Medical insurance bureau starts DRG pilot pharmaceutical enterprises facing real test

On December 20, 2018, the state health insurance bureau issued the notice on applying for the pilot countries to pay by disease diagnosis The notice said: in order to implement the task of "the country selects some regions to carry out the pilot projects to pay by DRGs" proposed in document 55, the State Health Insurance Bureau is studying and developing DRGs standards suitable for China's medical service system and medical insurance management capacity, and in some cities City launched DRGs payment pilot Medical insurance management departments at all levels should attach great importance to, actively participate in the pilot work of DRGs payment, accelerate the improvement of medical insurance fine management level, and gradually use DRGs for actual payment and expand the scope of application It is also expected that DRG will be launched as a pilot refined payment tool in the wake of 4 + 7 volume procurement On the premise of the decrease of the total cost of drugs, the rise of the price of medical services will be gradually promoted But for a long time, the fine management of medical services in China is missing, and effective tools are needed to assist the implementation With the promotion of DRG everywhere, fine management will be strengthened, which will help to reverse the unbalanced structure of medical expenditure As hospitalization expense is the main expenditure of basic medical insurance, the hospitalization expense accounts for 61% of the fund expenditure in employee medical insurance, and the figure is as high as 84% in urban and rural residents medical insurance; therefore, promoting DRG, a refined management tool, to control the hospitalization expense is the core of the problem The core of DRG mode is to classify patients The key is the design and use of classifier group According to the patient's age, disease category, disease degree, required medical resources, discharge status and other standards, relevant diagnosis groups are set up and paid according to these standards The excess part is borne by the hospital itself After DRG is fully implemented, the sales mode of pharmaceutical companies will be forced to change again Because DRG is paid according to the fixed quota of each similar disease group, the hospital must consider its cost, and the use of drugs and consumables is more considered from the cost-benefit The significance of the original reference drug sales data of pharmaceutical companies has been greatly reduced For a long time, pharmaceutical companies have been focusing on the specific data of their products in the hospital sales, through the comparison of their own sales with other competitors and the overall market sales situation to develop sales strategies There are two characteristics of drug companies' attention to data, one is for a certain drug itself, and the other is only focusing on sales volume The implementation of DRG will bring two changes First, hospitals pay more attention to costs and benefits Hospitals will be limited to cost considerations and must consider revenue, not just revenue This means that the expansion of sales is not necessarily beneficial to the hospital, especially after the implementation of volume purchase, the sales of the hospital will be limited, too high or too low estimation of their own sales of certain drugs is unfavorable to the hospital This will force pharmaceutical companies to also focus on the data in these cost areas to adjust their strategies The second aspect is that DRG enables the sales of pharmaceutical companies to change from single product sales to a group of product sales This means that what drug companies need is not only the sales data of individual drugs, but also the possibility of product mix sales in a certain field for a certain disease group In particular, if we continue to carry out volume purchase in the future, most of the hospital's volume purchase data will be determined by medical insurance, which means that pharmaceutical companies need new ideas to deal with the sales change It is of great value for pharmaceutical enterprises to sell products in groups In front of the above two changes, DRG data will play a key role in drug companies In terms of cost data, the cost structure shown in DRG shows the total cost, average case cost, risk level, DRG weight and profit and loss of a DRG group, such as heart transplantation This can also directly indicate the benefits of this DRG group If it is a loss group, through further cost structure analysis, we can see which categories of costs account for a relatively high proportion and whether the loss is caused, so the hospital may adjust drugs, consumables, inspection and use to improve the loss situation If the diseases that use the main products of pharmaceutical enterprises face losses for a long time, it means that they face improvement in cost structure, which may include cost structure adjustment, reducing the proportion of some costs that lead to losses, and reducing the number of days in hospital Accordingly, pharmaceutical companies can see the trend of fee control faced by their disease sector in a certain region in the future through the cost change of this disease category, and adjust their sales strategies in time DRG data, as the most effective data to reflect the resource consumption of disease group, is the most direct and real cost data, and its effectiveness will be significantly better than the drug data simply added by sales data In the future, with the tightening of drug purchasing power rising to a higher purchasing body, drug companies will face two major changes First, the discourse power on drug pricing is weakened Second, the ability of doctors to use drugs (affecting sales) will be seriously weakened, which means that under the pressure of cost accounting, hospitals will consider the use of products from the whole business, and the past practice of hospitals and doctors to promote the use of products and consumption of resources will be significantly changed In terms of product group sales, some pharmaceutical companies have the ability to carry out product group sales for DRG group This means that drug companies need to make clear the data of expenses, self expense, hospitalization days and so on of each DRG group At the same time, combining with the cost structure of DRG group, they need to plan how to carry out product portfolio sales for some DRG groups.