Policy "encirclement and suppression" in 2017, the days of public hospitals are more difficult

[policies and regulations of chinapharma.com] at two press conferences recently, Wang Hesheng, director of the medical reform office of the State Council, made it clear that the comprehensive reform of public hospitals will be carried out in an all-round way this year, and the drug mark up will be completely cancelled According to incomplete statistics, it is expected to save 60-70 billion yuan of drug costs for the masses again this year (policy "encirclement and suppression" the days of public hospitals in 2017 are more difficult picture source: Baidu picture) under the "encirclement and suppression" of various policies, the days of public hospitals may be more difficult this year At the moment when the policy documents are distributed like snowflakes, China's medical reform has gradually entered the real deep water area Many experts have asserted that 2017 is the year when China's medical reform has made substantial progress, and under the "encirclement and suppression" of various policies, the days of public hospitals can be more difficult this year 1 Cancel drug mark up: public hospitals are in trouble At the press conference of the two conferences recently, Wang Hesheng, director of the State Council's medical reform office, made it clear that this year, comprehensive reform of public hospitals will be pushed forward in an all-round way, and all drug mark up will be cancelled According to incomplete statistics, it is expected to save 60-70 billion yuan of drug costs for the masses again this year That is to say, public hospitals will cut down more than about 60000000000 drug costs this year, and a large number of provincial and municipal hospitals, as well as a number of large hospitals in Prefecture and municipal level cities, will become the target of zero plus drug reform in 2017! What kind of impact will zero plus bring to public hospitals? Also at this year's two sessions, Liu Yi, a deputy director of Nantong University Affiliated Hospital, admitted that taking Nantong University Affiliated Hospital as an example, after the implementation of "zero price difference" for drugs, the hospital's drug revenue dropped, and some hospital government subsidies were not in place, so it was necessary to take money to "subsidize" the lost revenue after "zero price difference" for drugs "As a top three hospital with an output value of more than 2 billion, the gap of reducing the net profit after the zero price difference of drugs is about 150 million, and the loss of this gap is 60 million Where is the (remaining) source of 20 million compensation through various channels?" After zero plus, there is still a gap of 40 million due to inadequate compensation In this case, it is difficult to raise the salary of medical staff It can be seen that if the compensation mechanism is not in place, more large public hospitals will be in trouble in 2017, when the drug mark up will be completely cancelled 2 Hierarchical diagnosis and treatment: the good days of large public hospitals are over! In 2016, there was a popular word, "medical community", referring to "county medical service community" With the promotion of hierarchical diagnosis and treatment, the county hospitals that were previously invisible to large hospitals suddenly became hot spots Inspector of Guangdong health and Family Planning Commission @ bozige Liao Xinbo said that it is imperative to reduce the scale of large hospitals First of all, the state increases financial investment in county-level hospitals, and the county-level hospitals continue to expand and improve the level of diagnosis and treatment, which will help the large hospitals According to the national development and Reform Commission's new "national health insurance project construction plan", since 2017, the central budget investment will not be arranged to support the construction of township hospitals and village clinics So who is the main investor? County hospital! Not only that, the state has set an incredible goal for hierarchical diagnosis and treatment Only in 2017, it will increase the county's medical treatment rate to about 90%, basically realizing that serious diseases will not leave the county Moreover, the continuous release of drug use at the grass-roots level directly impacts the outpatient volume of large hospitals If the serious illness doesn't leave the county, and the chronic patients don't go to the big hospital to buy medicine, can the days of the big hospital be good? It is understood that the number of patients in the first Department of internal medicine in a well-known third class a hospital in a municipality directly under the central government decreased by nearly a quarter compared with the same period last year, and began to cooperate with secondary hospitals in various regions to guide patients Third, the profitable laboratory and imaging department are facing "independence"! The national classified diagnosis and treatment documents clearly put forward that regional medical resource sharing will be promoted through integration We will integrate the existing resources of inspection, disinfection and supply centers in hospitals above the second level and open them to basic medical and health institutions and chronic disease medical institutions To explore the establishment of independent regional medical inspection institutions, pathological diagnosis institutions, medical imaging inspection institutions, disinfection supply institutions and blood purification institutions, to achieve regional resource sharing Strengthen medical quality control, and promote mutual recognition of inspection results among medical institutions at the same level and between medical institutions and independent inspection and testing institutions It can be seen that the third party of medical imaging, medical examination, pathology, hemodialysis, nursing and other departments has become the general trend In Zhejiang Province, more than one county-level hospitals in Tonglu have explored the third-party laboratory As we all know, the laboratory and imaging department are the main profit points of the hospital It can be predicted that the third-party of these departments will continue to advance in the next few years, and the loss of revenue caused by the public hospital can be imagined 4 Fee control: the era of payment by disease is coming! Duan Tao, the former president of Shanghai maternal and child health care hospital, once said that under the payment mode of charging according to the project, the control of medical expenses is very difficult, and hospitals, especially the top three public hospitals, have the idea and impulse to be bigger and stronger So in the past decade, the top three public hospitals have been developing and expanding crazily, with thousands of beds and billions of incomes However, this situation has not lasted for a long time! In January 2017, the national development and Reform Commission, the health and Family Planning Commission and the Ministry of human resources and Social Security jointly issued the notice on promoting the work of charging by disease, and deployed all localities to comprehensively promote the work of charging by disease The notice published a catalogue of 320 diseases, most of which are common diseases and frequently occurring diseases with standardized clinical path and clear treatment effect, and clearly stipulated that public hospitals at or above the second level should select a certain number of diseases to charge by disease The number of diseases to charge by disease in the pilot area of comprehensive reform of urban public hospitals should not be less than 100 by the end of 2017 It is also required that the number of diseases charged by disease type should be further expanded The document even said that it is necessary to establish a reward and punishment system for medical institutions based on disease charges, incorporate disease charges into the performance evaluation system of public medical institutions, strengthen supervision, evaluation and incentive constraints; all regions and relevant departments should strengthen organizational leadership in the reform, pay close attention to the implementation of policies, and ensure the effectiveness of the reform Now, many places in the country have begun to issue payment by disease documents, and payment by disease will be forced to be pushed out nationwide The era of pay per project is coming to an end In other words, how to control medical expenses has been clear and is gradually implemented In Liao Xinbo's view, under the trend of cost control, large hospitals are even more affected With the zero addition of drugs and consumables and the homogenization of technology, the income generating space is becoming smaller and smaller V regional registration of doctors: Legalization of multi-point practice, the hospital can't manage it!   At the beginning of 2017, the health and Family Planning Commission successively issued the new version of the administrative measures for the registration of doctors' practice and the detailed rules for the implementation of the regulations on the management of medical institutions, in which the administrative measures for the registration of doctors' practice changed the place of doctors' practice from the past "medical, preventive and health institutions" to "the provincial or county administrative divisions of the place where the medical, preventive and health institutions are located", and the practicing doctors The registration place of assistant medical practitioners is county-level administrative division, realizing "one-time registration and regional effectiveness" However, in the detailed rules for the implementation of the regulations on the administration of medical institutions, the restriction that in-service medical personnel shall not open clinics is deleted Both documents were implemented on April 1, 2017 In fact, the multi-point practice of doctors, which has been encouraged by the state before, has not been promoted smoothly due to various difficulties However, the introduction of these two documents provides legal and policy guarantees for doctors to go out of public hospitals As long as doctors go through legal procedures, public hospitals are not qualified to block them What does it mean to legalize multi-point practice? In the past, some patients who rushed to doctors are likely to be led to multi-point practice hospitals by doctors Therefore, whether ordinary patients or special needs of medical treatment, public hospitals will face the loss of patients following doctors Vi social medical service: launch a scramble for doctors and patients to public hospitals! At the beginning of the year, the incident that the Department Director of Guiyang hospital led the team and the patients to leave together made the medical community and even the whole society in a uproar In fact, according to a well-known expert, similar to the situation of private hospitals digging the corner of public hospitals is showing a spark Because in one year, 12000 private hospitals have been set up, and doctors, especially those in the top three hospitals, are becoming hot talents Taking a chain clinic in Guangdong Province as an example, a group of top three doctors were dug up at one go, which led to the evacuation of the chief paediatrician of a well-known top three hospital, and the emergency room was closed at night Take Guiyang Hospital of Guiyang airlines as an example In 2016 alone, more than 100 doctors and nurses were poached by Guiyang No.6 hospital Backbone doctors have been poached, patient resources will be naturally lost, and the operation of the hospital will not be affected? That's strange! 7 Will public hospitals cut salaries or even lay off workers? It is reported that although many large hospitals have not yet been unable to make up for their expenses and incurred real losses, Sun Hong, the president of Xiangya Hospital, said helplessly that in order to ensure that the treatment of medical staff does not decline, the hospital decided to cut the equipment purchase cost by 50 million yuan in 2017, which may affect the development of the hospital That is to say, at present, for some large public hospitals with a relatively large family base, whether it is layoffs or pay cuts, they have not reached that point But in fact, for the secondary public hospitals in some big cities, the situation is not optimistic In an interview with the media, the president of a first tier city's second tier a comprehensive hospital said that with the promotion of the abolition of the reform of supporting doctors with drugs, the drug revenue will be greatly reduced, and it may not be possible to issue year-end bonus to doctors Not only that, he said, "we should appropriately reduce the scale of core departments such as internal medicine and medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine based medicine, and more hospital resources It can be seen that the public hospital is going to be really broken!