Compensation for failure to clear the basic level of stripped pharmacy

Source: pharmaceutical economic daily march 21, 2012: the separation of pharmacies in primary medical institutions is a key step in the implementation of "pharmaceutical separation", and this step has not been officially started yet, and there are many obstacles According to the investigation report on the separate pilot of medicine in Hunan Province published by Hunan Province, the lack of clear compensation channels is the main reason for this work to be unsustainable However, grass-roots hospitals are more dependent on drug revenue, and the loss of revenue after the separation of pharmacies is difficult to supply through other channels According to related hospital personage, the income of basic hospitals from selling drugs accounts for more than 50% of their total income, while the outpatient pharmacy accounts for at least 30% - 40% of the hospital's drug income, and even some hospitals account for 60% If this piece of income is gone, it is estimated that the Dean can't go on Since 2011, the Ministry of Commerce has been promoting the pilot of pharmacy trusteeship Compared with the "pharmacy trusteeship" tried in Nanjing in the early years, this round of pharmacy trusteeship is essentially different In the top-level design of medical reform, we need to completely cancel the "medicine for medical treatment", and the separation of hospital pharmacy can be regarded as the first step to cancel the "medicine for medical treatment" Industry insiders pointed out: "the Ministry of commerce is to separate the outpatient pharmacy from the hospital, and then give the separated part of the business to the pharmaceutical commercial company In the future, pilot work will be carried out in community hospitals in Nanjing and other cities, and a number of pharmaceutical commercial companies including Sinopharm will be listed as pilot enterprises It is reported that the plans of each pilot city may be different " However, like Nanjing, Hunan Province, as one of the pilot areas of this "pharmacy trusteeship", the promotion of its pharmacy divestiture is also very difficult It is difficult to establish a basic drug system to cancel drug revenue and implement "zero margin" sales, which was once considered as a good way to solve the problem of "supplementing medicine with drugs" However, from the actual operation, the basic drug system has not cut off the interest chain of "supplementing medicine with drugs" Zhu hengpeng, a professor at the Institute of economics, Chinese Academy of Sciences, believes that although community hospitals do not sell drugs at a higher price in name, the interests of hospitals, including doctors and drug dealers, have not been cut off, "rebate" and kickbacks still exist Therefore, the separation of hospital pharmacy is regarded as the fundamental measure that can completely cut off the "remedy with medicine" The drugstores that have been engaged in prescription drug sales for a long time also want to accept the separated drugstores in order to get more prescriptions Zhu hengpeng, who participated in the investigation of the Ministry of Commerce, told reporters: "after the separation of outpatient dispensary of urban community hospital, judging from the ability of large drug sales chain enterprises at present, there is no problem in the ability of drug supply or drug service." However, such measures have encountered obstacles in medical institutions, and hospitals are obviously reluctant to give up drug sales revenue According to the survey of Hunan Provincial Department of Commerce, according to the current practice, medical institutions can increase the price of purchased drugs by 15% and then sell them to patients, which constitutes an important source of income for medical institutions In 2010, the drug revenue of primary medical institutions in an urban area accounted for 60% of the total medical revenue, and the drug price difference revenue was 13 million yuan After the implementation of zero margin sales of drugs, although the government grants more than 8 million yuan, there is still a funding gap of 5 million yuan In addition, medical practitioners hold a negative attitude towards "separation of medicine" In the process of drug sales in medical institutions, clinical expenses account for more than half of the cost of drug sales and promotion, which are all in the pocket of medical practitioners The safety of diagnosis and treatment process is also a factor that can not be ignored If the doctor is only responsible for diagnosis and drug treatment in the drugstore, once there is a medical accident, the determination of responsibility will become more complex, and the doctor-patient dispute may be further intensified Relevant experts pointed out that the purpose of carrying out the separation of medicine is to cut off the interest relationship between doctors and medicine, so that the medical behavior returns to the essence If we don't solve the problem of medical supplement, if doctors can't get reasonable return through diagnosis and treatment, then medical institutions and doctors will still get benefits through other ways, generate new excessive medical treatment, and cause waste of medical resources Therefore, in the implementation of "medical separation", we should simultaneously promote various supporting measures of medical reform to solve the problem of "medical supplement" As an important reform in the medical reform, the separation of hospital pharmacy will be gradually promoted everywhere, but the implementation of hospital resistance is also very obvious As the largest chain drugstore in Hunan Province, Xie Zilong, chairman of the common people's drugstore, told our reporter during the "two sessions" about the helplessness of the common people in Hunan to participate in the work "We have been doing and exploring this work," he said But now there is a big obstacle that can't be overstepped, that is, basic medical institutions need to make up for the lack of medical income with the help of their pharmacies " Due to the lack of government investment, medical institutions turn to the pharmaceutical companies that host their pharmacies to ask for money Xie Zilong pointed out: "now we talk about this work with several counties and districts in Hunan Province, but basic medical institutions require 30-40 points of rebate In fact, it's not realistic for retail pharmacies " Obviously, if the compensation problem is not solved, the pharmacy trusteeship is difficult to continue To solve the problem of compensation, the prescription of Hunan Province is to change the "hidden compensation" to "clear compensation", and promote the complete connection between retail drugstores and medical reform The so-called "secret subsidy" refers to the government's subsidy for the loss of medical institutions caused by the sale of essential drugs, while the "explicit subsidy" refers to the government's direct inclusion of a certain amount of subsidy into the insured's medical insurance account In the new medical reform plan, it is clear that "all retail pharmacies and medical institutions should be equipped with and sell national essential drugs to meet the needs of patients", but "zero margin" And the corresponding compensation measures are only for medical institutions In addition, the compensation schemes vary from place to place, which is difficult to implement in the process As a result, grass-roots medical institutions and retail pharmacies are faced with operating losses to varying degrees For the public, the policy of "zero difference rate" is a "secret remedy" to cure the symptoms but not the root causes, which has not fundamentally changed the policy of "medicine to cure the diseases" Only by using the financial financing to change the covert medical insurance system into the overt one, can we improve the purchasing power and consumption ability of the people, truly implement the benefits and conveniences, and at the same time reasonably guide the reform of medical institutions, and promote the improvement of their own service quality Hunan Province plans to adjust the current policy, take the function of pharmacy of medical institutions undertaken by large-scale pharmacies, and include large-scale chain pharmacies in the scope of overall payment of medical insurance At the same time, realize the sharing of patient medical records and prescription information between chain drugstores and community medical institutions; patients purchase drugs from pilot drugstores with prescriptions, and drugstores check prescriptions in the shared prescription inquiry system, and provide pharmaceutical services In the aspect of pharmaceutical service, we should share the benefits of hospitals and pharmacies Drugstores charge 5% of the pharmaceutical service fee, and the other 10% of the pharmaceutical service fee will be transferred to the community medical service or reduce the government's financial expenditure; the amount within the reimbursement proportion will be settled by drugstores to the medical insurance center, and the self paid amount will be paid by patients themselves.