Drug pricing mechanism will come out at the end of the year

The Third Plenary Session of the 18th CPC Central Committee put forward the “comprehensive deepening of the reform of the medical and health system.” With regard to the reform of public hospitals at the county level and public hospitals in the public hospitals involved in public hospital reform, the government, society, and medical institutions began to gradually reach consensus.

As a public hospital reform, one of the important options for medical reform, how can we find the next step? On October 17, the reporter participated in the first hospital management organization seminar hosted by the deputy director of the Beijing Municipal Health and Development Commission and the director of the Beijing Municipal Medical Management Bureau, Feng Guosheng, and the hospital management organization seminar hosted by the Chinese Hospital Association to visit public hospitals for reform.

At the same time, starting from the macroeconomic policy trends, typical examples of reforms in public hospitals in first-tier cities, second- and third-tier cities, and trying to establish a multi-dimensional public-

Public hospitals across the country are about to usher in a multi-dimensional reform.

Among the 336 tasks, public hospital reform is one of the important tasks. Liang Wannian, director of the State Health and Welfare Commission’s Department of Structural Reform, said at the first hospital management organization seminar that public hospital reforms have entered the deep-water region today.

It is understood that the level of public hospital reform is divided into two levels: the reform of county-level public hospitals and urban public hospitals. According to Liang Wannian, the comprehensive reform of county-level public hospitals in China is to be fully implemented in 2015. “This is the current top priority.” The relevant reports on the reform of urban public hospitals will also be announced to the public after the pilot city government self-assessment and on-site assessment by the monitoring ministries.

Liang Wannian also disclosed that at the end of 2014, the National Development and Reform Commission will form a document specifically targeting the drug pricing mechanism. Since then, the National Health and Family Planning Commission will also issue documents on public hospitals for centralized bidding and procurement.

Deepening the Reform of Public Hospitals at County Level in Cities

In response to the special reform of public hospitals, the operational ideas of the decision-making level have been increasingly refined and targeted.

In 2012, on the basis of the “Pilot Opinions on the Comprehensive Reform of County-level Public Hospitals”, the State Council selected 311 counties nationwide for pilot projects. In 2014, the six departments such as the National Health and Family Planning Commission jointly issued the “Comprehensive Opinions on Promoting the Reform of County-level Public Hospitals” and began to explicitly require that county-level hospitals implement comprehensive reforms and systematically put forward a set of reform strategies, goals, principles, and requirements. . And selected 700 counties to enter the second batch of pilots, the latest statistics show that the total number of pilot schools reached 1011, covering more than 500 million people in the country.

Recently, the State Council's Medical Reform Office will organize related departments and experts to supervise and evaluate the reform pilot areas of county-level public hospitals, explore and form the basic path of county-level public hospital reforms, and lay the foundation for reforms in the next year.

From the perspective of the reform of urban public hospitals, the decision-makers have put forward strict requirements in three areas and nine areas. 17 cities were selected as the first batch of urban public hospital reform pilots, including first-tier cities such as Beijing and Shanghai.

This year, the National Health and Family Planning Commission also organized experts and conducted a comprehensive assessment of 17 pilot cities together with related departments. “That is to say, the pilot city government must first self-evaluate, and then we conduct on-site assessment and eventually form an assessment report. Now this assessment report is still After the revision phase, we will announce it to the public." Liang Wannian said.

Although the final results of the assessment have not been published yet, Liang Wannian disclosed that according to the current situation, “the mechanism and deep medical contradictions of the reform have been fully exposed, but it can be felt that the reform of the entire urban public hospital has not yet formed a set of For everyone can copy, can be widely promoted model. Reform is not comprehensive, systematic, and synergistic enough."

Based on this, the National Health and Family Planning Commission has selected 17 other cities on the basis of the original 17 pilot cities. 34 pilot cities cover all provinces in the country.

The reporter was informed that the National Health and Family Planning Commission is currently organizing relevant departments to study and formulate guidelines for piloting comprehensive reforms in urban public hospitals. It is necessary to carry out comprehensive reforms for the 34 cities that have already been identified and some provinces' self-determined pilot cities, and put forward targets and related Some reforms require that pilot cities be combined with reality and that they can break ice on the institutional mechanism and be innovative.

The specific guidance and reform ideas involved will focus on "coordinating reforms," ​​including coordination between the government and the market, collaboration between public hospitals and social doctors, coordination between large hospitals and school hospitals, and public health institutions and public hospitals. Collaboration of medical institutions. The organic coordination of the medical, medical insurance, medical, and medical care groups is an overall consideration for reform.

From the microscopic point of view, the next step in the reform of public hospitals will be from the construction of a modern hospital management system to a compensation mechanism, to the encouragement and restraint of medical insurance, including supporting support, to the reform of personnel, preparation, and remuneration systems, and to the regulatory system. It plans to develop a series of contents such as drug distribution and tender procurement.

Drug pricing mechanism document issued at the end of the year

Whether it is the reform of urban public hospitals or the comprehensive reform of county-level public hospitals, one of the core steps that cannot be achieved is to “cut off any economic benefits between drug consumables and hospitals, especially medical personnel.”

Liang Wannian disclosed that one of the “most central considerations” at the current decision-making level is here. Specifically, the key step is to “really lower the price of drug consumables and imaginary high prices. To return to society and return to the masses, this is one of the most important reforms. We call it the key link. If we do not start from it, we will It is difficult to stimulate the motivation, determination and confidence in the reform of the medical system."

To this end, many ministries and commissions will jointly respond and introduce a series of detailed measures, such as the end of 2014, the National Development and Reform Commission will specifically document the pricing mechanism for drugs. The National Health and Planning Commission will also issue documents on the procurement of public hospitals for public bidding.

The specific approach, first of all, is to strengthen the elimination of the drug addition policy. On this basis, it is necessary to further carry out reforms in the circulation of medicines and supplies, the reform of the recruiting and mining system, and the regulation of the behaviors of the medical institutions and medical personnel for medication and consumables, and In a variety of links and comprehensive development.

In fact, one of the main sources of economic compensation of existing public hospitals at all levels for various reasons has been the addition of drugs and consumables. Once this block is cancelled, how to get the public hospitals to run normally requires the government to further fulfill its official functions and powers, and it must also come up with certain funds to provide policy subsidies for the cancellation of drug addiction.

More importantly, various localities should implement a price-based compensation mechanism as soon as possible to reverse the current distorted state of the medical service pricing system and vacate some of the reasonable losses arising from public hospitals, including the circulation of pharmaceutical consumables. The funding space is adjusted.

That is to say, under the premise of the total operation guarantee of public hospitals, it is ensured that the income of public hospitals does not decrease and the burden on patients does not increase. The future direction is to greatly improve economic returns such as medical treatment, nursing, bed days, and surgery that truly reflect the labor services of medical personnel. In the end, a reasonable price system can be formed.

An important sign of the success of these reforms is the change in the hospital's income structure, which is to change the status of 70% of medicines and consumables in the hospital's income structure, and to realize real-embossed labor and technology prices, which can reach 70% of the hospital's income. It is the goal of reform.

"But where does this money come from?" Liang Wannian said.

In fact, this "money" issue involves multiple reforms, including the lack of financial resources, the affordability of medical insurance, and the increase in the burden on the people. The reform path currently under consideration is to squeeze out the water in the circulation of pharmaceutical consumables, and at the same time, to control doctors' unreasonable drug use behavior. These two pieces will leave sufficient room for the ministry's future "price adjustment."

Another reform related to “money” is the sustainable reform of medical insurance and the reform of payment methods. At present, the supervisory level considers that the overall direction of reform should give full play to the mechanisms for the encouragement, supervision, and restriction of medical insurance to hospitals and medical behavior.

“Informatization, institutional arrangements and institutional arrangements must be made so that the medical insurance management department, the administrative department and even the society can see the medical behavior of each hospital and even each doctor, and publish relevant data and results and information to the public. Sunlight and transparency to monitor the behavior of medical institutions and doctors, said Liang Wannian.

Liang Wannian also said that at this stage, the payment methods for public hospitals at all levels in China cannot be implemented in a uniform manner. It is not only that one payment method is adopted to solve the problem, but “the general direction is still postpay.”

Kunming pushes for more effective practice in joint-run institutions

In addition to the first-tier city of Beijing, public hospital reforms have also carried out useful explorations in second and third-tier cities in China.

In recent years, Kunming City has conducted a series of reforms in the reform of public hospitals as a public hospital to reform the country's pilot cities in connection with Yunnan Province and a comprehensive pilot city in Yunnan Province.

In June 2011, when the current vice chairman of the National People's Congress Standing Committee and former Minister of Health Chen Hao studied reform of public hospitals in Kunming, he had reformed the local diversified medical model, the practice of doctors practicing more points, and the implementation of the national essential medicine system. Effectiveness, affirmation.

Today, the reform of public hospitals in Kunming is continuing to make efforts in many aspects such as property rights reform.

Citing the participation of public investment in hospital restructuring

Up to now, the reform of public hospitals in Kunming has also faced problems such as the allocation of health resources and the unreasonable layout of medical institutions, the incompleteness of multi-level medical service systems and the lack of high-level professional and technical talents and management personnel.

In order to solve the above problems and optimize the allocation of medical service resources, the reform of public hospitals in Kunming is making a fuss about property rights reform.

The specific approach is to encourage social capital to participate in restructuring and reorganization of public hospitals in a variety of ways, and to implement a joint-stock institution in accordance with the model of retaining stock, introducing increments, and increasing capital and expanding stocks.

The reporter was informed that at present, through exploration and practice, Kunming has completed the restructuring of the three public hospitals. Among them, Kunming First Hospital and Yunnan Provincial Urban Construction Investment Co., Ltd. jointly established Ganmei Medical Investment Management Co., Ltd., which marks the first triple-A public hospital in Kunming and has successfully implemented a shareholding hospital.

In order to promote the property rights reform of public hospitals in Kunming City, the city has established the Kunming Municipal Hospital Authority to strive to implement the management of the entire industry in order to ensure the realization of social welfare goals.

Kunming will further encourage social forces to set up a large-scale medical service and build a multi-level medical service system. It also provides preferential policies in nine aspects including taxation and land policy preferences, licensing access, personnel treatment, investment incentives, and compensation system tilt. And set aside space for the development of private hospitals in the setting up of medical institutions, and set up a city private hospital service center to provide tracking services.

At the same time, the establishment of public financial incentives to run medical institutions to award the proxy. Each year, it invests 3 million yuan to reward outstanding private hospitals. The newly established private hospital with a fixed asset investment of over 30 million yuan will receive one-time rewards in the amount of 8 to 10 yuan.

According to statistics, at present, the number of private hospitals in Kunming has reached 147, with 8,187 beds and 10,165 employees.

More practice encourages doctors to go to the grassroots

In addition to hospital-level property rights reforms, Kunming has also actively promoted more practice reforms for physicians in order to promote the flow of talent in the market.

According to the “Regulations for Implementing Multi-practice Doctors in Kunming City,” the physicians of the physicians with the titles of the above-mentioned physicians in Kunming may, with the approval of the administrative departments of health, be able to engage in medical treatment, prevention, and health care within three locations within the jurisdiction of Kunming City. activity. It also encourages eligible physicians to choose to practice at multiple points in the outskirts of the suburbs of Kunming City and basic medical institutions, and gradually establish a rational flow mechanism for high-level health personnel at all levels of medical institutions.

It is reported that at present, Kunming City has handled more than 2,134 people in practice, with 3.5% of public hospitals at or above the municipal level, 22.5% of county-level public hospitals, and a total of community health agencies, township hospitals, and private medical institutions. 74%.

On the basis of the flow of qualified personnel, Kunming’s future reform goal is to reform the compensation mechanism and establish a modern hospital management system as the starting point, strengthen the construction of talents, technology, and clinical specialties at county hospitals as the core, and effectively control medical expenses. Rapid growth, lower secondary average outpatient emergency expenses, the average number of days of hospitalization, and strive to increase the county's consultation rate to 90%, basically achieving serious illness without counties, making county-level public hospitals make comprehensive progress in the stage of progress.

At the same time, the national basic drug system will continue to be implemented to reduce drug prices.

As a pilot city for the national basic medicine system in Yunnan Province, in February 2010, 100% of the government-run grassroots medical and health institutions (municipal community health service agencies, township health centers, and village clinics) in Kunming City all equipped and used essential medicines and implemented zero. Differential sales.

At present, the investigation and drafting of the "Opinions on Implementation of the Comprehensive Reform of County-level Public Hospitals" has been completed and has been approved by the Kunming Municipal Government's executive meeting. In the next step, Kunming will further improve its policy framework in the process of comprehensive reform of county-level public hospitals. Through the pilot reform of county-level hospitals, the medical conditions and medical environment of the pilot hospitals will be improved, and efforts will be made to further eliminate the mechanism of using drugs to support medical care.

Reporter's notes

Looking at the reform of public hospitals from the perspective of "investors"

Similar to the control of central enterprises, the reform of public hospitals in China is also moving away from the supervision of investors. The specific regulatory agency is the hospital authority. Up to now, there have been 16 provinces, prefectures, and cities across the country that have established hospital management organizations under the background of medical and health reforms, fulfilled the responsibilities of the donors of medical institutions, and assumed the mission of public hospital reform in the new era.

Jumping out of routine analysis of medical institutions and patients' micro-concepts, looking at problems from the perspective of macro-regulatory management, and seeking further solutions from the perspective of medical institution managers can be a method.

How to seek public hospital reform under the background of new medical and health reform? The key point still lies in the "separation of management and management."

To achieve "separation of management and management," we must first clarify the problems existing in the current domestic health management system in order to be able to prescribe the right medicine.

Under the conditions of the planned economy, the health administrative department has mainly fulfilled the government's health functions through the establishment of directly-affiliated units, and the functions of the two sides have not been fully developed and exerted. Under the social background of multi-channel financing, the economic and social factors for health have become increasingly complex and diverse.

At present, on the one hand, the relevant agencies continue the system under the planned economy, while on the other hand they face the decentralized expansion of the government's health functions under the conditions of market economy.

There are two situations in which this kind of function is decentralized. First of all, there is a decentralization of functions in terms of management objects and aspects of cutting. For example, the field of health care financing is borne by health, people and society, and civil affairs.

The second is the decentralization of management functions and management affairs. The public hospitals are directly supervised by the health department. Actually, the personal insurance company is responsible for personnel and salaries, financial budget approval, financial assistance, and asset management. The development and reform department is responsible for pricing. With investment in major projects, the powers are highly fragmented, leading to long-term management, increasing administrative costs and reducing effectiveness, making it difficult to effectively solve major problems in the health field. In this way, it is bound to affect the healthy development of health services.

In particular, in the context of integration of decision-making and implementation, the health administration departments are prone to fall into the micro-management of the subordinate units, which will lead the government to adopt the division or establishment of new institutions from the health administrative departments when it newly adds and strengthens the health functions. the way. However, this approach will further exacerbate fragmentation of government health functions.

How to clarify the above issues, taking Beijing as an example, how can the Hospital Authority, which is the “funder”, further coordinate with the Health and Development Commission in the future?

The Health and Development Commission researches and formulates a unified policy, which is mainly responsible for the macroscopic aspect; the function of the HA is to explore the microscopic aspects. Mao Yu, deputy director of the Beijing Municipal Health Development Planning Commission, said: “We have always compared the functions of the Health and Planning Commission and the Hospital Authority to the ability of the Health and Planning Commission to go to heaven and the Hospital Authority to be able to land on the ground.”