China plans credit system to curb medical insurance misuse

China issued a guideline on Friday on developing a credit system for hospital and pharmacy personnel certified to process medical insurance funds in order to strengthen supervision.

Enhanced oversight will be carried out over related staff members at insurance-designated medical institutions, that is, medical professionals at hospitals providing services for the insured as well as owners of pharmacies, according to the guideline jointly released by the National Healthcare Security Administration, National Health Commission and National Medical Products Administration.

Similar to the nation's point-based credit systems related to driver's licenses, personnel who are found to commit dishonest or illegal behaviors will have their points deducted.

Minor offenses will lead to deductions of one to three points, and the most severe violations will result in 10 to 12 deducted points.

Those who accumulate nine point deductions in a year will see their insurance payment eligibility halted for one to six months, which means that healthcare services prescribed by them — except for first aid and emergency care services — will not be eligible for reimbursement.

Those who collect 12 point deductions in a year will have their insurance payment eligibility suspended and they will not be allowed to apply for eligibility again for one year or three consecutive years, depending on specific conditions.

Officials at the National Healthcare Security Administration said that misuse of medical insurance funds remains severe despite strengthened supervision over past years.

The new mechanism is aimed at increasing punishment for violators and effectively curb misuse of medical insurance funds.