Document No. 73 requires the state to talk about the path or the best way for drugs to fully land in the face of landing resistance

"On December 16, 2019, the National Health Insurance Bureau and the national health and Health Commission issued the notice on completing the implementation of national health insurance negotiation drugs in 2019 (medical insurance Fa [2019] No73), requiring all provinces to directly link 97 negotiation drugs to the Internet within the time limit specified in medical insurance Fa [2019] No65 document, and organize the procurement in a timely mannerThe most important requirement is to provide specific requirements for the allocation and use of these drugs, guide the designated medical institutions to allocate and use them in a timely and reasonable manner according to their functional positioning, clinical needs and diagnosis and treatment capabilities, and not to influence the allocation and use of drugs in the negotiation on the basis of the total amount control of medical insurance, the number limit of drug directories of medical institutions, and the proportion of drugs< br / > the supporting incentive policies are: according to the fund income and expenditure, the burden of patients can be reduced by including special disease guarantee in outpatient service, exploring single disease payment and other waysWhere possible, we can actively explore long-term prescription policies to facilitate patientsCompared with the original drugs, the cost-effective and completely replaceable drugs are encouraged to be used insteadExecutive level requirements: health departments at all levels guide and improve the negotiation of drug use guidelines and norms, standardize diagnosis and treatment behavior, and promote rational use of drugsAll designated hospitals should strengthen drug administration at the same time to ensure the rational and standardized use of negotiated drugsThe state health insurance bureau shall select some overall planning areas to focus on monitoring the use of relevant drugs" < br / > 70 of the 119 new drugs were negotiated successfully, and 27 of the 31 renewal drugs were negotiated successfullyMost of these drugs are listed in recent years and have high clinical value, involving more than 10 clinical treatment fields such as cancer, rare disease, hepatitis, diabetes, MDR-TB, rheumatism immunity, cardio cerebrovascular, digestion, etc< br / > there are still many difficulties in breaking through many obstacles from the establishment of system to the implementation of measuresThe superficial reason is the limitation in the bearing capacity of medical insurance fund and the proportion of clinical drugsThe deep reason is that the hospital doctors lack the power to purchase and useThis is the side effect after the implementation of zero plus, and there is also the stress response to the purchase with volume and price reduction< br / > how to complete the implementation of guotan drugs required in Document No 73 quickly and well? We have realized two points: first, we must be efficient, and respectively put forward specific requirements for tens of thousands of major designated hospitals in different regions The massive management and supervision contents are frightening, and may be very frightening; second, we must be effective, and we should be consistent with the thinking and practice of strategic purchase How to use efficiently and get instant results? We first thought of "Internet plus" may provide a realistic platform, resources and channels Then, combined with the propulsion countries, we discuss the existing supporting policies for drug landing and the bottleneck problems that need to be adjusted and improved We try to make clear the advantages of "Internet plus special" in solving this problem through the following suggestions < br / > it is the work of medical insurance and health care department to vigorously promote the implementation of national discussion on drugs The problem of the bearing capacity of medical insurance fund can be temporarily blocked here If there is any condition, it is also necessary to create conditions in order to focus on the people's health interests < br / > one of the bottlenecks that should be paid attention to is the proportion of drugs, which mainly faces three situations: < br / > one is to actively integrate the guarantee of mender's disease, explore the place of single disease payment, and make cost-effective drug substitution, and make room for the expenses of national drug delivery through prescription improvement and bird exchange; < br / > the other is not to make these medical reform attempts, Or if it is not enough, unstable and has no sense of concession, it can only passively accept the requirements of documents, often there is a big gap in the implementation; < br / > thirdly, there is no option for the medical institutions in some places to undertake the task of medical reform demonstration, and they are forced to introduce the national drug discussion into the hospital directory at the first time within the control line of total medical insurance budget, drug proportion, etc, But it's very difficult to be bigger and stronger in this respect, or to lead the surrounding hospitals to follow up < br / > in this way, it is a real contradiction that the proportion of drugs in guotan is limited greatly But we suggest that we should pay attention to the two development expectations to make this pair of contradictions turn false < br / > first, a hospital can play an active role, or even more hospitals can play an active role, through the replacement of cost-effective drugs, the exploration of single disease payment, the inclusion of gate disease guarantee and other methods, and the hospital can self-healing under the impact of the landing of national drugs through cage replacement; < br / > Second, through the participation of external forces, timely give another part of the hospital's auxiliary tools that are not well prepared, For example, even if the outflow of prescriptions from borrowing countries still affects the proportion of drugs, it does not occupy the working capital of hospitals, or even simply does not include the proportion of drugs in hospitals < br / > we believe that the second kind of development is not expected to be more active and responsible than the first, but it can enable more hospitals to complete the national drug talks with the hospitals that have made the first reform On the other hand, although the second development expectation is no more intense and personalized than the first one, it makes a considerable number of hospitals dare to take a more stable step in the wait-and-see period First action, then flexibility < br / > first of all, the Internet platform has working capital like the pharmaceutical business, and the Internet platform has included the national drug negotiation or will be able to easily have this ability Internet platform can send guotan medicine to basic medical institutions or certified patients by taking prescriptions The star advantage of the Internet is to quickly solve the accessibility It depends on whether the hospital doctors are willing to let go and participate in the special cooperation of the Internet < br / > secondly, there is competition among Internet platforms The departments of medical insurance, health care and other departments and hospitals can select exclusive Internet platforms or several to undertake the special assistance work of national drug talks Patients who use drugs can choose the successful drugs or the more favorable drugs after the drug companies voluntarily reduce the price (provided that the reimbursement policy is met) < br / > 5 of the 97 national drugs are also listed in the base drug list There is no platform that can respond to the implementation of dynamic real-time adjustment of base drug catalog and medical insurance catalog, including guotan pharmaceutical, faster than the Internet platform We can't predict what risks will be brought by the circulation of all catalogue drugs through the Internet platform However, based on the special work of real-time and dynamic implementation of guotan drugs, the risks are controllable < br / > Third, the Internet platform not only helps to complete the purchase and use of strategic purchase, but also has advantages in the special fight against fraud and insurance First, some hospitals have been bothered by the introduction of drugs If this kind of coping is deceptive, the Internet platform can help to share the work difficulties; the Internet platform has the ability and willingness to add another pre audit of drug delivery < br / > Second, the Internet platform has been engaged in drug traceability for several years Grafting a part of the flow of national drugs to the Internet platform can prevent the loopholes of drug exchange People can't step into the same river twice, and it's difficult to get drugs in and out From the perspective of data accumulation, the number of drugs prescribed by doctors and used by patients can be recorded clearly, which can be compared both historically and horizontally < br / > Fourth, the Internet platform enables the patients who just need to talk about drugs to run less errands They don't need to ask which hospital has introduced guotan drugs next to them, and they don't need to speculate about the inventory and delivery period of the hospital Even if they go to a lower level medical institution which is closer to home in hierarchical diagnosis and treatment, they may reasonably prescribe guotan drugs and don't need to worry about the embarrassing working capital of the hospital, There is no longer a long list of explanations from hospital doctors < br / > fifthly, under the new normal and new environment of the new health care reform, the Internet platform has been fully transferred to the development of big health, medicine and health If the future of its development is compared with traditional insurance companies and traditional social pharmacies, it is not known who wins or loses, who actually loses One of the logic of health insurance reform is to shift from passive payment to strategic purchase The specific reform measures are more legal and professional < br / > Internet platform can help medical insurance and patients alleviate the complexity and information asymmetry of medical industry In the final analysis, medical insurance is helping medical institutions, patients and even themselves to find a harmonious and sustainable development track The special cooperation between guotan drug landing and Internet platform does not mean that the doctors of the derailed hospital should build a test line first, and let the target of the task run first < br / > at the end of the paper, I put forward a digression about the new medical reform and Internet special cooperation to promote strategic tasks In Document No 73, there is no special reference to zero plus, but we believe that modern hospital management and decision-making must have cost pressure and profit motivation It's so important for guotan medicine to land If it's specially for guotan medicine to add 15%, medical insurance and patients can afford it It's too important for us to make medicine well.