Policy interpretation of Chongqing Sanming medical insurance reform plan

Source: about November 20, 2014, Chongqing and Sanming had pilot schemes for medical insurance payment price respectively, becoming the first reformer of medical insurance payment price policy 1、 Chongqing: according to the settlement price of medical insurance and the transaction price of drug exchange, the payment price of medical insurance in Chongqing has recently been released for review The main points are as follows: the formulation principle: according to the principle of "group purchase, large quantity and high price, average price settlement, low price compensation", drugs are included in the scope: "drugs first, devices, market first, districts and counties, pilot first, and push forward" The top 300 drugs used in the current medical insurance catalog are included in the scope of the pilot, and implemented in the scope of the municipal teaching hospitals Within three years, the whole city gradually pushed forward Formulation method: for the drugs in the medical insurance catalog, by referring to the settlement price of medical insurance and the transaction price provided by the drug exchange, through the analysis of medical insurance drug use in the past three years, the municipal human resources and Social Security Bureau, together with the Municipal Finance Bureau, the Municipal Health and Family Planning Commission, the Municipal Food and drug administration, the Municipal Price Bureau and the Municipal Drug exchange, jointly determine the average price of drugs For the specific price determination mechanism, the following two schemes are proposed: scheme 1: according to the average price of drugs with the same product specification Scheme II: it shall be determined by sections according to the high, medium and low prices of drugs with the same product specifications The proposal of the municipal human resources and social security bureau is scheme II Implementation adjustment: medical insurance shall be paid according to the average price If the price of drugs purchased by a medical institution at the Municipal Drug exchange is lower than the average price, the surplus shall belong to the medical institution; if the price is higher than the average price, the excess shall be borne by the medical institution itself Once the average price is determined, it will be publicized to the public for 7 days, and then it will be implemented after being approved by the municipal leading group of medical reform In principle, it will be adjusted once every half a year, and in case of major price changes, it will be adjusted timely 2、 Sanming City: according to "the lowest price of domestic generic drugs" to set the benchmark price of medical insurance, it comes from the news agency of great wisdom astak Zhan Jifu, Minister of Publicity Department of Sanming City, Fujian Province, said at a regular press conference of the health and family planning commission that Sanming City is experimenting with the benchmark price, which is based on the "lowest price of domestic generic drugs" "For example, in the market, for drugs with the same generic name, there are prices of 9 yuan, 20 yuan, 30 yuan, 50 yuan, etc., so the benchmark price is determined by 9 yuan." However, Zhan added that in consideration of the people's acceptance and adaptation of drugs, Sanming City has tentatively piloted more than a dozen varieties with "little difference between domestic and imported products, and a lot of difference in price", while it will not take this way for the original research drugs that are indeed therapeutic drugs Since last month, Sanming medical insurance fund management center has settled the price limit of the first batch of 14 inpatient imported drugs, and the basic medical insurance co-ordination fund for imported varieties exceeding the price limit will not be paid For the trial effect, Zhan Jifu responded that the prices of some imported pharmaceutical enterprises began to "dive" If it was extended to the whole country, "everyone will dive", and the prices will eventually return to nature 3、 Policy interpretation: 1 Under the system of payment price, only the low price of drugs is taken In the case of the above two cities, if Chongqing uses the average price of medical insurance payment as the benchmark and reduces the drug price through the market mechanism of two times price negotiation of the hospital, Sanming takes "strong control of the government" as the prominent measure to force the drugs that do not meet the low-cost conditions out of the market One is that hospitals only choose drugs at low prices, and the other is that government departments only choose catalogues at low prices Under the two kinds of medical insurance payment price management modes, manufacturers must try to reduce to the lowest supply price in order to have the opportunity to obtain hospital procurement Although this management mechanism is conducive to reducing the virtual high drug price, it is also a big blow to the drug companies that do not give kickbacks In the process of Sanming reform, there is a shortage of drugs with or without price 2 Chongqing's policy is relatively moderate, easing conflicts among all parties, leaving some room First, Chongqing allows hospitals to benefit from negotiated procurement Although it is mentioned that when the purchase price of the hospital is higher than the payment price, the hospital will bear the extra part of the cost by itself, but in fact, will the hospital bear it by itself? This bird thinks that it is only for patients to pay their own expenses Secondly, Chongqing Medical Insurance Department tends to set the average payment price of medical insurance by sections But understand that the role of health insurance payment is to encourage hospitals to use low-cost drugs If we learn from the original price department to set a separate pricing level and give high-priced drugs preferential reimbursement policy, will the medical insurance payment price lose its significance? Thirdly, the insiders know that there is an obvious tendency of local protection in the drug trade in Chongqing market, so when setting the medical insurance payment price in sections, whether it is preferential to local pharmaceutical enterprises? This aspect needs to be verified by later practice Fourthly, Chongqing's medical insurance payment price plan has a less impressive text "Support the development of Chongqing pharmaceutical industry, and make the trading platform of Chongqing pharmaceutical exchange bigger and stronger." If the Chongqing drug exchange supports the reform of medical insurance payment price successfully, it means that the exchange may move towards the whole country in the future? In the era of big data, data itself is wealth, and the development of Chongqing drug exchange is limitless How do you know the ambition of a swan?