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 persons, how to promote the reform of medical insurance, medicine and medical "three-medical" 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, in the limited level of medical insurance financing is particularly importantfor 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 siphon of grass-roots 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 high one of the main reasonsThe purpose ofpublic hospital reform 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 coststo drive 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 needSince last year, 30 cities, including Beijing and Tianjin, have launched a DRG pilot program, which will be rolled out nationwide in three yearsAlthough the medical insurance payment is the core mechanism in the "three medical linkage", but,, from the pilot to the national spread, to the DRG to play a control cost incentive role, the emergenceof hospitals to actively lower the price of drug supplies, reduce excessive provision and other results, need to go through a long 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 the 2016 four batches of national drug negotiations, with clinical value-oriented, with the national market as the "chip", under the premise of ensuring the quality of drugs to carry out the volume procurement, has 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 the formation of a drug price formation mechanism in line with the laws of market economy, and , 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, , in short, this is a purification of the pharmaceutical 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 high-quality development of the medical insurance system is to achieve the goal of improving health by establishing an efficient, fair and sustainable medical insurance system, maximizing the people's access to medical and health services and reducing the economic burden of medical care 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 through medical insurance payment, guide and adjust the allocation of medical resources, lead the public hospital and medical service system correct value orientation, establish the hospital cost-controlled profit incentive mechanism, on the basis of ensuring quality and improving capacity, to provide the most suitable services for the insured to improve health , the national market as a "chip", significantly reduce the price of pharmaceutical supplies, reduce the rebate space, regulate the service delivery behavior , and promote the effective use of health insurance funds, to help improve the level of compensation for the insured, while freeing up space to include more high-quality medical services, and ultimately improve the level of health insurance coverage for the insured in a word, "three-medical linkage" as an important way to promote the high-quality development of the medical insurance system, should be pushed forward.