Hebei Health and Health Commission issued a letter: "four medical linkage" comprehensive drug control costs.

Editor:
recently, Hebei Provincial Health and Health Commission issued the "Hebei Province To deepen the reform of the medical and health system leading group issued on the centralized procurement and use of drugs as a breakthrough to further deepen the four medical linkage reform and sound interest control mechanism of a number of policy measures" (hereinafter referred to as "Notice").
the Circular proposes the "four medical linkages" of medical, medical, medical and drug prices, and measures to control fees through comprehensive deepening of centralized drug procurement and use and joint reform, strict tax administration on drug purchase and sale, starting the actual payment of DRG in 2021, strengthening the monitoring of key drugs, and strengthening drug price monitoring.
different from the medical insurance, medicine, medical "three medical linkage", Hebei this creative addition of "medical price" put forward four medical linkage, no doubt worthy of attention.
implement the deployment of centralized procurement reform in the country. Expand the scope of the pilot implementation of the first batch of drug centralized procurement and use of the country, expand the first batch of 25 drugs centrally procured by the country, expand to targeted private medical institutions and military hospitals, and explore coverage of large-scale drugstore chains. In 2020, the centralized procurement and use of medicines will continue to be carried out in accordance with the unified national deployment. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration is responsible for the first place for the lead unit, the same below)
in accordance with national requirements, deepen strategic cooperation with the Fujian Sanming City Medical Security Bureau, organize the province OfsanMing Procurement Alliance City, and actively participate in the non-conformity evaluation of drug concentration and volume alliance procurement organized by Sanming City. We will continue to do a good job in the centralized procurement and use of high blood pressure and diabetes outpatient drugs for urban and rural residents in Hebei Province. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration responsible)
to punish drug procurement violations in accordance with the law. We will improve the system of market withdrawal, take compensation, discipline and withdrawal measures for enterprises that cannot guarantee the quality and quantity of drugs in procurement, and do a good job of alternative and emergency protection to ensure the quality and supply of medicines. For enterprises that appear in price alliances such as ringing, stringing bids, and maliciously cutting off supply and other illegal and illegal acts, the relevant centralized procurement finalists and online registrations shall be cancelled in accordance with the law, and the relevant breach information will be pushed by the competent departments of the industry to the national credit information sharing platform (Hebei). (Provincial Medical Security Bureau, Provincial Market Supervision Bureau, Provincial Government Service Administration Office, Shijiazhuang Central Branch of the People's Bank of China are responsible for the
reform of the drug payment settlement payment system. Starting with the centralized procurement reform of high blood pressure and diabetes outpatient drugs in urban and rural residents, the medical insurance operators and drug production or circulation enterprises will be directly settled, and the scope of direct settlement should be gradually expanded to ensure that payments to enterprises from acceptance of receipt to acceptance do not exceed 30 days. In areas where conditions are not available for the time being, the medical insurance agency shall advance the medical insurance fund to medical institutions as the working capital for centralized procurement of medicines. (Provincial Medical Security Bureau, Provincial Finance Department, Provincial Health And Health Commission, Provincial Drug Administration responsible for)
strengthen the procurement of drug real-time monitoring and management. Continuously improve the expansion of the provincial drug equipment procurement platform function, strengthen the procurement of drug payment real-time monitoring, in an appropriate manner to regularly disclose the city drug payment situation. For medical institutions that fail to pay for medicines on time without good reason, they shall take early warning interviews and other means to give warnings and suspend the payment of the medical insurance expenses of fixed-point medical institutions if they do not return the money within 5 working days. The head of the medical insurance agency that fails to pay the medical insurance fund on time without good reason and the head of the medical institution who does not pay the drug on time shall be informed of the criticism in the province. Strengthen the audit supervision of medical insurance payments for pharmaceutical products, settlement of medical expenses and payment of drug payments by medical institutions. (Provincial Medical Security Bureau, Provincial Health and Health Commission, Provincial Chinese Medicine Administration, Provincial Audit Office are responsible for
strict drug purchase and sale tax management. Normal supervision of the implementation of the two-vote system. We will strengthen the administration of invoices for pharmaceutical production and circulation enterprises and medical institutions, intensify the inspection of tax evasion in accordance with the law, and crack down on tax evasion by drug enterprises through intermediary organizations, such as false promotion fees and service fees. (Provincial Drug Administration, Provincial Tax Bureau, Provincial Market Supervision Bureau are responsible for the reform of the payment method of
. We will speed up the establishment of multi-complex medical insurance payment methods, guide medical institutions to actively control costs, and prioritize the use of high-quality and low-cost drugs, supplies and technology to save medical costs. To guide the city to do a good job in the pilot work of paying countries according to disease diagnosis-related grouping (DRG), to develop technical standards such as DRG packet system and rate weighting measurement, to improve the DRG payment information system, to further improve the health insurance payment policy, the management process and fixed-point management agreement, to start simulation operation in 2020 and to start actual payment in 2021. We will vigorously promote pay-per-disease and actively promote bed-by-bed payments. Encourage all regions to actively explore payment methods to better develop the characteristics of Chinese medicine in combination with the actual situation. (Provincial Medical Security Bureau, Provincial Finance Department, Provincial Health And Health Commission, Provincial Administration of Traditional Chinese Medicine)
optimize the structure of medical institutions. Implementation of the catalogue of medicines for basic medical insurance, work injury insurance and maternity insurance in our province (2019 edition). We will promote medical institutions to establish a drug-based drug-led mode, give priority to the use of essential drugs and medical insurance catalogues, optimize and adjust the drug catalogue in a timely manner, and increase the proportion of basic drug use. According to the adjustment of the national list of basic drugs, the proportion of basic drug equipment in government-run primary health care institutions, secondary public hospitals and tertiary public hospitals shall in principle be not less than 90%, 80% and 60%, respectively. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Administration of Traditional Chinese Medicine, respectively)
strengthen the monitoring of key drugs. Medical institutions should establish and improve the system of clinical drug monitoring, evaluation, extraordinary early warning and key monitoring drug management system, strengthen the selection, procurement, adjustment, use, monitoring, evaluation and prescription review and evaluation of the whole process management of auxiliary and nutritional drugs. Adopt negative lists, public announcements, interviews and other ways to strengthen supervision, focus on monitoring the clinical use of drugs into the scope of reasonable drug use assessment, assessment results and medical institutions verification, evaluation, performance evaluation linked. The medical insurance department shall promptly deal with the prescriptions which may affect or lose the expenditure of the medical insurance fund, so as to urge the medical institutions to strengthen their internal management and standardize the behavior of medical treatment. (Provincial Health and Health Commission, Provincial Chinese Medicine Administration, Provincial Medical Security Bureau)
strengthen the supervision of medical services behavior. Establish and improve the medical personnel drug use (supplies), inspection, testing and other medical service behavior monitoring index system, drug utilization rate, large-scale equipment test positive rate, secondary average cost, inspection and testing cost ratio into the scope of big data comparison management, severe investigation and punishment of large prescriptions and other ultra-common drug behavior, the violation of the physician limit or cancel the prescription right, serious revocation of the practice certificate, interview medical institutions related responsible person, according to the law. (Provincial Health and Health Commission, Provincial Chinese Medicine Administration, Provincial Medical Security Bureau responsible for)
establish a price restraint mechanism. For drug enterprises with price increases or frequency anomalies, large differences in prices between regions, serious bad distribution situation or repeated warnings, etc., they shall adopt measures such as cost investigation, correspondence interviews, public exposure, suspension of the internet, and punishment for breach of trust, and shall be punished in accordance with the law. Strengthen the supervision of drug price behavior, strictly investigate and punish price monopoly behavior in accordance with the law, regulate the price of drugs, receive reporting leads through the 12315 hotline, and effectively maintain the order of the market price of drugs. (Provincial Medical Security Bureau, provincial market supervision bureau responsible for)
it is not difficult to see that the second half of the new crown epidemic, the provinces of frequent medical policies, price reduction and control fees, structural adjustment is still the core theme.. The centralized procurement and use of medicines is a major mechanism reform and an important breakthrough in deepening medical reform. In accordance with the state's comprehensive deepening of the centralized procurement and use of medicines, exploring the deployment of medical supplies centralized supply procurement, seizing the opportunity of reform, adhering to the reform path of teng space, adjusting structure and maintaining convergence, properly handling the interests of the government, hospitals, medical personnel and patients, and comprehensively promoting the four-medical joint reform. Starting with expanding the centralized procurement and use of drugs, we should reform the mechanism of drug procurement, reduce the false high prices of drugs, and make room for deepening reform and profit control. We will steadily adjust the price of medical services, support the expression of the value of technical services, optimize the income structure of medical institutions, and enhance the sustainable development capacity of hospitals. Adjust the benefit guidance mechanism, improve the internal assessment and distribution of remuneration for medical personnel within the approved total performance pay, and guide medical personnel to take the initiative to carry out health education, health management, disease prevention and treatment services, so that no illness, less illness, less hospitalization, less money become the common goal of doctors and the masses. We will improve the policy of medical insurance treatment, adjust the proportion of medical insurance reimbursement in a timely manner, establish and improve the mechanism of hospital control cost guidance and the use of medical insurance funds, and ensure the sustainable development of medical insurance funds. We will implement financial input, strengthen industry supervision, promote joint reform, consolidate and improve the operation mechanism of the medical union, guide the sinking of high-quality medical resources, and promote the transformation of the service model from treating diseases to health as the center, so as to better solve the problem of the masses seeing a doctor.
(i) implement the deployment of centralized procurement reform in the country. Expand the scope of the pilot implementation of the first batch of drug centralized procurement and use of the country, expand the first batch of 25 drugs centrally procured by the country, expand to targeted private medical institutions and military hospitals, and explore coverage of large-scale drugstore chains. In 2020, the centralized procurement and use of medicines will continue to be carried out in accordance with the unified national deployment. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration is responsible for the first place for the lead unit, the same below)
(2) organizations to organize the centralized procurement and use of medicines in our province. In accordance with the volume of procurement, recruitment and integration, quality priority, to ensure the amount of dosage, to ensure the requirements of return, to carry out the province's centralized procurement and use of medicines. All relevant departments and medical institutions shall not affect the rational use and supply guarantee of the selected drugs on the grounds of cost control, drug proportion, requirements for the specification of the specifications of medical institutions. In accordance with the requirements of the state, deepen the strategic cooperation with the Medical Security Bureau of Sanming City, Fujian Province, organize the procurement alliance city of Sanming, our province, and actively participate in the procurement of non-conformity evaluation drug concentration belt alliance organized by Sanming City. We will continue to do a good job in the centralized procurement and use of high blood pressure and diabetes outpatient drugs for urban and rural residents in Hebei Province. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration responsible)
(iii) actively explore the centralized procurement and use of medical supplies. In accordance with national deployment, explore the development of medical supplies centralized tape procurement work. Relevant departments and medical institutions should give priority to the use of centralized volume procurement of medical supplies. According to the Framework Agreement on Centralized Procurement Cooperation of Beijing-Tianjin-Tianjin Medical Supplies, in accordance with the division of labor of the Beijing-Tianjin-Tianjin-Tianjin Medical Supplies Joint Procurement Agreement, cooperate with the joint procurement work (Beijing-Tianjin-Tianjin-Hebei are responsible for two categories of procurement), and share with Beijing-Tianjin six types of medical supplies joint procurement to reduce the price results. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration responsible for)
(4) to establish and improve the provincial drug equipment procurement platform. Relying on the provincial drug equipment procurement platform, the construction of a unified public procurement market for pharmaceuticals, unified coding, standards and functional norms. Strengthen the management of the provincial drug equipment procurement platform, medical insurance fixed-point medical institutions used drugs, medical supplies, must be through the provincial drug centralized procurement platform procurement. For the clinically necessary and easy-to-short drugs in the key monitoring list and the shortage of drugs list drugs, the provincial drug equipment procurement platform does not have an enterprise network or is not included in the province's centralized procurement directory, medical institutions may first purchase, after the provincial drug equipment procurement platform independent lying, to achieve transparency. Revise and improve the management policy of the hook-up network, give full play to the role of the market, promote the interconnection and resource sharing of drug prices in our province, and promote drug price linkage. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration responsible for)
(v) to explore multi-party procurement methods. We will encourage the formation of reasonable prices through the procurement of medical associations, joint procurement of specialized hospitals and procurement by regional alliances, encourage the active participation of non-public medical institutions, social pharmacies, etc., and jointly promote the formation of a market-oriented mechanism for drug price formation. (Provincial Medical Security Bureau, Provincial Health And Health Commission, Provincial Drug Administration)
(VI) to strengthen drug quality supervision. We will actively promote the evaluation of the quality and efficacy consistency of generic drugs, implement the responsibility of territorial supervision of drugs through consistency evaluation, and increase supervision and frequency. Combined with special rectification and daily inspection, strengthen the supervision and inspection of selected drugs in centralized procurement and product sampling, urge the selected enterprises to implement the main responsibility, improve the quality management level, to ensure the quality and safety of drugs. (Provincial Drug Administration, Provincial Medical Security Bureau, Provincial Health and Health Commission responsible)
(7) to promote the construction of a drug circulation supervision system. To establish the basic information database of drug circulation enterprises in the province, to realize the standardization and information management of the daily supervision and inspection and certification inspection of drug circulation enterprises, and to form a unified and efficient, interconnected and cooperatively shared information system for drug supervision. Establish an information-based traceability system covering the whole process of vaccine production, circulation and vaccination, so as to realize the traceability of the whole process of vaccine. (Provincial Drug Administration, Provincial Health and Health Commission responsible)
(VIII) to improve the level of drug supply. Establish and improve the system of investigation, evaluation, assessment and monitoring of the supply capacity of pharmaceutical production enterprises, especially those selected in centralized procurement. Establish a system of emergency reserve, inventory and capacity reporting for production enterprises. We will improve the system of direct reporting of the shortage of medicines in four-level medical institutions in provinces, cities, counties and townships, do a good job in early warning and monitoring of shortage drugs, and ensure the supply of medicines. (Provincial Health and Health Commission, Provincial Medical Security Bureau, Provincial Drug Administration, Provincial Industry and Information Technology Department are responsible for each unit according to their responsibilities, respectively, the same below)
(nine) to strengthen the emergency reserves of drugs. Establish an emergency safeguard mechanism for public health emergencies and strengthen the management of emergency reserve drugs. In accordance with the scientific and reasonable reserve cycle, the corresponding rotation methods shall be formulated, and the stocks of medicines shall be rotated in a timely manner under the premise of ensuring the variety and quantity of reserves. (Provincial Department of Industry and Information Technology, Provincial Finance Department, Provincial Health And Health Commission, Provincial Drug Administration, respectively)
(10) to punish drug procurement breach of trust in accordance with the law. We will improve the system of market withdrawal, take compensation, discipline and withdrawal measures for enterprises that cannot guarantee the quality and quantity of drugs in procurement, and do a good job of alternative and emergency protection to ensure the quality and supply of medicines. For enterprises that appear in price alliances such as ringing, stringing bids, and maliciously cutting off supply and other illegal and illegal acts, the relevant centralized procurement finalists and online registrations shall be cancelled in accordance with the law, and the relevant breach information will be pushed by the competent departments of the industry to the national credit information sharing platform (Hebei). (Provincial Medical Security Bureau, Provincial Market Supervision Bureau, Provincial Government Services Management Office, Shijiazhuang Central Branch of the People's Bank of China are responsible for, the provincial Drug Administration Bureau involved)
(11) reform of the drug payment settlement system. Starting with the centralized procurement reform of hypertension and diabetes outpatient drugs in urban and rural residents, the direct settlement between medical insurance agencies and drug production or circulation enterprises will be carried out, and the scope of direct settlement should be gradually expanded to ensure acceptance from receipts and receipts.