China plans to develop a points-based credit system for healthcare professionals who are certified to process medical insurance funds to curb the misuse of funds and strengthen punishment for violators, according to a guideline released recently.
Similar to the nation's point system for driving licences, the new system will target relevant staff members at insurance-designated medical institutions as well as owners of pharmacies, according to the guideline jointly released by the National Healthcare Security Administration, the National Health Commission and the National Medical Products Administration on 27 September, reported the newspaper China Daily.
Workers who are found to have engaged in dishonest behaviour will see deductions of points. They can lose one to three points for minor offences, while the most severe violations will result in a loss of 10 to 12 points.
Those who lose nine to 11 points in a year will see their insurance payment certifications suspended for one to six months, which also means that patients who use healthcare services and medications prescribed by them — except for first aid and emergency care services — will not be reimbursed for the amount they spent on these services.
An accumulation of 12 deducted points will lead to revocation of their eligibility to work as certified insurance agents. Also, they will not be allowed to apply for the qualification again for one to three consecutive years, depending on specific conditions. The report did not mention whether criminal charges would be brought against those who commit fraud.
Information on certification suspensions or revocations will be shared nationwide.
Despite the nation's intensified oversight over healthcare insurance funds in recent years, irregular and illegal use of insurance funds remains rampant.
Mr Gu Rong, head of the National Healthcare Security Administration's fund supervision department, said that at present, supervision is carried out over medical institutions rather than individuals who work there.
He said that extending the regulatory scope from designated medical institutions to all healthcare personnel and pharmacy managers is expected to enhance oversight and increase deterrence.
He added that the authorities would consider monitoring healthcare professionals and workers, including applying the points system to them as individuals.
The administration has carried out unannounced inspections at 500 insurance-designated medical institutions across the nation. These inspections have led to the discovery of CNY2.21bn ($344m) of misused insurance funds. From January to August, healthcare fund regulators nationwide recovered CNY13.66bn of ill-gotten insurance funds.