Dalian version of the implementation rules of 4 + 7 with quantity procurement was first published! In case of failure to comply with the regulations, the hospital will punish the Dean, deal with the doctor and affect the rating of the hospital

According to the latest information obtained by e-drug managers, the highly concerned "national organization drug centralized procurement pilot" is gradually entering the landing stage in various regions, and Dalian has announced the plan, which will be officially implemented on March 1, 2019 It is the key to ensure that the winning drugs enter the hospital and be used reasonably Once they are not purchased and used according to the regulations, the medical institutions can even be held accountable to specific doctors in addition to being affected Recently, e-medicine managers learned that Dalian, one of the 4 + 7 pilot cities, has taken the lead in announcing the work plan for implementing the centralized purchase and use of drugs organized by the state in Dalian (Draft for comments) It is worth noting that this document further elaborates and arranges the key issues of the selected drugs in the "pilot work of centralized drug procurement organized by the state" in bidding procurement, hospital access, medical insurance payment, sales receipt, clinical use, etc At the end of 2018, "4 + 7 urban drug centralized procurement" has set off a huge wave in the whole pharmaceutical industry Especially in the background that the specific bidding and procurement rules have not yet been issued, just the publication of the winning varieties and the winning price has produced a series of chain reactions in the industry: different supporting policies have also been launched in succession, which directly leads to a large number of enterprises lowering product prices in many places in the whole country, and even a large number of varieties have been kicked out of the market Now, Dalian, as one of the pilot cities, although only published a draft for comments, but to a large extent, it has made clear the specific operation methods of 4 + 7 pilot cities in the next, so it is also of great reference significance The announcement of these detailed rules will undoubtedly make the chain reaction of "4 + 7 urban drug centralized procurement" continue to be transmitted to 2019, and continue to enlarge the impact As a whole, the documents released in Dalian mainly involve several key links: purchase, use and payment So we will also look at these three aspects What should we do in the future when purchasing with 4 + 7 volume? 1 Procurement: the winning varieties are not affected by "drug proportion" After reading the documents, we can clearly feel that in order to ensure that the selected varieties can smoothly enter the hospital and be used, Dalian has taken into account very detailed places, including the provisions that the selected varieties can not be affected by drug proportion It is clearly stated in the work plan that the procurement channels of hospitals should be unblocked to ensure that the selected drugs enter the hospitals and are used preferentially, "the total cost, the proportion of drugs, the quantity of basic drugs used in hospitals, the review of drug Affairs Committee and the account opening of drug handling enterprises should not be taken as the reasons to affect the supply and rational use of the selected drugs." It is worth noting that the above factors have basically covered the key situations of medical institutions when deciding whether to use drugs, especially the provision that they are not affected by "drug proportion" Previously, the proportion of drugs was a knife on the top of the hospital The purpose was to strictly control the use of drugs Specifically, only some varieties involved in the national drug price negotiation and some varieties of anti-cancer drugs could not be included in the "proportion of drugs" assessment But this time, although Dalian did not clearly stipulate that the winning varieties of volume procurement can not be included in the proportion of drugs, it stipulated that hospitals should not intervene in the use of selected drugs on the basis of the proportion of drugs, which obviously put "volume procurement" on a higher position, and also showed a positive attitude towards the implementation of volume procurement in the following specific implementation process The opening of an account of a pharmaceutical trading enterprise is a situation that may be faced in the actual work As the varieties won this bid may not have opened accounts in relevant medical institutions in Dalian or even in Liaoning Province before, there may be some problems in the implementation of procurement procedures In fact, the document of Dalian also shows an attitude that the access and use of products purchased in volume cannot be affected by specific administrative procedures In addition, the work plan also emphasizes that "all public medical institutions in the city are the main purchasers of the selected drugs." It is stipulated in the document that the public medical institutions shall sign a volume purchase and sale contract with the production enterprise or the pharmaceutical trading enterprise formulated by the production enterprise, and ensure that the contract volume is completed within one year And in the implementation cycle of centralized procurement results, public medical institutions must give priority to procurement, use centralized procurement to select varieties, and ensure the completion of the agreed procurement volume In order to ensure the normal procurement on schedule, the work plan has also set up a supervision and management mechanism The provincial drug centralized procurement platform will be the main body of supervision to monitor the drug procurement of public medical institutions in the region 2 Use: it is directly linked with the hospital assessment, with accountability to the person After ensuring the successful drugs enter the hospital smoothly, the next step is the use link The characteristic of the work plan published by Dalian Institute is that it will directly include the use of selected drugs in hospital terminals into the assessment indicators of public hospitals Specifically, these assessment indicators are actually closely related to the operation of public hospitals themselves For example, total health insurance index According to the work plan, the procurement and use of the winning drugs will be managed by the medical insurance agreement That is to say, the pharmaceutical enterprises whose medical institutions complete the purchase of drugs with quantity are included in the management content of the medical insurance agreement, that is, as the management content of the daily assessment of the designated medical institutions If any medical institution fails to complete the purchase and use amount as required, the medical insurance department shall deduct the corresponding medical insurance settlement amount as the case may be Therefore, whether the amount of drugs used is up to the standard will be directly related to the practical interests of the hospital More importantly, the assessment will also be specific to the prescribing doctor According to the work plan, the municipal human resources and social security department shall be responsible for the doctors whose prescription quantity of the selected drugs has decreased significantly, and special interview on medical insurance shall be carried out Medical personnel who do not use drugs according to regulations shall be seriously dealt with in accordance with the corresponding provisions of the prescription management measures and the hospital prescription evaluation management standard (Trial) This is only one of the indicators In addition to the total amount index of medical insurance, the use of selected drugs in hospital terminals will also directly affect the rating evaluation of medical institutions, the qualification of designated medical insurance, the evaluation and review of national and local key specialties At the same time, it will also become one of the contents of the objective assessment of the head of medical institutions As in the purchase process, there are corresponding supervision measures in the use process The medical insurance information system is responsible for monitoring the use of selected drugs in medical institutions, especially for the process control of the use rate and the use amount, and for the low use amount, warning and verification will be given 3 Payment: explore the direct payment of medical insurance fund From the perspective of the whole purchase and use process, it will be an important link to ensure that medical institutions can receive payment within the specified time At present, the requirement of the work plan is that public medical institutions, as the first person in charge of drug payment settlement, should guarantee to collect the payment in time within 30 days from the warehousing of drugs, so as to reduce the transaction cost of drug enterprises In fact, there are many documents that regulate the collection of medical institutions before, but they often fail to solve the problem In the final analysis, first, the medical institutions are in a strong position relative to the enterprises, and second, some medical institutions are often in a state of financial tension, so they cannot repay on time Today's demand is to solve this problem from two aspects The first is to require medical institutions to guarantee repayment through administrative orders; the second is to provide solutions and support in specific ways, that is, to implement the pre allocation system of medical insurance fund, in which the medical insurance fund prepays the working capital by 50% of the purchase amount agreed by the designated medical institutions, and the medical institutions take this part of the money to ensure the repayment first In addition, this is no longer a matter of self-consciousness of medical institutions alone, but with corresponding regulatory measures According to the work plan, medical institutions shall be urged to settle accounts with enterprises in time in accordance with the provisions of the contract, the problem of failing to settle drug payments in time shall be strictly examined, and the medical institutions and responsible persons who fail to collect money in time in accordance with the requirements shall be subject to punishment measures such as interview and notification More importantly, Dalian also proposed to actively explore a new operation mode of medical insurance fund directly prepaying drug payments to enterprises If this mode can be implemented, then public medical institutions will no longer be the first person responsible for drug payment settlement, and some corresponding problems of difficult payment collection may also be targeted to be solved In addition, it is the issue of clear payment standards The work plan requires that the selected price of the pilot should be taken as the payment standard of the pilot varieties of medical insurance In principle, for the reference preparations under the same general name and the generic drugs passing the consistency evaluation, the medical insurance fund should be carried out according to the unified payment standard and implemented in all medical institutions in the pilot city Note that the impact of the health insurance payment standard is not limited to the public medical institutions within the scope of the pilot, but to all medical institutions On the premise of clear payment standard, Dalian also determined the mechanism of "surplus retention and reasonable over expenditure sharing", so as to ensure that public medical institutions use drugs with appropriate price selected in centralized procurement and reduce the operation cost of public medical institutions According to the work plan, the balance can be retained by medical institutions, and can be used for personnel compensation as a whole in accordance with the requirements of "two permits" (allowing medical institutions to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdraw various funds according to regulations, which are mainly used for personnel rewards) It can be imagined that the enthusiasm of medical staff will undoubtedly be greatly improved.