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Make children with leukemia manageable and affordable

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  • Source: Dongyang Information Network

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    Children with leukemia have a long treatment cycle, great difficulty, and high technical requirements, and the burden of medical expenses on patients' families is heavier.

    In this regard, on the one hand, China strongly supports the construction of pediatrics in children's specialty hospitals and general hospitals. Through the joint construction of specialists, business guidance, telemedicine, and "moving experts with children" and other management methods, it has improved the access to quality medical services for children with leukemia. Accessibility.

    On the other hand, we will increase the policy focus on children with difficult leukemia, actively promote the development and production of new anti-tumor drugs commonly used in children with leukemia, and negotiate prices, and encourage social charity to reduce the burden on children's families.

    At the Children's Hospital of Anhui Province, Xiaoma, a child with leukemia from Shucheng County of Lu'an City, recently completed her last chemotherapy. Two years ago, he was diagnosed with acute lymphoblastic leukemia. During the hospitalization, the total cost was about 250,000 yuan. His parents are disabled, the family is poor, and the heavy medical expenses make the family frown. After medical insurance reimbursement and assistance from social charity funds, the final personal outlay was only about 50,000 yuan.

    In recent years, the Party Central Committee and the State Council have attached great importance to the comprehensive protection of major diseases such as childhood leukemia. Localities continue to improve the system of designated diagnosis and treatment services, increase the strength of drug supply security, improve the level of comprehensive medical security, and strive to provide medical treatment for children with leukemia.

    Establish a diagnosis and treatment network

    Open the "Chinese Children's Leukemia Diagnosis and Treatment Registration Management System", and each child's personal information, diagnostic data, survival status, cost information, etc. can be seen at a glance. As of July 3, 34,995 cases of newly diagnosed childhood leukemia in 425 children's leukemia diagnosis and treatment designated hospitals nationwide were fully integrated into the system management.

    Children with leukemia have a long treatment cycle, great difficulty, and high technical requirements, and the burden of medical expenses on patients' families is heavier. Only by vigorously promoting standardized diagnosis and treatment can we obtain good curative effects, reduce toxic and side effects, reduce medical expenses, and then improve the overall level of diagnosis and treatment of childhood leukemia in China.

    In recent years, China has strongly supported the construction of pediatrics in children's specialty hospitals and general hospitals, and promoted the optimization of the allocation of pediatric medical resources. Actively improve the conditions of local children's medical and health services, and effectively improve the ability and level of pediatric diagnosis and treatment. At the same time, through the implementation of comprehensive measures to encourage taxation of social forces to organize pediatric medical institutions, including tax reduction and exemption, and simplified approval procedures, the supply of pediatric medical services has been increased. As of the end of 2018, there were 228 children's hospitals across the country and more than 20,000 hospitals with pediatric medical services.

    In August 2018, the National Health and Medical Commission and other departments issued the "Notice on Carrying Out the Management of Childhood Leukemia" and proposed the establishment of a diagnosis and treatment network that includes provincial designated hospitals and prefecture-level designated hospitals. At the same time, clarify the division of responsibilities between national children's medical centers, provincial and prefecture-level designated hospitals, and strengthen the graded diagnosis and treatment system for children with leukemia and the graded guidance and assistance system. Three member units of the National Children's Medical Center (Beijing Children's Hospital, Fudan University Affiliated Pediatric Hospital, Shanghai Children's Medical Center), Guangzhou Women's and Children's Medical Center, and Wuhan Children's Hospital led the establishment of a pediatric medical group or specialist alliance, covering more than 90% of the country Children's Medical Services Resources. Through the joint construction of specialists, business guidance, telemedicine, and the management of "patients who do not move experts" and other management methods, children with leukemia have access to quality medical services nearby. At present, at least one medical institution in all provinces (except Tibet) has the ability to standardize the diagnosis and treatment of childhood leukemia.

    On October 20, 2018, the "Chinese Childhood Leukemia Diagnosis and Treatment Registration Management System" was officially launched. Through the promotion of standardized diagnosis and treatment programs, the level of homogeneous treatment of children with leukemia has been continuously improved.

    Shanghai Children's Medical Center, as the unit responsible for the registration and management system for the diagnosis and treatment of childhood leukemia, is fully responsible for the data quality control of the registration system, the preparation of data analysis reports, and the coordination of data applications. The establishment of this system will help government departments understand the incidence and survival of childhood leukemia in China, provide evidence-based references for improving the diagnosis and treatment of childhood leukemia, and provide objective evidence for health policies such as medical security.

    Subsequently, the National Health and Medical Commission organized the formulation of the diagnosis and treatment of acute lymphoblastic leukemia and acute promyelocytic leukemia, and trained key experts and medical staff in designated hospitals nationwide through video conference calls. At the same time, the National Leukemia Expert Committee for Children's Leukemia was established, and a children's leukemia diagnosis and treatment registration management system covering all designated hospitals was established, and the treatment of children was included in the whole process tracking management. The expert committee evaluates the quality of diagnosis and treatment information and guides designated hospitals in various places to provide standardized diagnosis and treatment services.

    Weaving a security net

    Xiao Xiao, a child from Xiaopo Village, Longwang Township, Funan County, Fuyang City, Anhui Province, was diagnosed with acute lymphoblastic leukemia in October 2017 due to pale skin, fever, and cough. The child's family is in poverty and can enjoy the special medical insurance policy for the poor in Anhui Province, that is, the maximum deductible for treating individuals in county, city, and provincial medical institutions is 3,000 yuan, 5,000 yuan, and 10,000 yuan, respectively. At the Children's Hospital of Anhui Province, the child was given 10 courses of chemotherapy and paid only 10,000 yuan per year. At present, the child is recovering well and is undergoing maintenance treatment.

    Childhood leukemia is the most common malignant tumor in childhood. It is mainly divided into acute leukemia, chronic leukemia, and myelodysplastic syndrome. The treatment of childhood leukemia is mainly multi-drug combined chemotherapy, including high-intensity combined chemotherapy and maintenance treatment. The course of treatment is generally 2-3 years.

    In recent years, China has increased its policy on children with difficult leukemia. Encourage localities to implement payment by disease for children with leukemia, provide subsidies for children with impoverished leukemia and family insurance, and reduce the payment threshold, increase the reimbursement ratio and the maximum payment limit, and appropriately increase medical treatment for eligible children with leukemia and other major diseases Relief and other preferential policies. Bring together the strength of various medical security policies, strengthen the convergence of various security systems, actively explore and promote commercial supplementary insurance, mobilize social charity forces, and take comprehensive security measures. At the same time, streamline and optimize the settlement and reimbursement process for childhood leukemia, and actively promote "one-stop" settlement services such as basic medical insurance, critical illness insurance, and medical assistance. For qualified and difficult patients, the system of “first diagnosis and treatment followed by payment” is implemented to alleviate advancement pressure .

    China is also actively promoting the development, production and price negotiation of new anti-tumor drugs commonly used in children with leukemia. Establish a major new drug creation technology major project to support the development of new leukemia drugs, and accelerate the launch of generic drugs such as imatinib mesylate and dasatinib. In the national negotiations on the price of imported drugs, the price of imported drugs has been effectively reduced, and the burden on patients and medical insurance has been reduced. At the same time, we will ensure the supply of essential medicines, increase the management of the distribution of medicines, reduce the price of medicines through unified bidding and procurement, and improve the medicine supply guarantee system.

    Provide a rescue network

    There are 20 million children in Anhui Province, and about 800 new cases of leukemia occur each year. Among them, there are more rural patients than urban ones, and they are increasing year by year. In the past, due to the large gap between local diagnosis and treatment and developed areas, children often chose hospitals in Beijing and other places. Since last year, children with leukemia in Anhui have a “return flow” trend, and the number of people choosing to see a doctor in the province has increased significantly, reaching about 500 cases per year.

    Letting children with leukemia "stay" first benefits from the improvement of local diagnosis and treatment. The Children's Hospital of Anhui Province was identified as a provincial designated hospital, responsible for the diagnosis and treatment of children with difficult leukemia in the province. The hospital joined the National Acute Leukemia Collaboration Group and received direct guidance from the National Children's Medical Center, which greatly improved the level of diagnosis and treatment, achieved homogeneity in leukemia treatment, and gained the trust of parents of more and more children.

    For children with leukemia, in addition to suffering, the biggest pressure comes from financial burden. The acute leukemia treatment cycle for children generally takes 2-3 years, with a total cost of 200,000-300,000 yuan. Individual cases with severe complications, high-risk refractory, and relapsed leukemia require transplantation, and the total cost may exceed 300,000 yuan. For this reason, the basic medical insurance for urban and rural residents in Anhui Province implements a disease-based payment policy for children with leukemia. The reimbursement rate is 90%, and the economic burden on families with children is greatly reduced.

    China actively integrates social forces, encourages social charity assistance, strives to reduce the burden on children's families, and sends charcoal to children in the snow. For example, the Little Angel Fund of the Red Cross Society of Anhui Province supports families with impoverished leukemia patients, and the amount of assistance for each family can reach up to 50,000 yuan. For some families with difficulties, major children's hospitals across the country actively help children apply for various social donations, and carry out various fundraising, funding, charity and other public welfare activities from time to time, sending warmth to families with children with leukemia.

    "People's Daily" (13th edition, July 9, 2019)