How will 50 policies affect the pharmaceutical industry in the second anniversary of the establishment of the State Health Insurance Bureau
Last Update: 2020-06-19
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The state health insurance bureau has been listed for two yearsOn May 31, two years ago, the National Health Insurance Bureau officially listed its office in Yuetan North Street, Xicheng, BeijingIn the next two years, a series of policies, such as health insurance fund supervision, volume purchase, health insurance catalog adjustment, DRG payment, were studied, formulated and launched here, which brought great changes to the health care industryAs the regulator, the medical insurance bureau has become the most dazzling innovator in the industry, bringing increment and imagination to the future medical treatment< br / > < br / >In the future, while establishing a multi-level medical payment system, an innovative medical service system will also be establishedBeyond the path of < br / > < br / > < br / /, the greater logic lies in that the power of policy and its representation is not only forced and prevented, but also productiveIt produces new discourses, new types and new objects, and constitutes new practice and new ecology< br / > < br / > two curves < br / > < br / > as early as 2014, a report jointly issued by Huazhong University of science and technology and people's Publishing House predicted that by 2024, "medical insurance fund will face a serious deficit of 735.3 billion in balance deficit." < br / > < br / > < br / / > there is a certain basis for this predictionThe large increase of medical expenditure every year affects people's heart< br / > < br / > < br / / > in 2014, the medical insurance revenue was 968.7 billion yuan, and the expenditure was 813.4 billion yuanIn the following years, the pressure of medical insurance continued to increaseBy 2018, the growth rate of medical insurance expenditure was 22.08%, and the growth rate of medical insurance income was 17.61%For the first time, the growth rate of medical insurance expenditure exceeded that of medical insurance income< br / > < br / >< br / >< br / > < br / > < br / / > in the previous system, the supervision of medical insurance funds was scattered in the hands of four departments The medical insurance for urban employees and residents is managed by the Ministry of human resources and social security, the new rural cooperative medical system is managed by the health and Family Planning Commission, the medical assistance is managed by the Ministry of civil affairs, and the medical services and drug prices are managed by the development and Reform Commission In order to manage as a whole, we must integrate these functions and set up a new management department This integration can not only make the health insurance fund fully managed and regulated, but also promote the industry reform and other things through the identity of super payer < br / > < br / > < br / > in addition, when the medical reform enters the deep water area, it needs to find a more powerful fulcrum and focus point to reach a deeper level of reform In this context, the National Health Insurance Bureau was born In March 2018, the institutional reform of the State Council and the introduction of top-level design were carried out; in May, the state health insurance bureau was officially listed for office < br / >? < br / > < br / > 50 policies < br / > The National Health Insurance Bureau may take the opportunity of public opinion (the United Nations national health and Health Commission) to issue the first heavy policy since its establishment, "notice on carrying out provincial-level special centralized procurement of anticancer drugs" < br / > < br / > In this world, it's always like this Things are related to each other and separated from each other It's difficult for you to clarify the relationship between the two things < br / > < br / > < br / > < br / / > according to the public data in the "government documents" column of the official website of the National Health Insurance Bureau, the arterial website has obtained many inspirations through statistics and classification: < br / > < br / > < br / > (Note 1: after the establishment of the "government documents" column of the official website of the National Health Insurance Bureau, there are 54 documents, of which 4 are issued by other regulators, so they are not included in this statistics, and important policies will be listed and discussed separately in this article Note 2: some policies often involve multiple fields The classification results of this paper do not necessarily coincide with the policy Please pay attention.) < br / > < br / > in the two years since its listing, the state health insurance bureau has issued 50 policies independently or jointly with other departments Article 13 belongs to government matters and work notices, such as the notice on strengthening the construction of medical security system and the list of administrative law enforcement matters of the State Medical Security Bureau (2020 version), etc < br / > < br / > < br / > in addition to government affairs and work notices, 37 other heavy policies have brought far-reaching influence and great changes to the industry < br / > < br / > The purpose of centralized drug purchase is to explore and improve the mechanism of centralized drug purchase and the mechanism of drug price formation led by the market, reduce the burden of drug costs on the masses, standardize the order of drug circulation, and improve the safety of drug use by the masses The state health insurance bureau, with the power of payment, supervision and pricing, intends to explore the formation mechanism of drug price through the "4 + 7" pilot program < br / > < br / > In the initial stage, 25 of the 31 pilot varieties were selected Compared with the lowest purchase price of the same kind of drugs in the pilot cities in 2017, the average price of the selected drugs decreased by 52% and the highest price decreased by 96% < br / > < br / > < br / > by the end of 2019, the total amount of online purchase orders of 31 provinces (districts and cities) through the provincial drug centralized purchase platform has reached RMB 991.3 billion, according to the statistics express of medical security development in 2019 (hereinafter referred to as the "statistical express") released by the State Medical Insurance Bureau Among them, the order amount of Western Medicine (chemical and biological products) is 811.5 billion yuan, and that of Chinese patent medicine is 179.8 billion yuan The order amount of traditional Chinese medicine medicines for online purchase is 832.7 billion yuan, accounting for 84% < br / > < br / > < br / > by the end of 2019, the 25 selected drugs in the pilot areas of "4 + 7" drug centralized procurement had completed 183% of the agreed procurement volume, and the selected drugs accounted for 78% of the procurement volume of the same generic drugs After the nationwide expansion of the pilot program, all 25 generic varieties were successfully expanded and purchased The average price of the expanded products was reduced by 59%, and 25% on the basis of the "4 + 7" pilot program < br / > The national medical insurance catalog controls 80% of the sales market of public hospitals For enterprises, if they fail to enter the medical insurance catalog, they will lose the market volume advantage brought by the medical insurance catalog and fall into the fierce market competition And for consumers, if more life-saving drugs can be included in health insurance, they will save money < br / > < br / > < br / > on August 20, 2019, the notice of the State Health Insurance Bureau on printing and distributing the catalogue of drugs for national basic medical insurance, work injury insurance and maternity insurance triggered the industry earthquake This major adjustment of the drug catalog is the first comprehensive adjustment since the establishment of the State Medical Insurance Bureau, and also a comprehensive sorting of the original catalog varieties since the first version of the drug catalog in 2000 It is only two years since the last round of major adjustment of the medical insurance catalog < br / > < br / > < br / > < br / > < br / > according to the statistics express report data, in the national medical insurance drug catalog of 2019 edition, there are 2709 western medicine and Chinese patent medicine, including 1370 western medicine and 1339 Chinese patent medicine In addition, 892 pieces of Chinese herbal medicines with national standards have been listed < br / > < br / > there are five policies in the supervision of medical insurance funds The supervision of medical insurance fund is a primary task of the State Medical Insurance Bureau How can people's life-saving money be illegally seized and wasted For this reason, through various efforts, the state health insurance bureau has formed a high-pressure situation of cracking down on fraud and insurance fraud nationwide, and thus formed a series of working mechanisms, such as implementing responsibility, unblocking reporting and complaint channels, finding out problems strictly, seriously and quickly Now, in hospitals, communities and many other places, we can see the propaganda text of fighting against fraud < br / > < br / >, The settlement of 6595 people was suspended and 1183 people were transferred to the judicial organs; a total of 11.556 billion yuan was recovered throughout the year < br / > < br / > < br / > Four policies of the state health insurance bureau are focused on poverty alleviation and poverty alleviation < br / > < br / > According to the document, the bottom line of the hard task is to include all the poor people in the coverage of basic medical insurance, serious illness insurance and medical assistance system < br / > < br / > < br / / > in poverty alleviation, we should further strengthen the comprehensive guarantee function of the triple system We should comprehensively establish a unified medical insurance system for urban and rural residents, stabilize the expectation of hospitalization treatment, improve the overall planning of outpatient service, improve the level of serious illness insurance, continue to implement the preferential policy of reducing the minimum payment line by 50% and increasing the payment proportion by 5% for the poor population, and completely abolish the ceiling line for the poverty-stricken population in the establishment of archives; the medical assistance fund will continue to tilt towards the deep poverty-stricken areas, We will further improve the ability of medical assistance to provide basic support < br / > < br / > < br / > by the end of 2019, according to the statistical express report, the number of people covered by the full coverage basic medical insurance was 1354.36 million, and the coverage was stable at over 95% < br / > < br / > < br / > < br / > < br / > < br / > In August 30th 2019, the national health insurance agency issued the guidance on improving the policy of "Internet plus" medical service prices and medical insurance payment According to the policy, online and offline medical services shall be provided with fair price and payment policy; if the "Internet plus" medical services provided by designated medical institutions are the same as the offline medical services within the scope of medical insurance payment, and the charging price of corresponding public medical institutions is implemented, they shall be included in the scope of medical insurance payment after corresponding filing procedures and paid according to regulations < br / > < br / > < br / / > during the epidemic period, internet medical treatment has played a huge role Various platforms and physical hospitals have successively opened online fever clinics, and then expanded to online consultation in other departments First of all, we should guide the public
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