NATIONAL HEALTHCARE SECURITY ADMINISTRATION: DENTAL IMPLANTS ARE NOT CONSIDERED IN MEDICAL INSURANCE COVERAGE FOR THE TIME BEING

The National Healthcare Security Administration has recently issued the Reply to Proposal No. 6184 of the Fifth Session of the 13th National People’s Congress regarding the inclusion of dental implants in medical insurance coverage. The National Healthcare Security Administration mentioned that the current basic medical insurance system of China focuses on meeting the basic medical needs of the insured, and as dental implantology represents a medical need on a higher level, dental implants are not considered in medical insurance coverage for the time being.

The National Healthcare Security Administration mentioned that the state highly values strengthening the management of oral diagnosis and treatment services and improving the standardization of stomatology diagnosis and treatment. The National Health Commission has been actively advancing the clinical key specialty construction of stomatology in recent years to improve the diagnosis and treatment level and has organized the development and revision of related diagnosis and treatment guidelines, technical operation specifications, etc. The National Health Commission has also continued to improve stomatology quality control systems, strengthen the construction of quality control centers at different levels, advance the quality control evaluation work and improve the stomatology diagnosis and treatment quality level. The National Health Commission will keep on increasing efforts and organizing the development and revision of oral diagnosis and treatment specifications for dental implantology, etc. and work with related departments to strengthen regulation over stomatological medical institutions to further standardize their diagnosis and treatment activities.

With the improvement of living standards and the deepening of the aging degree, the costs of chipped tooth repair services such as dental implantology have become a new pain point for patients. In response to patients’ call for accessing high-quality, efficient and affordable chipped tooth repair services, the National Healthcare Security Administration has guided the Sichuan Provincial Healthcare Security Administration to conduct a great deal of survey and research work, basically grasped the clinical use characteristics, price levels and market competition pattern of dental implantology consumables as well as the composition of related medical service charges, and sought opinions from related experts, medical institutions and industry associations, to form a preliminary idea and solution for centralized volume-based procurement.

Regarding the inclusion of dental implants in medical insurance coverage, the National Healthcare Security Administration mentioned that the method of exclusion is currently adopted at the state level to stipulate the scope of medical service items in the basic medical insurance not to be reimbursed or to be partially reimbursed, and currently, basic chipped tooth repair services for fixed dentures and removable dentures do not fall within the coverage of the medial insurance fund. Furthermore, China’s basic medical insurance system currently is still based on the functional positioning of “basic insurance” to meet the basic medical needs of people insured. Dental implantology, compared to fixed dentures and removable dentures, represents a medical need on a higher level, and the inclusion of it in medical insurance reimbursement is neither in line with the positioning of “basic insurance” nor the principles of fairness and reasonableness and related requirements of the list of medical insurance benefits. Therefore, it is still impossible to include dental implants in medical insurance coverage for the time being from the perspectives of the overall development situation of the medical insurance system at present, the disease treatment needs of people, and the funding level and anti-risk capacity of the medical insurance fund.

According to the National Healthcare Security Administration, in the future, China will establish a sound medical insurance access management system for medical consumables, gradually improve the medical insurance payment management of medical consumables, and timely include eligible medical consumables and medical service items in medical insurance coverage, to better meet patients’ medical needs.

Disclaimer: This article is sourced from the Internet.