Notice of the State Medical Insurance Bureau on carrying out special treatment of dental implant medical service charges and consumables prices

Medical insurance [2022] No.27

All provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps Medical Security Bureau:

In order to implement the decision-making arrangements of the CPC Central Committee and the State Council, ensure the people to obtain high-quality, efficient and affordable dental restoration services, meet the people’s yearning for a better life, and promote the healthy and orderly development of the dental implant industry, according to the nine ministries and commissions jointly issued "In 2022, the main points of correcting unhealthy trends in the field of medicine purchase and sale and medical services were required, and the special treatment of dental implant prices covering public and private medical institutions was carried out. The relevant work requirements are hereby notified as follows:

First, standardize the charging methods of dental implant medical services and consumables

(A) the orderly promotion of dental implant medical services"Separation of technology and consumption".Public medical institutions provide dental implant medical services, mainly byThe charging method of "service items+special consumables" is priced separately. That is, the implant implantation fee is priced separately from the system price of implant consumables; The crown placement fee is priced separately from the price of the crown product; The cost of bone grafting operation is priced separately from the price of bone powder and periosteum. For the current situation that consumables are charged in the medical service price item, when "separation of technology and consumption" is implemented, the item price should be lowered simultaneously by deducting the average online purchase price of related consumables.

(2) Improve the price formation mechanism of dental implant crowns.Sichuan Medical Insurance Bureau organized bidding for clinical mainstream all-ceramic crowns in the province, and hung the net according to the sunshine transparent price formed by competition, and other materials were hung with reference to the price of all-ceramic crowns. The National Health Insurance Bureau guides other provinces to implement price linkage. Public medical institutions choose independently according to clinical needs, according to the price of hanging nets."Zero difference rate" sales. The price of dental crowns produced by a third-party factory includes the cost of returning to the factory for adjustment during the planting process, and no additional fees may be charged to patients. If the public medical institutions process and manufacture dental implant crowns by themselves, the price formation mechanism of "productization" shall be adopted. Based on the material cost and processing service, the medical institutions shall independently determine the price and hang the net according to an appropriate cost recovery rate, and keep the price comparison relationship with the competitive hanging net crown in a reasonable range. The specific operations of making dental implant crowns, such as over-mold finishing, scanning design, printing and cutting, sintering and glazing, and color change, will not be included in the price of dental implant crowns as cost elements.

(3) Standardize and integrate oral implant price items.according toThe basic principle of "output-oriented" is to integrate the medical service price items involved in dental implantation. Among them, the design, preparation and operation of the first-stage implantation operation (implant implantation) and the second-stage operation (placing the healing abutment) are merged into the implant implantation project; Dental crown placement services, including impression preparation, recording and transfer of jaw position relationship, installation of abutment and dental crown, debugging and modification, etc., are merged into dental crown placement projects of implants; Independent medical service price items are set for services such as bone grafting surgery, soft tissue repair, implant repair and removal. For complex implant operations such as total dental arch restoration and craniofacial implantation, differences can be reflected in the price items of medical services. In order to ensure the accuracy of missing teeth restoration, medical institutions use various inspection methods such as medical imaging, digital technology and artificial intelligence to construct virtual 3D models, make lesion models or surgical guide plates, and set up corresponding medical service price items according to service output. The specific guidelines for the establishment of the price project of dental implant medical services shall be issued separately by the State Medical Insurance Bureau. The provincial medical security departments should issue a document to standardize and integrate local price items before the end of November 2022.

Two, strengthen the price control of medical services such as dental implants.

(4) Do a good job in price control around the whole process of dental implant.Medical security departments at all levels should focus on the medical service price of a single conventional dental implant, in accordance with theThe medical service price of "check-up+implant placement+crown placement" shall be adjusted as a whole (see the annex for details). At present, the whole process of planting is completed in the third-level public medical institutions, and the overall medical service price is generally higher than 4,500 yuan per pill. Targeted measures should be taken to introduce it into a new range where the overall price does not exceed 4,500 yuan per pill, and the adjustment targets of public medical institutions below the third-level shall be reduced accordingly with reference to the local policy of graded pricing of medical services. Encourage qualified areas to further take measures such as negotiation, cost supervision and examination to reduce prices within the scope of control objectives, and further expand the control effect to benefit the masses. At present, the overall price of medical services has been generally lower than 4500 yuan per piece, and it is encouraged to maintain the current low price. Allow economically developed areas with high labor costs to relax the price control target of medical services according to local conditions, with the relaxation ratio not exceeding 20%; Encourage local medical institutions under certain circumstances such as high success rate of oral implant to explore the overall price control policy of oral implant medical services (see annex for details). The provincial medical security departments combined with the overall regulation requirements of medical service prices, as well as the results of centralized mining of implants and bidding for dental crowns, formulated and publicized the whole process price regulation targets (including implants, dental crowns and medical services) of dental implants in the region, and adopted targeted implementation measures.

(five) to strengthen the policy guidance for the price of oral medical services in public medical institutions.The cost of implant placement, crown placement and bone grafting surgery, which are strongly reflected by the masses and have a heavy burden, is mainly reduced. Among them, if the government-guided price of public medical institutions is significantly higher than the average price of private medical institutions in the region, it is necessary to adhere to the principle of public welfare, conduct special argumentation and focus on price reduction; If the independent pricing of public medical institutions varies greatly between hospitals, it is necessary to urge the medical institutions with the highest price order and significantly higher than the average level to take the initiative to adjust back, and give play to the reference and anchoring role of public medical institutions’ public welfare prices in the market. Projects with great technical difficulties and high risks, such as total dental arch restoration and implantation, craniofacial implantation and complex bone grafting, are allowed to open an appropriate gap with the price of conventional dental implant surgery. The price of medical services for other denture restoration methods such as fixed denture and removable denture remains relatively stable, and medical institutions are encouraged to give priority to providing patients with appropriate denture restoration services. For projects with technical services such as tooth extraction, periodontal scaling and tooth filling, the historical price is low, and the price can be appropriately increased. In areas where the oral implant project of public medical institutions is subject to government-guided price management, the provincial medical security departments shouldRe-formulate and announce the government guidance price before the end of December 2022. In areas where independent pricing is implemented, the medical security department shall, in accordance with the whole process of medical service price regulation and control objectives, organize all medical institutions to re-announce prices within one month after the local release and implementation of new price items, so as to make the price level match the hospital level, professional status and functional orientation, and regularly publish the average level of independent pricing of public medical institutions in the region.

(six) to strengthen the supervision and guidance of oral implant prices in private medical institutions.The prices of dental implants and other services in private medical institutions shall be regulated by the market, and the pricing shall follow the principles of fairness, legality, honesty and credibility, and the consistency of quality and price. Compared with public medical institutions in the region, reasonable prices shall be formulated in line with the laws of market competition and the expectations of the masses, and the prices shall be publicized in obvious areas voluntarily according to regulations, and the authenticity, timeliness and integrity of the publicity information shall be guaranteed. Private medical institutions should strictly regulate their own price behavior, and should not use false or misleading.Price means such as "subsidy" and "low price" induce fraudulent patients. For private medical institutions in the region with high reported rate of dental implants, high utilization rate of selected products, active commitment to accept the whole price process regulation, outstanding economic advantages of dental implant expenses and high evaluation ranking, medical security departments at all levels will display the price and expenses on the official website, provide guidance for patients to seek medical treatment, and publicly expose those with high prices who use "introduction fee" and "benefit fee" to buy and sell tourist drainage.

Third, carefully organize and carry out centralized procurement of dental implant consumables

(7) Establish an inter-provincial procurement alliance for dental implant consumables.An inter-provincial procurement alliance for dental implant consumables was established under the leadership of Sichuan Medical Insurance Bureau, and all provinces should participate. The centralized procurement of dental implant consumables adheres to the basic principle of integrating recruitment with procurement and linking quantity with price. According to the general idea of government organization, alliance procurement and platform operation, the complete implant system is taken as a unit (including implants, restoration abutments, covering screws, healing abutments, transfer rods, substitutes and other accessories), and the characteristics of production, supply and clinical use of dental implant consumables are fully considered to guide enterprises to compete fairly. The specific procurement plan is formulated and implemented by the Sichuan Provincial Medical Security Bureau in conjunction with the medical security departments of the allied provinces.

(eight) widely mobilize all kinds of medical institutions at all levels to participate.In principle, the number of medical institutions (including private ones) participating in this centralized mining in all areas should account for the proportion of medical institutions that carry out dental implant services.More than 40%, or the total demand submitted by the region accounted for more than 50% of the total actual use in the previous year. Medical security departments at all levels have widely mobilized medical institutions with dental implant services within their jurisdiction, organized all public medical institutions (including military medical institutions) to participate in the centralized procurement of dental implant consumables, and fully mobilized private medical institutions to take the initiative. The provincial medical security departments where the headquarters of the large dental medical service chain group is located should take the initiative and focus on coordinating the chain (holding and branch) medical institutions of the group to participate in the centralized procurement of implants and implement the successful results. It is necessary to explain the policy requirements, people’s expectations and social responsibilities of medical institutions to medical institutions, analyze the changing trend of industry pattern and patients’ medical treatment behavior after centralized procurement, emphasize relevant supporting and regulatory measures, and guide medical institutions to gain development opportunities in resonance with the national advocacy and people’s expectations. Doctors in public medical institutions practice more in private medical institutions, and as the person in charge or the backbone of the business, the public medical institutions should urge them to standardize their participation in centralized procurement. Please ask the medical institution to confirm in writing whether to participate or not to participate in this centralized procurement.

(nine) truthfully and accurately fill in the implant purchase demand.The provincial medical security departments respectively organized public and private medical institutions in the province to fill in the procurement requirements of dental implant consumables. The contents to be filled in include the actual purchase quantity, purchase demand and the number of dental chairs providing dental implant services in the last year. In principle, the reported demand shall not be lower than the actual purchase volume of the previous year, and at the same time, the factors of increasing demand for dental implants shall be considered prospectively, so as to ensure the accuracy and rationality of the reported demand, promote the better realization of price exchange by quantity, and facilitate the successful enterprises to ensure supply. Alliance areas can publicize the results of reporting by medical institutions in the region in an appropriate way, accept social supervision, and refuse to report the amount of dental implant services or the reporting rate is less than the actual use in the previous year.80% of public medical institutions implement differentiated price policies. Among them, in areas where government-guided price management is implemented for implant implantation and crown implantation, the actual fees of the above public medical institutions shall not exceed 80% of the government-guided price; In areas where independent pricing management is implemented, the actual charges of the above-mentioned public medical institutions shall not exceed 80% of the average level of independent pricing of public medical institutions in the region.

Four, the implementation of comprehensive management of oral implant fees

(ten) to explore the establishment of an abnormal price warning system for oral implants.The provincial medical security departments should establish an abnormal price warning system for dental implants on a city-by-city basis, and include all kinds of medical institutions at all levels that have more price complaints and reports, the pricing is obviously higher than the local average level, refuse or passively participate in dental implant collection, fabricate facts to derogate from the units involved in centralized procurement and the selected products, and do not cooperate with the regulation and control work to maintain false high prices in the price warning list, and make them public on the official website of the local medical security department every quarter. Medical institutions that have entered the warning list many times during the year will be notified by the provincial medical security department. If the circumstances are bad, it will be uniformly exposed by the National Health Insurance Bureau. For medical institutions listed in the warning list of abnormal prices, comprehensive monitoring and early warning, letters and interviews, reminders and warnings, cost investigation, information disclosure and public exposure are used to promote the formation of a good market order. If it belongs to a public medical institution, it shall treat with caution the declared items such as adjusting the medical service price and adding new medical service price items, and take binding measures when necessary.

(eleven) to carry out the investigation and inspection of the price of oral implant in the province.Special governance start-up stage (August 2022), in accordance with the principle of "horizontal to the edge, vertical to the end, full coverage", comprehensively carry out the investigation and registration of dental implant fees and medical service prices, laying a solid foundation for standardizing projects and prices and implementing centralized procurement with quantity. Investigate and correct the illegal charging clues found during the registration period. In the implementation stage of special treatment (December 2022-March 2023), medical security departments at all levels should focus on monitoring, pay close attention to the implementation of the price of dental implant medical services in various medical institutions at all levels and the actual procurement of dental implants and other consumables, as well as the changes of key indicators such as dental implant consumables, dental implant surgery price and patient’s average cost, to ensure the implementation of various treatment measures, and the provincial medical security departments should report to the National Medical Security Bureau on a provincial basis. In the "looking back" stage of special treatment (the provinces will choose the appropriate time period in the second half of 2023), the medical security departments at all levels, together with relevant departments, will focus on the medical institutions with the highest price ranking in the region, many complaints and reports from the masses, refusing to participate in the dental implant collection or concealing the reported amount. During the inspection, they will find illegal clues such as repeated charges, price fraud and false propaganda, as well as unreasonable and irregular inspection and diagnosis behaviors in the process of providing dental implant medical services, and report them to the industry in time. The National Health Insurance Bureau will organize supervision and cross-examination in due course.

(twelve) earnestly perform the duties of the whole industry of pharmaceutical price management.Medical security departments at all levels should attach great importance to the special treatment of dental implant and other dental restoration medical service prices and consumables, earnestly perform the duties of medical price management in the whole industry, organize special forces, conscientiously promote the implementation of various measures, achieve full coverage of public and private medical institutions, and form a long-term treatment effect. It is necessary to implement the people-centered ruling concept, strengthen the coordination between the price control of dental implant medical services and the centralized procurement of consumables, effectively reduce the inflated prices of dental implant medical services and consumables, reduce the burden of people’s expenses, and guide medical institutions to develop healthily through orderly competition such as transparent prices, quality services, standardized management and good reputation.

I hereby inform you.

Some situations in which the annex allows to relax the overall control target of medical service price

National Healthcare Security Administration (NHSA)

September 6, 2022