Health Insurance Bureau important speech draft outflow: the third batch of collection recently launched a crackdown on commercial bribery, fraud and insurance

Wen/Linanrecently, the State Health Insurance Bureau Hu Director in the deepening of the reform of the health care system training course speech in the industry circulationNearly 20,000 words of content reveal the future health care system reform of the important tasks and directions, including centralized procurement, catalog access negotiations, payment method reform and so onThese reforms will deeply affect the entire pharmaceutical industryin the speech, the State Health Insurance Bureau Hu director revealed that the State Bureau will comprehensively promote the purchase of belt volumeSpecific is to gradually realize the normal operation, policy standardization, operation standardization, team specializationOn the one hand, the implementation of the second batch of national collection, on the other hand, will carry out high-value medical supplies centralized procurementThe State Bureau said that on the basis of summing up the experience of local procurement in the early stage, the national organization organized a nationwide coronary bracket and other high-value medical supplies centralized band procurement pilotand, in accordance with the normal trigger mechanism, the recent launch of a third batch of national organization sourcing of drugsIn addition, the State Bureau to guide all regions, especially the pilot provinces of comprehensive medical reform, will be more non-evaluated drugs and high-value medical supplies into the scope of collectionworth mentioning, the State Medical Insurance Administration recently issued a letter to establish the pharmaceutical price and recruitment credit evaluation systemThe move is also a way to curb commercial bribery and squeeze out the price of drugsAccording to incomplete statistics, the annual cost of drugs used for commercial bribery amounted to 200-250 billion yuan, and these are ultimately paid by the people and the health insurance fundstate bureau said the system would require companies to commit in writing to eliminate commercial bribery and voluntarily declare cases of judgment or administrative punishmentThe collection and collection agencies shall conduct verification and credit evaluation with the information of court decisions and administrative penalties, and take measures to deal with the enterprises that have failed to do so, including a written reminder warning, warning to the purchaser of the risk of the enterprise, suspending the bidding network and distribution qualifications, and publicly disclosing the breach of trust enterprisethe volume of procurement, combined with this system, will directly block the dead drug companies with gold sales, commercial bribery modelAt present, medical reform has entered the deep water area, reform every step forward, is bound to offend a group of interest groups From the attitude of the National Health Insurance Administration, it will continue to promote the medical insurance system towards maturity, to achieve high-quality development of the cause of health insurance The tide of reform is unstoppable the 2019 adjustment of the national health insurance drug catalogue, including the national key monitoring drugs and other 154 drugs were transferred out, this initiative for the health insurance fund to save more than 15 billion yuan , there are still a series of problems in the management of medical insurance catalogues, such as the scientific adjustment mechanism has not been established, the management level needs to be improved, the imbalance between regions, the lack of medical treatment projects and supplies catalog management revealed that each year only public medical institutions use a separate fee for medical supplies spending more than 370 billion yuan On June 8th, the State Administration of Medical Insurance issued the Interim Measures for the Administration of Medical Supplies for Basic Medical Insurance (Draft for Comments) This is the first time at the national level to develop the "basic medical medical supplies catalog", the document especially stressed that the catalog refers to medical supplies, refers to the approval of the drug supervision and administration department, can be charged separately, and has a unified code of medical supplies for medical security supplies As can be seen, for this part of the medical supplies, the National Health Insurance Administration has been out of charge the speech, the Next national health care bureau will improve the policy system, clear responsibility and authority, the development of payment standards, and grasp the directory landing important elements include: 1 The Medical Insurance Bureau has studied and drafted the Provisional Office of Drug Administration of Basic Medical Insurance, which is to be issued in the near future We will set up and improve the catalogue of high-value medical supplies and medical treatment items, and 2 The national level will focus on the formulation and adjustment rules of medical insurance payment standards, and take the standard of medical insurance payment as an important measure to refine the management of the catalogue The new access catalog of drugs and consumables will be negotiated, collection and other ways to develop payment standards, 3 The Health Insurance Bureau asked all regions to speed up the formulation of provincial supplementary varieties of three-year digestion program, by the end of June this year, the national key monitoring varieties out of the catalog, and ensure the completion of the first year at least 40% of the digestion target For a few provinces still break through the policy to adjust the list of self-adjustment, the National Health Insurance Administration will take seriously the establishment of the National Health Insurance Administration in 2018, launched the DRG Paying National Pilot, identified 30 cities as the DRG Pay19 National Pilot Cities, formed chS-DRG sub-groups and paid technical specifications and subgroups programs, and actively promoted the payment of big data-based by disease however, from the overall effect, the incentive and restraint mechanism of medical insurance payment method to both supply and demand of medical services has not been effectively played Mainly from the number of co-ordination areas, the implementation of disease-based multi-complex medical insurance payment methods accounted for the majority of the co-ordination area, but from the total amount of funds, the traditional pay-per-project-based way or mainstream, reaching about 70% in deepening payment reform, NHS reveals 1 Improve the total budget management Explore the establishment of a combination of the regional budget total points method and the total budget control of institutions, do a good job of the point method and by disease, disease group payment, and gradually use the regional (or within a certain range) of the total amount of medical insurance fund management instead of the total management of specific institutions 2 Form a multi-composite payment pattern As soon as possible, in-patient medical services to achieve a full coverage of DRG-based or big data-based pay-per-disease Bed-time payments for inpatient medical services, such as mental illness, rehabilitation, etc., that are not suitable for paying for DRG or disease sub-rates The family contract services for the people to fully implement pay-per-head, and actively promote the combination of chronic disease management To achieve the goal of paying less than 50 per cent per project for in-patient medical services In addition, the study and development of close-type county medical community payment methods, improve the performance appraisal management in addition, in addition to the speech also conveyed two industry issues of concern, the State Health Insurance Administration will continue to step up efforts to combat fraud insurance, aimed at fraud and insurance "soil" to cut grass root;