In 2015, the pricing mechanism of ice breaking drugs in public hospitals will be released by the end of the year

Source: the Third Plenary Session of the 18th Central Committee of the national economic news 2014-10-20 proposed "comprehensively deepening the reform of medical and health system", and the government, society and medical institutions began to reach a consensus on the reform of county-level public hospitals and urban public hospitals involved in the reform of public hospitals As one of the important options of medical reform, how to seek for the next step in the reform of public hospitals? On October 17, the reporter participated in the first seminar on hospital management institutions sponsored by the Chinese Hospital Association and advocated by Feng Guosheng, deputy director of Beijing Municipal Health and Family Planning Commission and director of Beijing Municipal Medical Administration Bureau, to explore the path of public hospital reform At the same time, starting from the macro policy trend, typical cases of public hospital reform in first tier cities and second tier and third tier cities, this paper attempts to conduct a multi-dimensional reform for public hospitals nationwide "Among the 336 tasks, public hospital reform is an important one." Liang Wannian, director of the system reform department of the national health and Family Planning Commission, said at the first hospital management organization seminar that the reform of public hospitals has entered the deep water area It is understood that the reform of public hospitals can be divided into two levels: county level public hospitals and urban public hospitals According to Liang Wannian, in 2015, the comprehensive reform of county-level public hospitals across the country should be pushed forward in an all-round way, "this is the top priority at present" The relevant report of urban public hospital reform will also be released to the public after the pilot city government self-assessment and the on-site assessment by the regulatory department Liang also revealed that at the end of 2014, the national development and Reform Commission will document the drug pricing mechanism Since then, the national health and Family Planning Commission will also issue a document on centralized bidding and procurement of drugs in public hospitals The reform of urban and county-level public hospitals has deepened the special reform of public hospitals, and the operational thinking of decision-making level has been increasingly refined and targeted In 2012, the State Office selected 311 counties nationwide for the pilot based on the opinions on comprehensive reform of county-level public hospitals In 2014, the national health and Family Planning Commission and other six departments jointly issued the comprehensive opinions on promoting the reform of county-level public hospitals, beginning to clearly require county-level hospitals to implement comprehensive reform, and systematically put forward a set of reform strategies, objectives, principles and requirements And 700 counties have been selected to enter the second batch of pilot projects According to the latest statistics, there are 1011 pilot institutes in total, covering more than 500 million people in China Recently, the medical reform office of the State Council will organize relevant departments and experts to supervise and evaluate the pilot areas of county-level public hospital reform, explore and form the basic way of county-level public hospital reform, and lay the foundation for next year's reform From the perspective of urban public hospital reform, the decision-making level has put forward strict requirements from three areas and nine aspects 17 cities were selected as the first batch of pilot city public hospital reform, including Beijing, Shanghai and other first tier cities This year, the national health and Family Planning Commission organized experts to conduct a comprehensive assessment of 17 pilot cities together with relevant departments, "that is, the government of pilot cities is required to conduct self-assessment first, then we conduct on-site assessment, and finally form an assessment report Now the evaluation report is still in the revision stage, and we will release it to the public after it comes out " Liang Wannian said Although the final results of the evaluation have not yet been published, Liang Wannian revealed that according to the current situation, "the mechanism and system of reform and the deep-seated medical contradictions are fully exposed, but it can be felt that the reform of the whole city's public hospitals has not yet formed a set of models that can be copied and widely promoted by everyone The reform is not comprehensive, systematic and coordinated enough " Based on this, the national health and Family Planning Commission has selected 17 more pilot cities, 34 of which cover all provinces in the country The reporter learned that the national health and Family Planning Commission is currently organizing the relevant departments to study and formulate the guiding opinions on the pilot comprehensive reform of urban public hospitals, and the 34 The pilot cities and some provinces have carried out comprehensive reform, put forward goals and relevant reform requirements, and strive to combine the pilot cities with the reality, break the ice in the system and mechanism, and make innovations The specific guiding opinions and the reform ideas involved will focus on "coordinated reform", including the cooperation between the government and the market, the cooperation between public hospitals and social hospitals, the cooperation between large hospitals and school hospitals, the cooperation between public health institutions and public hospitals as well as medical institutions This is the overall consideration of the reform From the micro perspective, the next step of public hospital reform will be planned from the construction of modern hospital management system to compensation mechanism, to the incentive and restriction of medical insurance, including support and guarantee, to the reform of personnel, staffing and salary system, to the regulatory system, to the circulation of drugs, and bidding procurement At the end of the year, whether it is the reform of public hospitals in cities or the comprehensive reform of public hospitals at the county level, the core link that cannot be bypassed is to "cut off any economic benefits between drug consumables and hospitals, especially with medical personnel" Liang Wannian revealed that this is one of the "core considerations" of the current decision-making level Specifically, the key step is to "truly reduce the cost of drug consumables and inflated prices The most important reform is to return to society and the masses, which we call the key link If we do not start from then on, it will be difficult to inspire the motivation, determination and confidence of the reform of the medical system " To this end, many ministries and commissions will work together to deal with it and introduce a series of detailed measures For example, at the end of 2014, the national development and Reform Commission will document the pricing mechanism specifically for drugs The national health and Family Planning Commission will also issue a document on centralized bidding and procurement of drugs in public hospitals First of all, we should strengthen the cancellation of the drug markup policy On this basis, we should further carry out the reform of the circulation of drugs and consumables, the reform of the recruitment and acquisition system, and the supervision of the behavior norms of medical institutions and medical personnel in the use of drugs and consumables, and make comprehensive efforts in multiple links In fact, due to various reasons, one of the main sources of economic compensation for existing public hospitals at all levels in the past was the addition of drugs and consumables Once this is cancelled, how to make the public hospitals operate normally requires that in addition to the government's further performance of the government's office functions and powers, a certain amount of funds be allocated to the hospitals to cancel the drug mark up for policy subsidies More importantly, all localities should implement the price based compensation mechanism as soon as possible, reverse the distorted state of the current medical service price system, and adjust some reasonable losses caused by the public hospitals, including the space for funds in the field of drug consumables circulation reform That is to say, under the premise of general operation guarantee of public hospitals, ensure that the income of public hospitals does not decrease and the burden of patients does not increase The future direction is to vigorously improve the economic returns of diagnosis and treatment, nursing, bed days, surgery and other services that truly reflect the situation of medical personnel Finally, a reasonable price system can be formed The important sign of the success of the above reform is that the income structure of the hospital has changed, that is to say, the proportion of drugs and consumables in the current income structure of the hospital has changed by 70%, and the price income that truly reflects the labor technology can reach 70% of the income of the hospital, which is the goal of the reform "But where does the money come from?" Liang said In fact, the problem of "money" involves multiple reform paths, including not taking more money from the government, affordable health care, and no increase in the burden on the people At present, the reform path under consideration is to squeeze out the water in the circulation field of drug consumables, and at the same time, control the irrational drug use behavior of doctors These two pieces will leave sufficient space for the future "price adjustment" of the Ministry The other involves the reform of "money", which is the sustainable reform of medical insurance and the reform of payment method At present, the consideration of the regulators is that the general reform direction should give full play to the incentive, supervision and restraint mechanism of medical insurance to hospitals and medical behaviors "It is necessary to make sure that the medical insurance management department, the handling department and even the society can see the medical behaviors of every hospital and even every doctor through the system arrangement of informatization, system and mechanism, release the relevant data, results and situations to the society, and supervise the behaviors of medical institutions and doctors through sunshine and transparency." Liang Wannian said Liang Wannian also said that at this stage, the payment methods of public hospitals at all levels in China cannot be all inclusive, not only one payment method can solve the problem, but "the general direction is still to change payment after payment into prepayment" Besides the first tier city Beijing, the reform of public hospitals has also carried out beneficial exploration in the second and third tier cities in China In recent years, as a pilot city for the reform of public hospitals and a comprehensive pilot city in Yunnan Province, Kunming has made a series of demands in the reform of public hospitals In June 2011, when Chen Zhu, the vice chairman of the Standing Committee of the National People's Congress and former Minister of health, investigated the reform of public hospitals in Kunming, he affirmed the achievements of the reform, such as the local diversified medical model, the multi-point practice of doctors and the implementation of the national basic drug system Up to now, the reform of public hospitals in Kunming is making continuous efforts to property rights reform and other aspects Up to now, the reform of public hospitals in Kunming still faces the problems of unreasonable distribution of health resources and medical institutions, imperfect multi-level medical service system and lack of high-level professional and technical personnel and management personnel In order to solve the above problems and optimize the allocation of medical service resources, the reform of public hospitals in Kunming is in the process of property right reform The specific approach is to encourage social capital to participate in the restructuring and reorganization of public hospitals in various ways, and implement the joint-stock system to run hospitals in accordance with the model of retaining the stock, introducing the increment, increasing capital and expanding shares The reporter learned that at present, through exploration and practice, Kunming has completed the share-holding system reform of three public hospitals Among them, the first hospital of Kunming City and Yunnan Urban Construction Investment Co., Ltd jointly established Ganmei Medical Investment Management Co., Ltd., marking the first Class-A public hospital in Kunming, which has successfully implemented the joint-stock system In order to promote the property right reform of public hospitals in Kunming, Kunming Municipal Hospital Administration Bureau has been established, striving to implement the industry wide localized management, in order to ensure the realization of social public welfare goals Kunming will further encourage social forces to run medical services on a large scale and build a multi-level medical service system It also provides nine preferential policies, such as preferential tax and land policies, permission access, personnel treatment, investment incentive and compensation system tilt And reserve the development space of private hospitals in the planning of setting up medical institutions, and set up the municipal private hospital service center to provide follow-up services At the same time, we should establish a mechanism of public finance to encourage the running of medical services and replace investment with awards Every year, 3 million yuan will be invested to commend and reward excellent private hospitals, and 8 ‰ - 10 ‰ will be given to new private hospitals with fixed assets investment of more than 30 million yuan Statistics display