Anhui: the relationship between the use of essential drugs and the individual pay performance of medical staff

Recently, the general office of Anhui provincial government has issued the implementation opinions on improving the national basic drug system In principle, the proportion of national basic drugs purchased by three-level, two-level and grass-roots medical institutions in the total purchase amount shall not be less than 20%, 30% and 70% respectively; the use of basic drugs is linked to the individual salary performance of medical personnel, and is integrated with public hospitals The reform award is linked to the distribution of funds The implementation opinions include the implementation of the basic drug catalogue, the practical guarantee of production and supply, the full allocation and priority of use, the reduction of the burden of drug expenses of the masses, and the improvement of the quality and safety level, so as to ensure the safety and effectiveness of drugs, the reasonable price and adequate supply, and alleviate the problem of "expensive medical treatment" As for the overall allocation of priority use, our province has made it clear that we should establish an incentive mechanism for priority use, strengthen the assessment of the use of essential drugs, link the assessment results with the individual salary performance of medical personnel, the allocation of subsidies for the implementation of the basic drug system at the grass-roots level, and the allocation of subsidies for the comprehensive reform of public hospitals In order to reduce the burden of drug expenses of the masses, put forward the implementation opinions, improve the payment policy of medical insurance, and for the therapeutic drugs in the catalogue of basic drugs, when the medical insurance department adjusts the catalogue of medical insurance, it shall, according to the procedures, give priority to the qualified drugs in the catalogue or adjust the classification of Party A and Party B, and gradually improve the actual guarantee level We will establish a parallel review mechanism for low-cost drugs, improve the dynamic adjustment mechanism, conduct timely special investigations for those with frequent and large price changes, and investigate and punish illegal acts such as price monopoly, fraud and collusion according to law In the management of chronic diseases such as hypertension, diabetes and severe mental disorders, we should encourage all localities to give priority to the use of basic drugs on the premise of ensuring the efficacy of drugs, so as to minimize the cost of drugs for patients The full text is as follows: the general office of the people's Government of Anhui Province on improving the implementation of the national essential drug system the national essential drug system is the basis of the drug supply security system, and is an important part of the basic public services in the field of health care In order to thoroughly implement the opinions of the general office of the State Council on improving the national essential drug system (GBF [2018] No 88), the following implementation opinions are hereby put forward with the consent of the provincial government 1、 General requirements Guided by Xi Jinping's socialist ideology with Chinese characteristics in the new era, we carried out the spirit of the nineteen and third Plenary Session of the party's nineteen and China's Central Committee in accordance with the party's Central Committee, the State Council and the provincial Party committee and provincial government We will improve policies on the production, circulation, use, payment and monitoring of essential drugs, comprehensively promote the construction of the drug supply guarantee system, strive to ensure the safety and effectiveness of drugs, reasonable prices and adequate supply, and strive to alleviate the problem of "expensive medical treatment" We will promote the convergence of drug use between higher and lower medical institutions, help build a hierarchical diagnosis and treatment system, promote the transformation and upgrading of the pharmaceutical industry and the supply side structural reform, and accelerate the comprehensive deepening of the reform of the medical and health system 2、 The implementation of the basic drug catalog (1) to ensure the basic medical and health needs Guided by meeting the basic drug demand for disease prevention and treatment, we should strengthen the leading position of basic drugs Public medical institutions should be fully equipped with and give priority to the use of basic drugs to meet the main clinical needs of common diseases, chronic diseases, emergency rescue and other major clinical needs We should also give consideration to the needs of children and other special groups and public health prevention and treatment (responsible units: provincial health and Health Commission, provincial health insurance bureau, provincial finance department, provincial economic and information department, Provincial Department of Commerce, provincial drug administration Those listed in the first place are the leading units, the same below) (2) standardize the selection and allocation of essential drugs Medical institutions should adhere to the principle of scientific, open, fair and just, based on the diagnosis and treatment norms, clinical diagnosis and treatment guidelines and consensus of experts, integrate the factors such as clinical application practice of drugs, changes in drug standards and new drug listing, attach equal importance to both Chinese and Western drugs, and scientifically select and reasonably allocate the essential drug varieties for clinical needs Strengthen evidence-based decision-making, highlight the clinical value of drugs; standardize the dosage form and specification, be able to take orally without intramuscular injection, be able to intramuscular injection without infusion We will encourage the purchase and use of traditional Chinese medicine products and support the development of traditional Chinese medicine (responsible units: provincial health and Health Commission, provincial medical insurance bureau and provincial drug administration) 3 Ensure production and supply effectively (3) improve effective supply capacity Take the implementation of the basic drug system as an important part of improving the pharmaceutical industry policy and industry development plan, actively promote the implementation of several policies of the provincial government on supporting the development of modern medical and pharmaceutical industry, encourage innovation, research and development and promote drug imitation production, encourage technological progress and technological transformation of enterprises, and promote the construction of advantageous enterprises with the production quality in line with the international advanced level The system will promote the merger and reorganization, transformation and upgrading of the pharmaceutical circulation industry, accelerate the development of modern drug logistics, guide the development of "Internet plus drug circulation", and enhance the ability to guarantee the supply and supply of essential drugs To investigate the current situation of production enterprises, the government can set up a platform to ensure the supply of essential drugs that are easily short of market supply due to clinical necessity, small dosage or low transaction price, insufficient production power of enterprises, etc., through market matching to determine reasonable purchase price, fixed-point production, unified distribution, included in reserves and other measures (responsible units: Provincial Development and Reform Commission, Provincial Department of economy and information technology, Provincial Department of finance, Provincial Department of Commerce, provincial health and Health Commission, provincial market supervision bureau, provincial medical insurance bureau, provincial drug administration) (IV) improve the procurement and distribution mechanism We should give full consideration to the special commodity attributes of drugs, give full play to the role of the government and the market, adhere to the direction of centralized procurement, implement classified procurement of drugs, and guide the formation of reasonable prices We will improve the application function of the provincial pharmaceutical centralized procurement platform and strengthen the construction of the pharmaceutical supply guarantee system We will do a good job in linking the use of drugs by medical institutions at higher and lower levels, promote the centralized procurement of public medical institutions within the city (county) region, standardize the varieties, dosage forms and specifications of basic drugs, and meet the needs of the masses We will explore the centralized procurement of national essential drugs, encourage cancer and other specialized hospitals to carry out cross regional joint procurement, and carry out single variety and quantity procurement for drugs with high price and large dosage As the first responsible unit to guarantee the supply and distribution of essential drugs, the production enterprise shall earnestly perform the contract, especially to guarantee the distribution of drugs in remote and inconvenient areas In case of drug shortage due to the reasons of the enterprise, the enterprise shall bear the liability for breach of contract, and the relevant departments and units shall timely list it in the record of dishonesty The medical insurance department shall timely allocate medical insurance funds to medical institutions in accordance with the agreement The medical institution shall settle the payment for goods in a timely manner in strict accordance with the contract; if the payment is delayed, it shall be criticized in a notice and ordered to rectify within a time limit (responsible units: Provincial Medical Insurance Bureau, provincial health and Health Commission, provincial development and Reform Commission, Provincial Department of finance, provincial market supervision bureau and provincial drug administration) (V) strengthen the early warning and response to the shortage Establish and improve the monitoring network system and early warning system of shortage drugs at the provincial, municipal and county levels, improve the consultation linkage mechanism, and timely release the monitoring and early warning information of shortage drugs We will strengthen the collection of multi-source information on drug research and development, production, circulation and use, accelerate the realization of online direct reporting of drug shortage information of medical institutions at all levels, track and monitor the supply of APIs, enterprise inventory and market trading behavior, comprehensively study and judge potential shortage factors and trends, find out shortage risks as early as possible, and make classified response and precise implementation of policies for different shortage reasons Drugs that are clinically necessary and have a great impact on shortage shall be included in the key monitoring catalogue; for those that monopolize the raw material market and push up the price of drugs leading to drug shortage and are suspected of constituting monopoly agreements and abusing the dominant position of the market, anti-monopoly investigation shall be carried out according to law and punishment shall be intensified In accordance with the requirements of the state for the emergency support of drugs in short supply, we should take effective measures to effectively guarantee the supply of medicine for the army's emergency shortage and emergency operation reserve (responsible units: provincial health and Health Commission, provincial medical insurance bureau, Provincial Department of economy and information technology, Provincial Department of finance, Provincial Department of Commerce, provincial SASAC, provincial market supervision bureau, and provincial drug administration) IV priority use of comprehensive equipment (VI) strengthen the management of equipment use Adhere to the leading position of basic drugs, strengthen the management of the use of basic drugs in medical institutions, give priority to the selection of basic drugs in the formulation and implementation of clinical pathways and diagnosis and treatment guidelines, strengthen the overall allocation and priority of use, and constantly improve the use of basic drugs in medical institutions In principle, the amount of national basic drugs purchased by tertiary medical institutions, secondary medical institutions and primary medical institutions accounts for the total The proportion of purchase amount shall not be less than 20%, 30% and 70% respectively According to the functional orientation and the scope of diagnosis and treatment, public medical institutions should reasonably allocate basic drugs to ensure the clinical basic drug demand The centralized drug purchase platform and the information system of medical institutions shall mark the essential drugs, and prompt the medical institutions to give priority to purchase and doctors to use Take the use of essential drugs as the key content of prescription review, and notify the units and individuals that do not choose essential drugs without justified reasons We will increase the training of doctors, pharmacists and managers on the basic drug system, clinical application guidelines and prescription sets, and improve the level of rational use and management of basic drugs Other medical institutions are encouraged to equip and use essential drugs, and enterprises are supported to carry out the consistency evaluation of generic drugs in the catalogue of essential drugs Medical institutions should give priority to the purchase and use of essential drugs that pass the consistency evaluation and are priced appropriately (responsible units: provincial health and Health Commission, provincial health insurance bureau, provincial finance department, provincial market supervision bureau and provincial drug administration) (7) establish incentive mechanism for priority use Medical institutions scientifically set up indicators for the use of essential drugs in clinical departments, which are included in the assessment of departments and personnel, and are linked to the individual pay performance of medical personnel The use of essential drugs will be included in the performance evaluation index system of medical institutions, and the evaluation results will be linked with the allocation of subsidies for the implementation of the basic drug system at the grass-roots level and the allocation of subsidies for the comprehensive reform of public hospitals We will deepen the reform of payment methods for medical insurance, and establish a sound incentive and risk sharing mechanism for "surplus retention and reasonable overspending sharing" between medical insurance departments and medical institutions To guide medical institutions and medical personnel to make reasonable diagnosis and treatment and rational use of drugs through the formulation of medical insurance payment standards and other ways (responsible units: provincial health and Health Commission, provincial medical insurance bureau, Provincial Department of Finance) (VIII) implementation of clinical use monitoring Relying on the existing resources, establish and improve the provincial drug use monitoring platform and the provincial, municipal and county three-level monitoring network system, focusing on monitoring the equipped varieties, use quantity, purchase price, supply and distribution of basic drugs in medical institutions, and whether the prescription drugs meet the diagnosis and treatment specifications and other information We will build a comprehensive clinical evaluation base for provincial drugs, support medical institutions, scientific research institutes, industry associations and other third-party professional evaluation institutions to carry out comprehensive clinical evaluation of drugs focusing on essential drugs, and guide clinical safe and rational use of drugs Strengthen the information interconnection between departments, and carry out dynamic monitoring of the whole process of essential drugs from raw material supply to production, circulation, use, price, reimbursement, etc (responsible units: provincial health and Health Commission, provincial medical insurance bureau, provincial finance department, provincial economic and information department, Provincial Department of Commerce, provincial drug administration) 5 Reduce the burden of drug expenses of the masses (9) gradually improve the actual level of security perfect