Breaking the pattern of interests Pharmaceutical industry again to meet the storm

Medical network June 11th, one side is the problem of gold sales repeatedly banned, on the other hand, the lack of transparency of medical resources brought about further deterioration of the doctor-patient relationship, China's medical environment is difficult to say optimisticWith the change of recruitment structure and the reform of the medical system into the deep water area, the government departments will further intensify the efforts to combat the acceptance of bribes, excessive drug use, and seek personal gain, and promote the healthy development of the medical and health market.
Strict investigation of kickbacks Commercial Bribery Punishment "Micro-corruption" June 5, the State Health and Sanitation Commission, the Ministry of Industry and Information Technology, the Ministry of Public Security and other 9 departments jointly issued "on the issuance of 2020 to correct the pharmaceutical purchase and sale of the field and medical services in the main points of work ( see annex at the end of the text"), to open a comprehensive correction, crack down on fraud fraud and fraud of medical insurance funds, consolidate the effect of reform in the field of medical circulation, clean up the medical industry around the security industry, improve the medical insurance price mechanism.
Relevant people said that in accordance with the "management industry must be in charge of the wind" "who is in charge of who is responsible" governance requirements, the notice is intended to clear the line of behavior for the field of pharmaceutical purchase and sale and medical services, the formation of a clean industry of the new atmosphere, and the medical industry "nine not allowed" upgrade and improvement.
Among them, medical behavior management will be included in the health and health work supervision focus, clean up the masses around the medical industry chaosFor example, in the medical services to obtain or receive patients and their families gifts of "red envelope" gifts or other improper benefits and other violations, according to the seriousness of the serious treatmentTo investigate and punish medical institutions and medical personnel who use their practice to obtain improper benefits, collect rebates from pharmaceutical supplies enterprises, etc.
"There will be a special governance of 'micro-corruption' such as 'kickbacks' from doctors"The above-mentioned people said, will focus on the inspection of medical institutions practitioners to accept drugs, medical equipment, medical hygiene materials and other pharmaceutical products production, business enterprises or distribution personnel in various names, forms of rebatesAt the same time, he revealed that the exploration of the establishment of enterprise credit evaluation and disciplinary mechanism, for bribery enterprises, in addition to administrative and even criminal penalties, serious even prohibit the enterprises involved in the network qualifications.
Recently, the State Medical Insurance Administration on the establishment of pharmaceutical prices and recruitment credit evaluation system guidance (draft for comments) (hereinafter referred to as "guidance") and "pharmaceutical prices and recruitment credit evaluation of the operating norms (draft for comments) " (hereinafter referred to as "operational norms") for the second consultation.
The Guidance clearly states that China intends to establish a list of pharmaceutical prices and breach of trust matters, including but not limited to pharmaceutical commercial bribery, abuse of market dominance, manipulation of market prices, breach of contract agreements, disturbing procurement order and other illegal and illegal acts, contrary to good faith and fair competition.
At the same time, according to the medical enterprise breach of trust assessment as general, medium, serious, especially serious four grades, dynamic updates on a quarterly basisAmong them, the credit rating of "particularly serious" pharmaceutical enterprises, "operational norms" requirements, in addition to warning, warning, warning risks, should be suspended all drugs of the enterprise hanging network, bidding or distribution qualifications, suspension period to the pharmaceutical enterprise credit repair, grade changes.
It is worth mentioning that the Guidance states that pharmaceutical enterprises need to implement a proactive commitment systemThat is, pharmaceutical enterprises to participate in or entrust editing for the centralized procurement of drugs and medical supplies, platform network, as well as medical insurance fixed-point medical institutions for the record procurement, should be pharmaceutical and medical supplies centralized procurement agencies to submit a written commitment, commitments include non-occurrence of the list of breach of trust, its employment personnel, entrusted to the agent enterprises for their own drug implementation of the breach of trust to assume responsibility; For pharmaceutical companies that have not submitted their commitments, they will not accept their medicines or medical supplies, or otherwise sell them to medical institutions.
Even if the relevant drugs or products have been linked to the Internet, the enterprise in the field of pharmaceutical purchase and sale of commercial bribery, the provision of prescription rebates, below the production cost of maliciously declared prices, disrupt the market order and other bad records, drug production activities have serious violations of the record, serious adverse reactions, provide false supporting documents and other irregularities, cancel the product's online eligibility, until the cancellation of the enterprise's all drug network qualification.
The simultaneous escalation of anti-corruption efforts in health insurance, fraudulent insurance, illegal use of health insurance funds is another important area in the anti-wind action It is reported that in 2020, China's various types of medical insurance fixed-point medical institutions will carry out to ensure the safety of the medical insurance fund self-examination and self-correction special rectification activities Among them, for public medical institutions will focus on the investigation and punishment of super-medical insurance payment policy scope, non-indication of diagnosis and treatment, high-set disease, clinical drug test projects into the medical insurance double reimbursement and other acts;
"Institutions that maliciously defraud medical insurance funds shall, in accordance with the law, seriously investigate and punish them and disqualify them from medical insurance services." "The relevant people said that the dequalification of health insurance will greatly increase the cost of fraud insurance of the institutions involved, thereby curbing the impulse of institutions to cheat insurance." In addition, in addition to holding the parties involved accountable, the relevant leadership will also be held accountable.
In fact, on May 29th, the Fujian Provincial Medical Insurance Bureau, the first army for medical reform, issued the Interim Measures for Credit Management in the Field of Medical Security in Fujian Province, which gave a direct example of future policy implementation.
The Measures state that the institutional credit subjects such as fixed-point medical institutions, pharmacies and pharmaceutical and equipment production enterprises in Fujian Province will be dynamically evaluated and deducted, and institutions with different credit ratings will be subject to different incentives and disciplinary measures.
Among them, retail pharmacies and pharmaceutical, consumables production and distribution enterprise cycle deduction points to the monthly supply performance management deduction divided by 12 cumulative calculation Credit E-class drug enterprises all kinds of cancellation of the network, within 2 years do not accept the application of the internet, and credit E-grade fixed-point retail pharmacies, termination of medical insurance service agreement, no more agreement within 3 years.
The Measures impose more severe penalties on designated medical institutions "Measures" clearly, should not be paid by the medical insurance fund medical expenses, resulting in the loss of the medical insurance fund more than 3000 yuan (inclusive) and in-patient medical orders, treatment documents, examination reports and disease records inconsistent resulting in the loss of the medical insurance fund more than 6000 yuan (inclusive), the above acts suspended medical insurance service personnel medical insurance services for 6 months, the media public notice, transferred to the health care department to deal with.
In recent years, China's efforts to combat fraud and insurance have been escalating Hu Jinglin, director of the State Health Insurance Administration, previously published by the State Health Insurance Administration, said in an article that in 2019 the State Administration of Health Insurance maintained a high-pressure situation to combat fraud and insurance, a total of 815,000 medical institutions to check the medical insurance fixed-point, basically achieve full coverage, direct investigation and prosecution of illegal funds of more than 10 billion yuan.
Take Beijing as an example, since 2019, Beijing has completed 2,916 fixed-point medical institutions, 445 fixed-point retail pharmacies on-site inspection "full coverage", refused to pay and recover the non-compliance expenditure of the health insurance fund more than 30 million yuan, dealing with serious violations of the problem of 83 fixed-point pharmaceutical institutions, more than 7,000 non-compliance of the insured personnel, transferred to the judiciary 22 people After the cooperation of relevant departments, the Beijing public security organs have cracked 47 cases of fraud and insurance fraud, eliminated 12 criminal gangs, criminal criminal detention of criminal suspects 112 people.
Teng cage for birds Reform into the deep water area "wind picketing" the fundamental purpose is to ensure the health care industry development of health and sustainable Recently, Hebei Province launched the four-medical linkage reform, with the centralized procurement and use of drugs as a breakthrough, deepen the health care, medical insurance, medicine, medical price linkage reform, improve the interests of the control mechanism Under the reform path of insisting on Teng space, adjusting structure and maintaining convergence, adjust the benefit structure, reflect the value of technical labor services through "Teng cage for birds" and optimize the income structure of medical institutions Zhejiang Medical Insurance Bureau issued a notice that the implementation of basic medical insurance hospitalization costs DRGs points payment provisional measures, becoming the first province in the province to implement the DRGs points method of payment.
Recently, the leading group of Hebei Province to deepen the reform of the medical and health system issued the "Hebei Province To deepen the reform of the medical and health system leading group issued a number of policy measures to further deepen the four-medical linkage reform and sound interest control mechanism with the centralized procurement and use of drugs as a breakthrough." It proposes to carry out medical, medical insurance, medicine, medical price "four medical linkage", through various aspects to deepen the centralized procurement and use of drugs and linkage reform, strict drug purchase and sale tax management, the city in 2021 to start THE actual payment of DRG, strengthen the monitoring of key drugs, strengthen drug price monitoring and other policies to control the initiative.
The circular states that a dynamic adjustment mechanism for the price of medical services will be established and improved, and that the expenditure of the health insurance fund, which will be reduced through various means such as centralized volume procurement, will be used to adjust the price of medical services, and the remaining 30% will be used to supplement the health insurance fund and benefit the patient.
"This adjustment in line with the principle of first move and then adjustment, steady and orderly, comprehensive consideration of the total cost of medical care, medical insurance fund revenue and expenditure, and other conditions, regular price adjustment assessment, to achieve the start-up conditions, according to the procedures to start the price adjustment work." Hebei Province Health Insurance Bureau said that due to the adjustment of medical services prices increased disposable income of medical institutions, can be extracted 60% to 70% for medical personnel pay, the rest for hospital development.
Zhejiang, On May 17, Zhejiang Provincial and Hangzhou Municipal Health Insurance Bureau issued the "Zhejiang Provincial and Hangzhou City Basic Medical Insurance Hospitalization Costs DRGs Point Payment Regulations" pointed out that the implementation of basic medical insurance hospitalization costs DRGs points payment provisional measures, requiring the annual cumulative hospital stay of more than 90 days (inclusive), in the second and below fixed-point medical institutions in the case of the internal medicine DRGs group, included in the bed-day payment management Bed daily reimbursement limit 450 yuan / sheet.
The Rules require that designated medical institutions shall adhere to the principle of treatment for illness, reasonable examination, reasonable treatment, reasonable medication and reasonable charges, and shall not reduce the necessary medical services and affect the quality of medical care At the same time, the fixed-point medical institutions shall reasonably control the cost of drugs, materials and medical treatment items at the expense of inpatients, and the proportion of expenses outside the scope of individual policies shall be controlled in principle within 15%.