Deep Thinking . . . The internal logic of "three medical linkage" is promoted by taking drug collection as a breakthrough.

The quality and efficiency of medical service supply is related to the effective use of medical insurance funds, more related to the health of the insured, how to promote the reform of medical insurance, medicine and medical "three-doctor" in coordination, on the basis of ensuring the people's access to high-quality medical services, standardize the service delivery behavior, guide the rational allocation and effective use of medical resources, promote the high-quality development of the medical security system, is an important part of deepening the reform of the medical security system, which is particularly important in the limited level of medical insurance financingGive full play to the "leverage" of medical insurance
for a long time, public hospitals mainly adopt the expansion-oriented development strategy, do large-scale, large service volume, large income operation mode, in the absence of effective constraints, leading to blind expansion of scale, equipment competition, excessive service, and so on, and siphon of primary-level patients and backbone medical personnel, is the rapid growth of medical costs, unreasonable medical expenses and the overall efficiency of the medical service system is not highThe purpose of the reform ofpublic hospitals is to change this mode of operation and establish the incentive mechanism of activecost control under the premise of ensuring qualityThe key to reform is the "three-medical linkage" of medical insurance, medicine and medical care, in which medical insurance payment is the core mechanism and the lever of public hospital reformFor hospitalization, the implementation of clinical path by disease payment and DRG payment-based multi-complex medical insurance payment method, for outpatients, some chronic diseases, the implementation of per head-to-head payment, guide hospitals in the premise of quality assurance to actively control costskeep down the price of pharmaceutical supplies is keyThrough the collection of national organizations, significantly lower the price of pharmaceutical supplies, for the reform of payment methods to create conditions, but also to make room for the adjustment of medical services prices, in the control of the total increase in business income, under the premise of raising the price of medical services, reflecting the value of doctors' technology and labor servicesAt the same time, it reduces the spending on the inflated price of medical supplies, and frees up the scope for health insurance funds to incorporate new technologies with highclinical value that more patients needthe linkage between "health insurance" and "medical" reform, to promote the change of the operation mode of public hospitals, at the same time, the inflated price of pharmaceutical supplies is depressed, reducing the rebate space, help to standardize the service delivery behavior, and then support the reform of the income distribution system, in mobilizing enthusiasm at the same time to further standardize medical behaviorTo drug supplies collection as a breakthrough
since last year, in Beijing, Tianjin and other 30 cities to carry out DRG pilot, the plan three years later in the country to push openAlthough the medical insurance payment is the core mechanism in the "three medical linkage", on the one hand, from the pilot to the national spread, to the DRG to play the incentive role of controlling costs, the emergence of hospitals to actively lower the price of drug supplies, reduce excessive provision and other results, need to go through a longer period; Therefore, at this stage, effectively lower the price of pharmaceutical supplies has become the key to promote the reform of the "three-care linkage"2019, the state organization of two batches of drug centralized procurement and 2016 to carry out 4 batches of national drug negotiations, clinical value-oriented, to the national market as a "chip", under the premise of ensuring the quality of drugs to carry out the volume procurement, achieved remarkable resultsIn the pilot of drug collection in the city of 4 plus 7, the price of 25 generic drugs decreased by an average of 52%, with a maximum decrease of 96%In September 2019, the opening of the tender, compared with the "4 plus 7" pilot price level, an average reduction of 25% In January 2020, the second batch of drug belt procurement reduced the average price of 33 varieties by 53%, with a maximum reduction of 98% In November 2019, the national drug price negotiations were successful, with an average price reduction of 60.7% It can be seen that through the national collection, drug prices have been greatly reduced, significantly reducing the economic burden of the people's medical treatment, better protection of the people's medical treatment, ease the expensive to see a doctor, reflects the concept of people-oriented at the same time, centralized volume procurement has changed the competitive model of the pharmaceutical industry In the past, the pharmaceutical industry competition is not quality, price, efficiency, but kickbacks and other irregular, even illegal practices, not only destroy the market order, but also bring about changes in medical behavior, but also lead to the lack of innovative motivation, low quality of growth, long-term lack of sustainable development Belt purchases ensure sales, allowing companies to focus on improving product quality, productivity and innovation in research and development On the one hand, to promote effective competition and form a drug price formation mechanism in line with the laws of market economy, on the other hand, to promote the transformation and upgrading of enterprises, from extensive growth model to efficiency-based endogenous growth, technology innovation-driven intensive growth model, to achieve the continuous improvement of the quality of growth At the same time, to guide doctors to use drugs rationally, in order to promote the reform of payment methods, establish a cost control mechanism and the price adjustment of medical services to create conditions, forcing hospitals to change the way of development in short, this is a clean medicine circulation environment, improve the industry ecology, the construction of fair competition market order, promote the pharmaceutical industry innovation strategic measures, especially in the medical reform into the deep water area, "bite hard bones" of the current, is to promote the "three medical linkage" breakthrough It is not only of practical significance, but also of far-reaching historical significance To promote the "three-medical linkage" to promote the high-quality development of the medical insurance system
the high-quality development of the medical insurance system is to establish an efficient, fair and sustainable development of the medical insurance system, maximize the people's access to medical and health services and reduce the economic burden of medical care, to achieve the goal of improving health Because the quality and efficiency of medical service supply are related to the effective use of medical insurance funds and the health of the insured, the high-quality medical insurance system depends not only on the reform and optimization of the system itself, but also closely related to how to promote the supply side of medical service and the supply side of medicine through medical insurance Therefore, under the premise of following the law of medical insurance, medicine and medical "three-doctor" development, we should take medical insurance as the core and push forward the reform of "three medicines" to form a policy of coordinated treatment is to speed up the reform of the payment method of health insurance Through medical insurance payment, guide and adjust the allocation of medical resources, lead the correct value orientation of public hospitals and medical service systems, establish the incentive mechanism of hospital cost-controlled profit, and provide the most suitable services for the insured to improve their health on the basis of quality assurance and ability Second, continue to implement the drug volume procurement, and as soon as possible to expand the collection of varieties, the national market as a "chip", significantly reduce the price of drug supplies, reduce rebate space, regulate the service delivery behavior Third, the measures are linked, the compensation mechanism of public hospitals is further improved, the operation and development mode of public hospitals are transformed, and the medical insurance funds are effectively utilized, which will help to improve the level of compensation for the insured, at the same time, make room for more high-quality medical services, and ultimately improve the level of medical insurance coverage for the insured in a word, "three-care linkage" as an important way to promote the high-quality development of the medical insurance system, should be pushed forward .