Happy and worried about the implementation of zero drug addition policy
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Last Update: 2017-05-15
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Source: Internet
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Author: User
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Source: economic reference daily May 15, 2017 medical network according to the notice of comprehensively promoting the comprehensive reform of public hospitals, all kinds of public hospitals at all levels in China will cancel the drug mark up before the end of September this year In Fujian, Hunan, Sichuan and other provinces where the drug markup has been cancelled, the reporter of economic reference found that the burden of medical treatment for the masses was generally reduced, but in some places, due to the reform of "individual breakthrough", there were also some phenomena, such as the lack of supporting compensation measures leading to the "out of pocket" filling gap in public hospitals, and the "bidding death" of low-cost drugs caused by the cancellation of drug markup With the elimination of drug addition in some provincial public hospitals, zero margin sales of drugs have gradually changed, which has brought real benefits to the masses and avoided the "return to poverty due to illness" From December 20 last year, Sichuan began to implement the policy of canceling drug markup in urban public hospitals Zhuang Yun, a 49 year old villager in Longqiao Town, Xindu District, Chengdu, said: "not long ago, my father was hospitalized in a large hospital for surgery due to early colon cancer, which cost 38000 yuan Then I transferred it to the second people's Hospital of Xindu District for inpatient rehabilitation treatment I paid 1000 yuan in advance After more than 10 days in hospital, the nurse sent me the list I didn't dare to see it at first I thought it would cost thousands of money When I opened it, all the inpatient expenses were only 300 yuan! " Mr Xu, a Fujian patient, needs to take medicine all the year round because of chronic hepatitis B He calculated an account for the reporter of the economic reference: "there are 14 lamivudine tablets in a box for the treatment of hepatitis B, which used to be 54 yuan, but now it's only 38.5 yuan For our patients with chronic diseases, we can spend a few hundred yuan less in a month, and the effect of" load reduction "is particularly obvious." "Drug markup is a kind of compensation policy for public hospitals since 1980s Under the condition of market economy, it has gradually evolved into a mechanism to supplement medical services with drugs, which makes public hospitals deviate from the track of public welfare, leads to the virtual high price of drugs, and promotes the unreasonable rise of medical expenses." Yuan Mingyong, director of Pharmacy Department of Affiliated Hospital of Chengdu Medical College, said Lai Bitao, deputy secretary-general of Fujian provincial government, said that Sanming, Fujian Province, solved the problem of "supporting doctors with drugs" from the "water test" in 2013, and simultaneously established a new compensation mechanism Through multiple channels such as increasing the price of medical services, it compensated the income from the reduction of drug addition, effectively controlled the unreasonable growth of medical expenses, and reduced the burden of patients' medical expenses Since 2015, Fujian Province has taken the lead in promoting "zero margin" sales of public hospital drugs nationwide Zhu Shufang, director of the health and Family Planning Commission of Fujian Province, said that in 2016, the proportion of medical consumables in public hospitals in Fujian Province decreased by 4.64 percentage points year-on-year, and the proportion of medical service income such as consulting, nursing and surgical treatment reflecting the technical and labor value of medical personnel increased by 2.51% year-on-year On April 8 of this year, the implementation plan for the comprehensive reform of the separation of medicine in Beijing was officially released More than 3600 medical institutions carried out the reform around three aspects of "separation of medicine, standardization of basic medical service projects, and implementation of pharmaceutical sunshine procurement" They said goodbye to the "great exchange of blood" in the compensation mechanism After the reform, the proportion of drug cost and drug cost decreased, and the change of medical service and cost met the reform expectation According to the data, from April 8 to May 5, the average cost of outpatient and emergency medicine in Beijing tertiary hospital decreased by 9.6% compared with March this year; the average cost of inpatients decreased by 4.1%; the average cost of inpatients decreased by 17.7% The average drug cost of outpatient and emergency treatment in the second level hospital decreased by 14.8%; the average drug cost of inpatient decreased by 14.1%, and the average drug cost of inpatient decreased by 24.0% In the interview of public hospitals "back discount" to fill the gap, the reporter of economic reference also found that after some local public hospitals cancelled the drug mark up, the corresponding supporting compensation measures were not in place, leading to chain reactions such as "back discount" in public hospitals, which caused the concern of some public hospital managers and medical staff Since last year, public hospitals in all cities in Hunan Province have fully implemented zero margin sales of drugs However, the current situation is that there is little government compensation, and the increase of medical service costs cannot make up for the decrease of drug income Xiang Hua, vice president of Hunan people's Hospital, said: "at present, many hospitals in Hunan have not achieved the expected 80% compensation rate after the implementation of zero drug difference rate Among them, the average compensation rate of three hospitals in Xiangya is 51.2%, and that of hospitals directly under Hunan Province is 67.44% At present, hospitals rely on their own profits to buy equipment After the implementation of zero difference rate of drugs, the purchase of large-scale medical equipment in hospitals will face the problem of insufficient funds If this situation is not improved, public hospitals will face the embarrassing situation that they will not be able to replace medical equipment in a few years Wang Yunhua, member of the CPPCC Hunan Provincial Committee and professor of Xiangya No.2 Hospital, thinks that now the drug price of large public hospitals in Hunan Province has dropped, and the inspection fee has also decreased This gap can only be compensated by the price of medical services However, the hospital charges in this respect are not enough to make up for the reduced drug mark up and inspection costs Once the hospital's income and expenditure are difficult to balance, it will certainly affect the treatment and enthusiasm of doctors Zhang Deming, vice president of Ya'an people's Hospital of Sichuan Province, said that for a long time, whether the public hospitals expand the scale or improve the software and hardware facilities, the vast majority of investment mainly depends on the hospital's self financing funds, resulting in the rapid rise of hospital liabilities After the cancellation of drug mark up, if the price of medical services is not raised in place, the government's insufficient compensation will make the public hospitals even worse in terms of debt repayment ability "Medical personnel are also the main body of medical reform It should be a comprehensive project to cancel the drug markup But at present, in public hospitals, the labor value of doctors has not been well reflected, especially in obstetrics and Gynecology, pediatricians, who work 24 hours with high labor intensity, often face disputes How the doctor's income will be reflected after the cancellation of drug mark up is a common concern of medical staff " Said Gu Xiangru, President of Xindu people's Hospital in Chengdu, Sichuan Province A person in charge of Chengdu Xindu District Health and Family Planning Bureau said that public hospitals should adjust their income structure to ensure timely digestion of the "gap" caused by the elimination of drug mark up The death of low-cost drugs caused patients to worry about the interview with the reporter of economic reference newspaper It was found that in some places where the policy of "zero margin" of drugs had been implemented, low-cost drugs and basic drugs were cut off due to the hasty landing and other reasons, causing patients to worry Industry insiders said that in the process of reform, we should be careful to prevent similar phenomena from "nibbling" the reform results In a hospital in Chengdu, a number of patients told reporters that they are now buying commonly used drugs in the hospital Some drugs are indeed cheaper, but the registration fee is almost the same as that in the market The key is that the waiting time for registration is the same One patient said: "we are more afraid of drug disappearance than drug price rise Recently, the commonly used medicine of hypothyroidism patients, eujiale, is not available in the market " Cheng qianrong, director of Pharmacy Department of Chengdu Second People's Hospital, said that under the background of incomplete compensation mechanism at present, public hospitals generally adopt "medicine to support doctors" to obtain income and maintain operation and development After the cancellation of drug mark up, if the supporting reform fails to keep up, it may aggravate the shortage of some cheap drugs Lin Song, director of Fujian medical equipment joint purchasing center, said that in the light of the situation in Fujian Medical Reform in recent years, some pharmaceutical enterprises do not produce after winning the bid at a low price, leading to the lack of temporary and seasonal basic drugs in public hospitals, which is commonly known as "winning the bid" "In the early stage of Sanming medical reform in Fujian Province, due to the small purchasing market and low bargaining power, many pharmaceutical companies also encountered" joint encirclement and suppression ", leading to" low-cost drugs "and" life-saving drugs "cut off supply This is a general problem that may be encountered in the reform After promoting medical reform at the provincial level in Fujian Province, through the formation of hospital negotiation "Consortium", the bargaining power has been enhanced, effectively alleviating the shortage of some drugs " Lin Song said.
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