Do not "fill in the blanks" for the decline in the proportion of drugs, and change the price of medical services to the same frequency as residents' income

Since November, the seventh batch of centralized procurement of drugs has been successively landed in various places
.
A total of 60 drugs were successfully procured, and the average price of selected drugs was reduced by 48%.

So, how much space does centralized procurement and price reduction provide for medical service price reform?

 

The experience of Fujian Sanming medical reform is to reduce the price and cost of drugs and other materials through centralized procurement, and provide resource space
for adjusting labor prices.
In April 2016, the State Council issued Document No.
26, summarizing Sanming's experience in medical service price reform as follows: vacating space, adjusting structure, and ensuring connection
.
In the same year, the "Opinions on Promoting the Reform of Medical Service Prices" issued by the former National Health and Family Planning Commission and other four departments put forward the overall requirements of "total volume control, structural adjustment, rising and falling, and gradually in place", hoping to free up the resource space
for medical service price reform through centralized procurement and price reduction.

 

Is the proportion of tests on the rise?

 

Upon checking the website of the Guangdong Provincial Health Commission, the "2021 Guangdong Province Medical and Health Resources and Medical Services Briefing" and "2020 Guangdong Province Medical and Health Resources and Medical Services Briefing" show:

 

In 2021, among the medical revenue of public hospitals in Guangdong Province, drug revenue accounted for 26.
9%, consumables revenue accounted for 13.
8%, examination and laboratory revenue accounted for 28.
9%, and technical labor services (registration, diagnosis, nursing, surgery, treatment, etc.
) accounted for 28.
7%.

Compared with 2020, the proportion of drugs decreased by 1.
5 percentage points, the proportion of consumables increased by 0.
2 percentage points, the proportion of inspection and laboratory tests increased by 1.
2 percentage points, and the proportion of technical labor decreased by 0.
2 percentage points
.

 

In 2020, among the medical revenue of public hospitals in the province, drug revenue accounted for 28.
4%, consumables revenue accounted for 13.
6%, examination and laboratory income accounted for 27.
7%, and technical labor services (nursing, surgery, treatment, etc.
) accounted for 29.
0%.

Compared with 2019, the total medical revenue decreased by 5.
3%, the proportion of drugs decreased by 1.
2 percentage points, the proportion of consumables increased by 1.
1 percentage points, the proportion of examination and laboratory tests increased by 0.
9 percentage points, and the proportion of technical labor decreased by 0.
5 percentage points
.

 

From the above data, it can be seen that the proportion of drugs in medical income has decreased year by year, and the proportion of examination and laboratory tests has increased
year by year.

 

The reason is that, on the one hand, the price reduction of centralized procurement and the price change of medical services are not synchronized or not at the same time; On the other hand, there are no direct and effective control measures
for micro-actual diagnosis and treatment.
Therefore, some medical institutions may shift their revenue channels to diagnosis and treatment behaviors
that are not effectively controlled when their income is reduced due to the centralized procurement of drugs and other materials.

 

Technical labor services are related to the standardization of diagnosis and treatment, or their related requirements are more clear, and they will not or cannot be incremented
in quantity before the price is adjusted.
And the marginal cost of technical labor is basically unchanged, and increasing the quantity will not bring about efficiency improvement
.

 

How is the institutional level designed?

 

In view of the above situation, the level of institutional design has already been involved
.

 

In September 2021, the Pilot Plan for Deepening Medical Service Price Reform, jointly issued by the National Health Insurance Administration, the National Health Commission, and the National Development and Reform Commission, explained in more detail the content of the "total amount of medical service price adjustment in public medical institutions within a certain period of time
".
That is, the space for price adjustment is no longer constrained by the adjustment of materials such as drugs, but is directly determined according to the content contained above and the corresponding macro data (big data), and then directly determined
according to the actual situation of each relevant party.
There is no preset for the increase or decrease of the total amount, it will fall when it should fall, and it will rise when it should rise
.

 

Subsequently, in July 2022, the Office of the National Health Insurance Administration issued the Notice on Further Improving the Management of Medical Service Prices, which clearly stated that it is necessary to "correctly handle the relationship between medical service prices and centralized procurement of medicines", that is, "clarify the respective functional positioning of medical service prices and centralized procurement of drug consumables, the trigger mechanism of price adjustment is not directly linked to the centralized procurement of drug consumables, and the total amount of adjustment is not directly translated and replaced
。

 

Where is the resource space for price change?

 

Since the trigger mechanism for price adjustment is not directly linked to the centralized procurement of drug consumables, where is the resource space for medical service price reform? The Notice states that it is necessary to "adapt the timing, rhythm and scale of medical service price adjustment to the overall economic and social situation, policy orientation, medical insurance fund income and expenditure
, and other fundamentals.
" It is necessary to unify the specific rules of the dynamic adjustment mechanism at the provincial level, clarify the starting conditions and constraints, improve the price adjustment procedures, rules and index systems, and avoid each doing its own thing.
"

 

According to the dynamic adjustment of the initiation and constraint indicators of medical service prices in public medical institutions in Guangdong Province (trial) (August 2022), one of the initiation indicators is that the increase in the income of urban and rural residents or the increase in average social wages in the region exceeds the increase in patients' medical expenses (Guangdong Province).

 

In Zhejiang Province's Implementation Opinions on Establishing a Dynamic Adjustment Mechanism for Medical Service Prices (Draft for Comments) (August 2021), dynamic adjustment of medical service prices can be initiated if one of the following conditions is met for triggering criteria: the growth rate of regional medical revenue in the previous year is significantly lower than the growth rate of regional GDP (except for force majeure factors such as major disasters and major public health events); In the previous year, space was freed up by carrying out centralized procurement of drugs or medical consumables; In the previous year, the proportion of revenue from drugs, medical consumables, examinations and inspections decreased significantly by standardizing diagnosis and treatment behaviors; Due to the price of medical services, the DRG patient group generally charged high or low
fees in the previous year.

 

Compared with the two programs, the increase in income generated by social and economic development is undoubtedly the resource space
for medical service price reform.