register online and conduct online medical activities such as follow-up visit of chronic diseases. After mastering the patient’s medical records, doctors can issue online prescriptions for some common and chronic diseases, and carry out online follow-up visits for some common and chronic diseases.
For hospitals, the new online mode can improve the outpatient work efficiency of hospitals and doctors, and bring convenience to patients. Hospitals have real needs; For doctors, doctors visit out-patient clinic for 2-3 days a week on average, and most of the patients with common and chronic diseases in the hospital. General doctors have the demand of income generation, and also have the ability and time to diagnose.
Secondly, Internet health will promote the business model reform of medical IT companies. Traditional medical IT enterprises obtain revenue from hospital orders through competitive bidding. Under the new mode of Internet hospital, medical IT enterprises apply for Internet hospital through cooperation with physical hospitals. Hospitals provide services and medical IT companies provide software systems. Relying on the service sharing of online diagnosis and treatment, the profit model is expanded from software implementation to diagnosis and treatment service sharing.
The launch of the new model brings new profit points, as well as technical and cost challenges. At present, the main profit point of Internet hospital platform construction is to collect system construction fees, but good progress has been made in the mode of relying on service flow Commission and cashing in the form of prescription outflow. At present, 94.7% of the prefectures and cities have the pilot and implementation of medical consortia, the number of diagnosis and treatment of grass-roots institutions is increasing, and the number of difficult and miscellaneous diseases undertaken by tertiary hospitals is not increasing. In the city to promote the medical group, the county medical community, telemedicine collaboration network, specialist alliance and other four Medical Union.
In July 2018, the Ministry of finance, together with the Health Commission, issued a subsidy of 2.33 billion yuan from the central government to improve the medical service capacity, and specially supported 832 national poverty-stricken counties to improve the clinical service capacity of county and township medical and health institutions. Among them, 670 million yuan was used to support 1664 primary medical and health institutions in 832 poverty-stricken counties to allocate telemedicine equipment, carry out telemedicine and other services, improve the ability and efficiency of primary medical services, and promote the construction of an orderly hierarchical diagnosis and treatment pattern.
At present, the development and Reform Commission and the health authorities are mainly responsible for the expenditure of capital construction, including information construction. By the end of 2018, provincial telemedicine platforms had been established in 19 provinces, covering more than 24000 medical institutions in all prefecture level cities and 1808 counties (county-level cities), including all national poverty-stricken counties. The construction of telemedicine platform and Internet hospital becomes the foundation of Internet Medical realization.
Internet medical insurance will benefit the following four types of computer companies. First, help offline hospitals establish platform operators for Internet hospitals; Second, regional health platform operators; Third, Internet enterprises providing medical consultation, insurance and other services; Fourth, government health insurance related information and service providers. It is suggested to focus on four representative companies: Weining health, Chuangye Huikang, Ping’an good doctor (Hong Kong stock) and Jiuyuan Yinhai.
With more and more regional and Internet diagnosis and treatment projects included in the medical insurance, under the trend of medical insurance as the main business insurance as the auxiliary, there is a large space for cooperation between medical informatization and insurance, and the cooperation direction includes hospital business insurance direct connection, direct payment platform, desensitization of medical big data, sales share of business insurance, etc. Therefore, internet medical and commercial insurance may become the two major areas of medical informatization to realize innovation. With the resonance of policies, information infrastructure improvement, data interconnection and other aspects, the realization of innovative business in the medical information industry has gradually ushered in an inflection point, and is optimistic about the in-depth layout in the internet medical field.