Health insurance balance rules With volume procurement of lost varieties may be less than dead!

Recently, the State Health Insurance Administration, the Ministry of Finance, "on the state-organized drug centralized procurement work of the health insurance balance of funds retention guidance" (health insurance issued 2020 26 issued, the hospital to implement the amount of procurement compensation program determinedThis opinion will have a very big impact on the third batch of national collection, and the failure to vote is almost equal to extinctionThe guidance is clear, the collection of drugs to implement the health insurance fund budget management, that is, the health insurance fund is expected to be the total amount of expenditure on all products under the generic nameThe calculation is published as follows:the budget of medical insurance funds for collected drugs, the basic amount of agreed procurement, the weighted average price of drugs before collection, the proportion of actual payment of medical insurance funds in the co-ordination area, and the proportion of patients insured in the general-purpose drug co-ordination areaaccording to the above formula, the budget of medical insurance funds for the collection of generic drugs will be the product of the agreed purchase volume base, the weighted average price of the generic drugs before the collection, the actual payment ratio of the regional medical insurance fund, and the proportion of patients insured in the co-ordination area of the general name drug co-ordinationIn addition to the weighted average price of drugs collected, the proportion of actual payment of medical insurance funds in the co-ordination area, medical institutions can not be left or so, the agreed procurement volume basis and the proportion of patients insured in the overall area are highly correlated with the initiative of medical institutionsin short, the hospital compensation mechanism and the use of the volume procurement directly linked, the more products purchased with the band, the higher the hospital's reporting and dosage, the more compensation the hospital can getalthough there is no indication that the unselected drugs can not be used, the document clearly encourages the use of selected drugs, and points out that the use of selected drugs by fixed-point medical institutions exceeds the agreed purchase amount, in the approved balance of the calculation base may not be included in the collection of generic drugs medical insurance payment amountin the case of the total amount, the balance of medical insurance funds is calculated according to the amount of drug procurement, the price of the winning, the amount of non-selected products used, as well as the proportion of actual payment of the regional medical insurance fund and the proportion of patients using the general name drug co-ordination area, etcThe calculation formula is:balance calculation base - collection of drug medical insurance fund budget - (the selected product purchase amount , the price of the non-selected product s/ the amount of non-selected productuse) - the overall regional health insurance fund actual average reimbursement ratio , the proportion of patients insured in the general name drug co-ordination area
from the calculation formula, medical institutions can obtain the balance reward will be closely related to the agreed purchase base, non-selected product use amountIn the reimbursement ratio and the proportion of patients insured in the co-ordination area, the less the amount of non-selected products used, the more the balance measurement base, on the contrary, the more non-selected products used, the less the balance reward spent on the hospital, in order for medical institutions to obtain as much balance measurement base as possible, they need to minimize the amount of non-selected products usedThis is the hospital to minimize the use of non-secondary products of great motivationNon-selected products in the hospital will no longer be favored, living space or will be further squeezed the unselected drugs greatly affect the balance measurement base, then medical institutions can be through offline procurement of lost products to avoid this adverse effect? after determining the base of the health insurance balance measurement, according to the assessment results, the hospital can get up to 50% of the health insurance balance fund reward The documents show that the hospital has a total of 10 assessment indicators Among them, there are four major indicators are the key indicators of assessment These four indicators are: 1, whether to complete the state organization on time in the centralized procurement of selected drugs purchase volume 2, whether to achieve 30 days back 3, fixed-point medical institutions drug cost growth rate 4, offline procurement ratio for offline procurement clear: in principle, do not allow offline procurement, specificby by the provinces (autonomous regions, municipalities directly under the Central Government) or the overall set standards can be seen, the proportion of offline procurement amount requirements is to prevent the hospital secretly engage in small action of another trick, to ensure that all drugs are online procurement, to prevent the hospital will be the defeated drugs to offline procurement at the national level, on the one hand, to further ensure the use of selected varieties, on the other hand, to the unselected drugs with the balance of the calculation base of the "tight spell", and the path of the procurement of failed drugs has been blocked Generally speaking, the price of the selected varieties is the lowest and lower, then those who once high pricewith rebateproduct products will be directly out, so in the high-priced high-cost gold sales model failure, even if the doctor wants to open, there is no path, health insurance balance reward on the basis of medical institutions will undoubtedly be more inclined to choose the product spent significantly, the non-selected drugs will be completely out.