Good example Sanming medical reform: when is it no longer an island?

Source: Economic Observer 2015-04-18 introduction: Shen Nianzu and Zhao Yanhong started the medical reform in 2012 Sanming, a mountain city in Northwest Fujian Province, has experienced a nationwide shock However, now Sanming medical treatment is facing the trouble of reform island It is Zhan Jifu's biggest wish to let Sanming model go to the whole country On April 1, the deep restructuring meeting of the Central Committee talked about breaking the profit-seeking mechanism of public hospitals, and said that we should speed up the reform pilot based on China's national conditions, and form replicable and generalizable experiences as soon as possible Sanming is neither the first batch of 17 pilot cities of public hospital reform in China, nor the first batch of 311 pilot areas of county-level public hospital reform However, since February 2012, in the three years since the reform of self testing public hospitals, not only turned the health insurance fund into profit, but also created many "first" measures in Fujian and even the whole country In February 2014, Liu Yandong, vice premier of the State Council in charge of health, visited Sanming to investigate the work of medical reform, focusing the whole country's attention on this small mountainous city Before and after, there are many "government" scholars who tend to the health sector to support the "Sanming model" of medical reform Subsequently, the Forum on comprehensive reform of urban public hospitals was held in Sanming Li Bin, director of the national health and Family Planning Commission, and Wang Baoan, Vice Minister of the Ministry of Finance attended and delivered speeches respectively The meeting was interpreted as the affirmation of "Sanming model" by the two ministries and commissions, which is a signal to push it to the whole country However, although last year alone Sanming welcomed more than 300 groups of study and investigation groups across the country, there were few local replication and promotion of Sanming model Some of the representatives who came to investigate the situation said frankly, "it's a good practice They can't learn, and they don't have the law!" Zhan Jifu, leader of Sanming medical reform leading group, thinks: "reform is the adjustment of the whole interests, which is very difficult", "what is difficult in medical reform is not investment, not plan, but determination" Whose cheese has Sanming medical reform moved, making it difficult for the pilot promotion which is widely favored by the higher authorities? Among them, there are not only the protracted battle between the health sector and the human resources and social sectors for the power of medical insurance management, but also the game between the prefecture level cities and the provincial government for the power of pricing, and at the same time, it also touches the multiple interests of medical companies, doctors' grey income and so on An official deeply involved in Sanming medical reform was worried about Sanming medical reform: "if the promotion at the national level is not kept up, Sanming will be put out." Zhan Jifu, 54, a leader with the power to understand business, beat the coffee table rhythmically with his knuckles, with a strong sense of righteousness in his voice: "medical reform is a war without smoke of gunpowder, and it must be based on the harmony of time, place and people, that is, you want to do it, you can do it, and the leadership requires you to do it!" Previously, among the reasons why Sanming medical reform was called non replicable, Zhan Jifu was the first to bear the brunt Zhu hengpeng, who has visited Sanming for many times, spoke highly of Zhan Jifu, saying that he was an energetic official with power and understanding of business Zhan Jifu called himself "not only the designer of medical reform, but also the promoter and clapper" He once served as the deputy director of Fujian Provincial Drug Administration and the deputy director of provincial medical reform and provincial bidding Leading Group, who was familiar with the way of reform He went to other places to preach Sanming medical reform, which never needed a bottle of water or a microphone, and didn't need to prepare in advance His subordinates also introduced that Zhan Jifu often worked late into the night and would convene a meeting as soon as he had an idea Zhan Jifu played an indispensable role in Sanming medical reform Among them, he did the most important two things First, he took "government reform" as the first step of medical reform, and unified the management of health, human and society Second, in the "three medical linkage" reform, he pointed to the price of drugs According to the traditional practice of the division of labor of Sanming municipal government, education, science, culture, health, social security and social assistance are in the charge of two municipal leaders respectively, and the specific management functions are scattered to the Health Bureau, Personnel Bureau, development and Reform Commission, Finance Bureau, etc After the beginning of the reform, Sanming centralized the relevant government departments of "Sanyi" to Zhan Jifu, the then vice mayor, and gave him full authorization No other leaders intervened in specific affairs Sanming City medical reform leading group issued more than 70 documents, all issued by him alone "Since it is a campaign, the generals on the front line must have all the power of decision, disposal and command," Zhan explained He believes that the reform of public hospitals is to change the government, not the hospital Public hospitals and presidents are operators, and the system and rules are set by the government If this is not changed, hospitals and presidents can only walk on the old road This measure of centralizing the power of medical reform is now affirmed by the leaders of Fujian Province, but it also faces the problem of implementation and promotion On February 26 this year, Li Hong, vice governor of Fujian Province, said at the pilot Conference on deepening the reform of the medical and health system, "all regions should pay special attention to the operators of medical reform, which is very important For example, Comrade Ji Fu of Sanming is very familiar with and proficient in the work of medical reform He is an expert and invited to give lectures by relevant ministries and commissions such as the national health and Family Planning Commission and many places in the country Local governments should also choose a competent leader to take charge of the relevant work of medical reform The division of labor in our province has been adjusted Although I am not in charge of human resources and social security, food and Drug Administration and other departments, I have adjusted the medical insurance, drug circulation and other three aspects involved to a person in charge All regions should also adjust quickly, which is more conducive to the overall planning of medical reform " In addition to integrating the power of medical reform, Zhan Jifu also integrated the "Three Guarantees in one" and solved the problem of whose management it belongs to, so as to ensure that the medical insurance policy comes from one department In June 2013, Sanming City integrated three types of medical insurance agencies including urban employee medical insurance, resident medical insurance and new rural cooperative medical insurance into "medical insurance fund management center" The center is subordinate to the municipal government and temporarily managed by the financial department (mainly considering that the management responsibilities have not been integrated at the national level) A person familiar with the matter said that the reform was not recognized by the province at first, and the two major departments of people's and social security and health care vied to manage medical insurance As early as 2013, the social security department and the health department at the national level had a fierce game around the management right of medical insurance In order not to offend the two sides, Sanming reform gave the management power to the fiscal agency In fact, it was through the financial system that the medical reform in this small mountainous city was first pushed to the central government At the end of 2013, Wang Baoan, Vice Minister of finance, led a team to investigate the reform of Sanming public hospitals The results of the survey were released in early April 2014 - "the linkage of" three medical services "requires dividends from comprehensive reform - the survey report on the reform of public hospitals in Sanming City, Fujian Province" He praised Sanming's medical reform measures, saying that "the starting point, principle and general direction of the reform are undoubtedly correct", and "proposed to hold a public hospital reform field meeting in Sanming as soon as possible in the name of the medical reform office of the State Council, to promote the successful experience of Sanming's public hospital reform" After that, Liu Yandong and more than 300 groups of delegation visited Until the pilot conference of Fujian Medical Reform held in February this year, Li Hongcai, vice governor, recognized and supported the "integration of medical insurance agencies" "It's necessary to combine It doesn't matter where we put them together No matter whether it's sanitation, human resources and social security, or even finance, the provincial government agrees But the bottom line is that health care policies have to come from one department " We have also set tasks for cities to complete in the first half of this year In August 2013, Zhan Jifu was promoted from the position of vice mayor to the Standing Committee of Sanming municipal Party committee and Minister of publicity, and still served as the leader of the leading group of medical reform He was not only the operator of Sanming medical reform, but also the promoter of Sanming model He hoped to be able to push it to the national level“ It is proved that the reform of the medical and health system is to let the common people enjoy the maximum health insurance with the lowest medical cost, which is actually a way to go " However, it was Zhu hengpeng, who praised Zhan Jifu's personal courage, who put forward the view that "Sanming model can neither be sustained nor copied" "There are very few officials in China who understand business and have power like Zhan Jifu He relies on administrative power and personal courage to do so Once he retires or leaves, the reform will be unsustainable It's hard to keep going without a mechanism In terms of system, Sanming medical reform is a reflection This is an enhanced version of the public health care of that year " "It's no use for us to study with such a great deal of reform We have to ask our mayor to come," said an official from the human resources and social security department in Jiangxi Province According to Zhan Jifu, it's not the investment, not the plan, but the determination of the leaders "The problem we are facing now is not that there are no generals, there are generals but they dare not do it Many of them are vested interests." "More than 90% of drugs have room for price reduction, with 50% of the price cut There is no problem at all," Zhan Jifu quoted Wei Feiyan, deputy to the National People's Congress and chairman of Guangxi Huahong pharmaceutical, as saying at this year's "two sessions" He calculated an account that "the bidding price of provincial procurement reaches 3-4 times of the factory price, and the final price paid by the patients is 4-5 times of the factory price The difference between the sales price and the factory price is 15-20% of the drug markup by the medical institutions, 6% of the distribution fee by the distribution enterprises, 20% of the marketing fee by the pharmaceutical agents, and 30% by the doctors." About 10% commission will be paid to the overseas ticket companies Turn down 34 and connect 33 What Sanming has to do is to squeeze out the water in the middle However, the price adjustment is in the provincial Price Bureau Department, and the prefecture level cities do not have this power Sanming came up with a price limit It is reported that the price of Sanming medical reform Chinese medicine has been significantly reduced because it can be negotiated twice under the provincial bidding platform After the reform, medical expenses have been effectively controlled The annual growth rate of total medical expenses has decreased from 19.4% in 2006-2011 to 6.6%, and that of sub average medical expenses has increased by 6.7%, which is lower than the national average growth rate of 7.8% The average medical expenses of discharged patients increased negatively, and the total and secondary average medical expenses decreased "These data are rare in China," said Ying Yazhen, director of the development research center of the national health and Family Planning Commission, who has twice been to Sanming for research According to Sanming's official statistics, after the reform, although the price of 69 kinds of drugs dropped by more than 50%, thousands of drugs dropped only 10% Zhan Jifu admits that Sanming's whole volume is too small and the dosage of medicine is too small It's very difficult to peel off all the water Zhan admitted that Sanming should still have 20% of the water During a visit to Sanming, the reporter of the Economic Observer learned that all nine pharmaceutical distribution enterprises in Sanming are facing the dilemma of declining performance "Our group's performance in other parts of Fujian is growing, only Sanming is declining Quanzhou sells more than two billion yuan a year Sanming had 60 million to 80 million yuan before the medical reform Now it's hard to do 10 million yuan for Sanming " Zhuang Yong, head of Sanming Jingshan Pharmaceutical Co., Ltd This company is a little weak among nine distribution enterprises in Sanming.