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

The "4+7" pilot procurement with quantity has been running for more than 7 months since it was fully implemented at the end of 3 months this year Among them, the preliminary presentation of patent cliff, the acceleration of consistency evaluation, and the improvement of drug use scale in hospitals 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 So, recently, in Chinese Medicine The industrial information center and the Management Committee of Taizhou pharmaceutical high tech Industrial Development Zone jointly hosted the drug policy and enterprise strategy forum of the 2019 (12th) China Pharmaceutical Strategy Conference At the forum, the representatives of relevant government departments, scientific research institutions, top three hospitals and other policy experts gathered together to focus on the implementation results of volume procurement and the obstacles to sustainable development The role of hospitals and doctors in medical reform and positive incentive mechanism "has become the focus of hot discussion among experts It is well known that the medical industry consumers have no choice The choice is 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 By the end of March 2019, the first batch of bid winning drugs purchased with volume in Beijing began to land Without intervention in the first two months, the pharmacy Office of a hospital in Beijing detected (as shown in the figure) that a bid winning drug, which should have completed 20% of the target amount according to the schedule, had only completed 10% of the total In this way, only 60% of the target could be achieved in the whole year, far from the expected effect! What is the problem? Due to doctors' prescription habits and patients' stickiness, the original drugs are often regarded as the biggest "enemy" of the winning drugs However, from the perspective of monitoring data, there is no change in the original drugs On the contrary, there is a significant abnormal increase in other alternative varieties Therefore, the pharmaceutical department began to intervene in several alternative varieties (E, f) with the largest increase However, it is unexpected that there will be more Second, after intervention, although the growth of the original larger increase of the alternative varieties (E, f) was controlled, the use of 4 + 7 bid winning varieties was still ineffective, but the rest of the alternative drugs (b) that were not focused on rose abruptly, with a maximum growth rate of 73%, which can be described as "beyond prevention" "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 the research results of a city where the "4 + 7" policy is implemented, the substitution of generic drugs is closely related to doctors' prescription behavior even under the high pressure of the policy, including: 92% of the participating doctors' hospitals have introduced 4 + 7 landing measures; 85% of the participating doctors' hospitals have restricted or (partially) stopped the prescription of the same category of drugs that failed to win the bid; More than 64% of doctors will encounter patients who question the quality and efficacy of generic drugs; more than 90% of doctors will encounter patients who ask to prescribe drugs that fail to win the bid and need doctors to spend more time communicating with patients; 50% of doctors are very familiar with the "4 + 7" volume procurement policy and say they need more training to understand the expansion policy "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 In the post medical reform era, hospitals and doctors should be included in the interest chain According to Zhang Lan, director of the Pharmaceutical Department of Xuanwu Hospital, Capital Medical University, "the implementation of zero plus of drugs really opens the post medical reform era This landmark policy pushes 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 build a doctor incentive and restraint mechanism of "combination of dredging and blocking, focusing on combing": blocking: the supervision committee, the industrial and commercial bureau, etc., and 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 2 GPO is an important supporting policy under the policy of non volume bidding and procurement For drugs beyond the scope of "4 + 7" volume purchase policy, hospitals can group purchase (GPO) Among them, medical insurance determines the bidding purchase price standard, and hospitals and pharmaceutical companies negotiate the price to determine the new bidding purchase price This part of the price difference should be given to the hospital, so that the price of drugs can be controlled reasonably, both the price and the effect can be achieved, and the drug price can decline slowly and steadily, Avoid precipitous price falls In a word, medical reform is a structural change of stock, which makes public hospitals return to public welfare, makes financial investment and medical insurance fund fixed, and makes people's burden unable to increase It is the core purpose of medical reform This requires the joint reform of medical treatment, medical insurance and medical treatment, and the policy is vigorously promoted At the same time, it also requires hospitals and doctors to stand at the front line of medical reform to implement, In this reform process, the interests of hospitals and doctors should also be protected by positive incentive policies Only in this way can we truly make the medical reform sustainable development.