How to coordinate the interests of the four parties in the "three-medicine linkage"?

Text | Zhao Xinxi, Secretary of the Party Leadership Group and Director of Hebei Medical Security Bureau

Medical security is a major institutional arrangement for the country to relieve all the people from the worries of illness and medical care, and to improve people's livelihood and well-being.

1.

First, implement the universal participation plan to expand the size of the medical security fund.

Second, the overall planning level should be implemented to improve mutual support and risk resistance of funds.

Third, strengthen the supervision of medical insurance funds and severely crack down on fraudulent insurance fraud.

2.

First, carry out centralized procurement of pharmaceuticals and consumables to reduce the burden of medical expenses for the masses.

Second, strengthen the management of the medical insurance catalog, and include more life-saving medicines into medical insurance reimbursements.

Third, deepen the reform of decentralization, management and service, and provide insured persons with more high-quality and efficient medical security management services.

3.

First, establish a dynamic adjustment mechanism for medical service prices in public medical institutions, and gradually straighten out the relationship between medical service prices.

Second, implement the policy of rewarding and returning the balance of the medical insurance fund to support the healthy development of medical institutions.

Third, establish a medical insurance prepayment working capital system to reduce the pressure on medical institutions to advance funds.

4.
Overall planning and taking into account the interests of pharmaceutical companies is the intended meaning of transforming the advantages of the medical security system into governance efficiency

Medicines and medical consumables are "weapons" for human beings to fight diseases.
With the growth of world wealth and the aging of the population, as well as the increasing importance of people's health and the ability to pay, the existing drugs are far from satisfying the treatment of diseases.
Rare diseases will not be mentioned for the time being, even common diseases such as cancer, leukemia, and Alzheimer’s disease still lack effective treatments.
Due to the continuous strengthening of national policies to support drug research and development, my country has made great achievements in drug research and development.
However, we still need to be soberly aware that compared with some developed countries, there is still a gap.
We must give full play to the advantages of the system, and in the process of deepening the reform of medical security, especially in the context of the normalized and institutionalized centralized procurement of pharmaceuticals and consumables, we must create a good environment for innovative R&D and fair competition for pharmaceutical manufacturers.

First, regulate drug listings to promote fair competition among pharmaceutical manufacturers on the same platform.
For a long time, my country's drug price formation mechanism is not sound enough.
On the surface, it seems that the market regulates the formation of drug prices.
However, after digging deep, it is not the "market" that determines the price of drugs at all, but the pharmaceutical companies and hospitals.
The "market" emphasizes both parties of supply and demand, that is, buyers and sellers.
Although pharmaceutical companies are sellers of drugs, hospitals are not the real buyers of drugs.
Whoever pays is the buyer.
The real buyers of drugs are medical insurance and patients.
Medical institutions can only purchase and use drugs after the company’s drugs are listed on the Internet.
Therefore, the “source” control of the amount of drugs and the price of drugs is the drug listing.
We must give full play to the "entry" role of the recruitment platform, standardize drug listings, and provide drug manufacturers, especially generic drugs and original research drugs that have passed the consistency evaluation, with a fairer opportunity to compete, which is beneficial to the return of drug prices.
A reasonable level can also avoid "bad money driving out good money", thereby further stimulating the endogenous motivation of pharmaceutical companies' research and development, guiding them to shift their focus to the right track of improving drug quality and promoting drug research and development, and promoting the transformation and upgrading of pharmaceutical companies.
In this regard, Hebei took the lead and carried out beneficial explorations.
Through the revision and improvement of the online policy, the classification and refinement of the conditions for the online registration of chemical drugs, biological agents and Chinese patent medicines with the same generic name and the same quality level were specified, and the same generic name and quality were specified.
The price between the lowest and highest level of chemical drugs is generally no more than 1.
8 times, and biological preparations and Chinese patent medicines are generally no more than 3 times, so that pharmaceutical manufacturers can fully compete on the same platform of fairness and openness, and realize the survival of the superior and the elimination of the inferior.
Good results have been received.

Second, ensure the amount of selected products to ensure that pharmaceutical manufacturers earn reasonable profits.
The state organizes and implements centralized procurement of medicines and medical consumables, which greatly reduces the cost and promotion cost of selected products to enter the hospital.
At the same time, the unit production cost of pharmaceutical consumables is greatly reduced through the effect of scale at the market exchange price, so that pharmaceutical manufacturers can change from " Completely liberated from the disorderly competition of "sales with gold" has created a good environment and favorable opportunities for pharmaceutical companies to engage in research and development without distraction.
Although the price of selected pharmaceutical consumables has fallen sharply, the main thing that is squeezed out is the cost of the sales link of pharmaceutical products.
As long as we ensure the amount of selected products, the manufacturer can still earn normal profits.
Hebei is not a "4+7" pilot.
Under the strong support and guidance of the National Medical Security Administration, our province proactively followed up the pilot work of the first batch of centralized drug procurement and use of the national organization.
July 1, 2019, in 2020.
The first procurement cycle expired on June 30, and 341.
22% of the contracted procurement volume was completed; on April 1 last year, we overcame the impact of the epidemic and took the lead in implementing the results of the second batch of centralized drug procurement in the national organization.
March 31 this year The first procurement cycle of Japan was completed, and 134.
98% of the contracted procurement volume was completed, effectively protecting the interests of the selected enterprises.

Third, ensure timely payment of funds and reduce the funds and financing costs of pharmaceutical manufacturers.
In the past, many hospitals had a long payment cycle.
Some were due to the difficulty of fund turnover, and some were due to the payment process.
Of course, some hospitals used the drug payment for infrastructure and other aspects.
Default payment became a habit, and mutual influence formed a common situation.
phenomenon.
The problem of late payment has seriously affected the operating efficiency of pharmaceutical manufacturers, and also restricted the R&D and innovation of enterprises to a certain extent.
After the National Medical Security Administration implemented centralized drug procurement, it immediately issued supporting measures documents, which clearly stipulated that hospitals should settle settlements with enterprises in a timely manner in accordance with the contract, reduce corporate financial costs, and encourage medical insurance agencies or purchasing agencies to directly settle settlements with enterprises Or prepay for medicines.
Hebei earnestly implements the deployment requirements of the National Medical Security Administration, and attaches great importance to the collection of drug payments.
The supporting measures for each batch of centralized and large-volume procurement work put forward specific requirements for the timely collection of payments to the enterprise, and stipulates that the purchaser shall not be allowed to pay from the acceptance of the goods to the payment More than 30 days.
Our province currently implements two settlement methods: direct settlement between medical institutions or medical insurance agencies and drug manufacturers or distribution companies.
For medical institutions and drug manufacturers or distribution companies, the medical insurance agencies will purchase amounts according to the contract.
A certain percentage is prepaid to the medical insurance fund of medical institutions as a working capital for medical institutions to pay the company for drug purchases, and the special funds are used for special purposes; for medical insurance agencies that directly settle settlements with drug manufacturers or distribution companies, the medical insurance agencies will settle with the enterprise in a timely manner , To maximize support for enterprise development.

This year is the 100th anniversary of the founding of the party.
In accordance with the deployment requirements of the Central Committee and the Hebei Provincial Committee of the Communist Party of China, the Hebei Provincial Medical Security Bureau regards the study and education of party history as an important political task throughout 2021.
The new bureau transforms the effectiveness of party history learning and education activities into a driving force for the high-quality development of medical security, and takes into account the "quartet interests" of the country, patients, medical institutions, medical staff, and pharmaceutical companies in overall planning, and promotes the transformation of the advantages of the medical security system into governance efficiency In terms of further exploration and innovation, we will demonstrate new deeds in building a new pattern for the development of medical security in the new era.