Multi-provincial intensive action Drug proportion will eventually reach the "hidden corner"?

The concept of drug proportion was first proposed by Shanghai in 1994, and by 2015 the General Office of the State Council issued a clear nationwide policy of enforcing the drug ratio of no more than 30%, pinching a single, 21 years, to today, has been a full 26 yearsAugust 20, 2018, issued by the General Office of the State Council, "deepening the reform of the medical and health system in the second half of 2018 key tasks notice", clearly pointed out that to strengthen the supervision of medical insurance for medical behavior, take measures to focus on solving the "hanging bed" hospitalization, fraud and other issues, scientific control of unreasonable growth of medical costsAt the beginning of 2019, the State Council Information Office held a regular state council policy briefing, answering questions about the link, the State Health and Health Administration Medical Administration Director Zhang Zongju said that the performance appraisal, with reasonable drug-related indicators to replace the single drug ratio assessmentfrom the perspective of the initial heart, the proportion of control drugs is for excessive drug use, but in fact, the proportion of control drugs, one is to let doctors clinical prescription is always worried about, not from the actual treatment, but from the left to the right, the ideological burden is heavy, afraid of using "expensive" medicine, with "wrong" medicineSecond, there is a policy, there are countermeasuresControlling the proportion of drugs becomes the pursuit of molecular differentiation, the drug expenses of the molecule unchanged, reduce the denominator (medical expenses) can also achieve the role of reducing the proportion of drugsSuch "counterfeiting", directly led to a lot of hospitals to the assessment of the time only helpless to do a junior high school students will do things: reduce the molecules, increase the denominatorAnd the final effect is that the drug should be used, enterprise investment is still not reduced, patients are still shouting can not afford to buy medicinelet the doctor headache, let the enterprise helpless, let the patient confused up the proportion of the gourd up, on earth how to come?trace back to its rootsIn November 2015, the then National Health and Planning Commission, together with the National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, and the State Administration of Traditional Chinese Medicine jointly issued the Notice of Several Opinions on the Issue of Control of Unreasonable Increases in Medical Expenses in Public HospitalsIn terms of the income structure of medical institutions, special lying lists the drug revenue, inspection and laboratory income, health materials income and other indicators as a proportion of medical income, according to the definition of the time, the proportion of drugs (excluding Chinese medicine tablets) - hospital drug income / medical income x 100%, excluding Chinese medicine drink tablets, used to reflect the level of hospital drug costs and income structureand it is well known that medical income includes income from services (diagnosis, nursing, surgery, examination, examination, etc.) and drug revenueAccording to the relevant policy requirements, by the end of September 2017, all public hospitals at all levels of the country must abolish the drug mark-up by the end of September, and the sale of medicines except Chinese medicine tablets at a zero rateAccording to the relevant policy requirements at that time, the new procurement system requires to strengthen budgetary constraints, the future hospital drug expenditure is generally not higher than the hospital operating expenditure of 25% to 30%This is to control the cost of drugs from the budget link, which is conducive to reducing the inflated price of drugsThat is to say, under the pressure of the policy and the cost of drug conversion and operation, the pharmaceutical portion of the medical institution's business income needs to carefully calculate how to obtain it, and at the same time, how to expand the service incomeIn terms of operational expenditure, "drug expenditure" is not less than a pointon the one hand, drug revenue reduction, on the other hand, drug expenditure compression is limited, in addition to provincial belt volume, with budget procurement price reduction, in the context of the total advance of medical insurance, medical institutions only in the "molecule", "denominator" aspects of the operationSo, came to the article mentioned before the phenomenonIt is not difficult to see that the purpose of the establishment of the proportion of drugs is to inhibit hospitals from selling drugs to make profitsIn the drug cancellation of the mark-up, tender price reduction led by medical institutions today, the role of the proportion of drugs is undoubtedly in a relatively helpless situationat present, we can see that several trends in the pharmaceutical industry are very obviousfirst of all, the state organized three rounds of two-batch procurement and four rounds of national negotiations, these varieties belong to rigid demand, belong to the political task, therefore, from a policy point of view, these two types of varieties have been strong to clear the existence of the drug share of the needsecond, the provinces with volume procurement has been painful determination, not only to knife and bone cut meat, but also to further expand the area of Traditional Chinese medicine, biopharmaceuticals into the collection range, the current price reduction efforts need not be well knownfinally, the reduction of drug procurement has become a trend, from the previous tens of thousands of rules (medical insurance, self-funded and even including the size of drugs) the winning bid flooded into disaster, and just five or six years, the current drug procurement of the three/second/grass-roots total of drugs are: 1500-1800/1200-1000/800, even if the drug into the health insurance? Into the health insurance can not enter the base medicine is not subject to the strong restrictions of 1 x?! Moreover, now into the base medicine if not just need varieties do not necessarily have a good lifeIn this trend, drug procurement catalog streamlined as bone, drug proportion is really no longer necessary to occupy too much spacewith the continuous promotion of pay by disease throughout the country, clinical efficacy evidence is not sufficient, did not obtain authoritative disease diagnosis and treatment guidelines or evidence-based medical support, do not have the advantages of drug economics, clinical use, low cost-effective, prescription review problems, super-common drugs or not suitable for drug use high probability of varieties, has been faced with the disaster, with the health insurance supplement 442 strong clearance, such varieties have become more and more sad days, therefore, continue to blindly take the proportion of drugs as an important means and content to avoid overdraft of health insurance funds, hospital performance management, in fact, it is no longer necessaryPerhaps the relevant parties are aware of the role of drug proportion to some extent alienated, perhaps the current policy efforts have been used to do not use the proportion of drugs to sing the main role, remember the previous year the relevant parties in charge of the joint meeting on drug safety cooperation has said that the responsibilities of the Health Insurance Bureau, mainly can be summed up in 10 words: protection, price, bidding, payment and supervisionWhen these five aspects really fall and execute in place, the drug ratio of the mission contains the plan is also overthe proportion of medicine, one day, will complete the historical mission, to reach a "hidden corner", no one knows, and disappear from now on.