Medical insurance premium payment? Group GPO? How will medical institutions benefit in the future in the post-centralized procurement era

Wen shyi Since the "4 + 7" pilot procurement with volume was fully implemented at the end of March this year, it has been in operation for more than seven months, among which, the preliminary presentation of patent cliff, acceleration of consistency evaluation, improvement of hospital medication scale and other transformation effects are gradually emerging in the exploration The second batch of expanded list of centralized procurement was also published in September this year The landing plans of 25 expanded provinces and regions were announced in succession, and the scope of coverage was further expanded In the face of its unstoppable development trend, the comprehensive impact of its pilot results should be highly valued Recently, at the drug policy and enterprise strategy forum of the 2019 (12th) China Pharmaceutical strategy conference jointly hosted by China Pharmaceutical Industry Information Center and Taizhou pharmaceutical high tech Industrial Development Zone Management Committee, policy experts from relevant government departments, scientific research institutions, top three medical institutions and other policy experts gathered together to focus on the landing results and sustainability of volume procurement Among them, "the role of hospitals and doctors in medical reform and positive incentive mechanism" has become the focus of hot discussion among experts As we all know, consumers in the medical industry have no right to choose The right to choose lies in the hands of hospitals and doctors After the implementation of 4 + 7 volume purchase, all regions have given the hospital indicators according to the actual situation, but the indicators will encounter various difficulties in the process of completion "We began to realize that it's not a natural process to complete the target task, and we can't just rely on strong administrative intervention to implement it Even if we stop all alternative drugs, we can use traditional Chinese medicine and proprietary Chinese medicine to replace the '4 + 7' varieties in clinical practice," the head of the pharmaceutical department introduced According to a survey of cities where the "4 + 7" policy has been implemented, the substitution of generic drugs is closely related to doctors' prescription behavior even under the pressure of the policy, including: "Doctors are directly facing patients, and they will be responsible for the final treatment effect of patients We must not put doctors on the opposite side, only rely on high-pressure policies such as constraints and restrictions to intervene We must make them the best comrades in arms, only unite clinicians, ensure the efficacy of generic drugs, let clinicians really accept this policy, and formulate it according to clinicians' opinions With their active efforts, the alternative plan can finally let patients accept the generic substitution "After several months of running in, the hospital finally embarked on the right track of 4 + 7 policy implementation According to Zhang Lan, director of the Pharmaceutical Department of Xuanwu Hospital, Capital Medical University, "the implementation of zero drug mark up will really open the era of post medical reform, and this landmark policy will push the whole medical reform into the deep water area." The key of medical reform is to make public hospitals return to public welfare, of which the virtual high price has always been the core problem In order to squeeze out the water in the process of drug circulation, a series of policy combinations such as drug zero plus, two vote system and quantity purchase have made a great impact on China's pharmaceutical industry, which has also fundamentally changed the operation mechanism of medical and health care Among them, the volume procurement which caused the industry turbulence is to achieve the dual effect of price reduction and volume control, and also plays a positive role in guiding and supervising the rational use of drugs in hospitals It is worth noting that although this part of interests under the current volume purchase policy is not enough to touch the core interests of doctors, with the expansion of 4 + 7 and the implementation of a larger scale in the future, the fundamental interests of hospitals and doctors are bound to be affected Luo Li, deputy director of Hospital Management Research Institute of Fudan University, said that from the perspective of long-term operation, the hospital should be included in the interest chain of drug bidding and purchase And make it benefit from drug price reduction, which is the core factor to promote the implementation of drug bidding and purchase policy To this end, he suggested: 1 The supervision committee and the medical insurance bureau jointly set up a doctor's incentive and restraint mechanism of "combination of dredging and blocking, focusing on combing": Blocking: the Supervision Commission, the industrial and commercial bureau, etc., vigorously investigate and deal with commercial bribery and interest related events of pharmaceutical enterprises Comb: the medical insurance department adopts the way of premium payment to pay 15% premium to the hospital on the basis of drug bidding price, so as to mobilize the enthusiasm of medical institutions to participate in the target of volume purchase.