China Implements Credit System for Medical Personnel Handling Insurance Funds

In a move to strengthen supervision and combat misuse of medical insurance funds, China has implemented a credit system for hospital and pharmacy personnel certified to process these funds. The new system, outlined in a guideline jointly released by the National Healthcare Security Administration, National Health Commission, and National Medical Products Administration, will subject designated medical professionals and pharmacy owners to enhanced oversight.

Similar to the nation's point-based credit systems for driver's licenses, personnel engaging in dishonest or illegal behaviors will face point deductions. Minor offenses will result in deductions of one to three points, while severe violations will lead to deductions of 10 to 12 points.

Accumulating nine point deductions within a year will lead to a suspension of insurance payment eligibility for one to six months. This means that healthcare services prescribed by these individuals, except for first aid and emergency care, will not be eligible for reimbursement.

For those who accumulate 12 point deductions in a year, their insurance payment eligibility will be suspended, and they will be barred from reapplying for one year or three consecutive years, depending on the specific circumstances.

Officials at the National Healthcare Security Administration acknowledge that despite strengthened supervision in recent years, misuse of medical insurance funds remains a significant issue. The new credit system aims to increase penalties for violators and effectively curb such misuse.