Reasonable drug assessment and upgrade to help health insurance "cage for birds"

the end of 2019, the General Office of the National Health and Health Commission issued a "notice on doing a good job in medical institutions reasonable drug use assessment." The purpose of the document is to strengthen the assessment of rational drug use in medical institutions, improve the level of pharmaceutical management in medical institutions, and improve the quality of medical care. This also means that the National Health and Health Commission on reasonable drug use assessment and upgrade. Industry experts analysis pointed out that the implementation of the new five reasonable drug assessment content, will undoubtedly lead to medical institutions drug use subversive "big shuffle." From the simple and crude "drug proportion" assessment, to a more scientific and humane "reasonable drug use" assessment, can be said to be an important sign of progress in medical reform.

"Three Grips" and "One Intent"The Notice puts forward four requirements for the medical institution's rational drug use assessment work: to raise awareness of the importance of rational drug use assessment work, to clarify the scope and content of rational drug use assessment, to do a good job in the organization and implementation of rational drug use assessment work, and to strengthen the application of the results of the assessment.In defining the scope and content of the assessment of rational drug use, the Notice states that the key contents of the assessment of rational drug use should include at least: 1. The use and management of specially managed drugs such as narcotic drugs and psychotic drugs, radioactive drugs, toxic drugs for medical use, drug-type easily-to-toxic chemicals, and stimulant-containing drugs; 2. Antibacterial drugs, anti-tumor drugs, focus on monitoring the use and management of drugs; 3. The use of basic drugs in the state of public medical institutions; 4. The use of selected varieties in the centralized procurement of drugs by the state organizations of public medical institutions; and 5. the use of drugs for the negotiation of access to national medical insurance in designated medical institutions.These five key contents, including not only special drugs, antibacterial drugs, auxiliary drugs, etc., but also basic drugs, collected drugs, medical insurance negotiations access drugs. The intention, Henan Yingguo Enterprise Management Consulting Co. , Ltd. General Manager Zhang Shanguo pointed out that there is no doubt that "the three grasping one intention." Three grasping hands: first, the use and traceability of high-risk drugs; In fact, it is a goal: to achieve the landing of the above four categories of products on the basis of ensuring the safety of drug use. This shows that the integration of policy-making and landing implementation has been achieved, and the precision of large-scale management has been improved.Zheng Pei, general manager of Henan Marketing Enterprise Management Consulting Co., Ltd., said that 2020 is the "new year" of medical reform, because many of the heavy-weight health care reform policies issued in 2019 will be implemented in January 2020. The main purpose of the "Notice" issued is to urge the medical reform policy to land, including the new version of the medical insurance directory, involving auxiliary drugs are adjusted out of the health insurance directory, "national talk" drugs to join the health insurance directory. In addition, since the implementation of the "Resistance Limit Order" in 2012, although the abuse of antibiotics in hospitals has been basically curbed, but still can not be taken lightly, in the special file management, catalog adjustment, provision, classification and prescription rights, standardized use, children's use and other aspects still need to focus on monitoring. Basic drugs need to monitor the progress of medical institutions in using the target because of the "1 plus X" mode of medication and the "986" equipment target requirements.Previously, medical institutions to implement the "drug proportion" should not be higher than 30% of the indicator management, it forced many varieties out of the hospital market, and now the implementation of the new five reasonable drug assessment content, will undoubtedly lead to medical institutions drug use subversive "big shuffle." Zheng Pei said: "At present, the top medical insurance generic drugs and complementary drugs, occupy more medical insurance funds of large varieties, either included in the auxiliary drug kick out of the health insurance catalog, or participate in the national collection, the price dropped significantly, freeing up a large amount of health insurance funds for the national '685' base drug catalog and 'national talk' varieties." In this way, the purpose of health insurance 'cage for birds' is achieved. In the future, the hospital drug use structure will become three national character varieties (national basic drug catalogue, national centralized procurement catalogue, national health insurance negotiation directory) based on drug use, other innovative drugs and self-funded drugs to supplement the drug treatment structure.Zhang added: "On the basis of the scientific layout of basic drugs and health care, to prevent abuse at the policy level is to complete a transformation for medical institutions: from what they want to drive, how much they want to drive, to the prescribed products in accordance with the prescribed actions." This is the same as DRG, from the source to eliminate the 'difficult to see a doctor, expensive to see a doctor'! Thenotice also points out that assessment coverage should be improved. The provincial health administrative departments should do a good job in the management planning of rational drug use assessment, and gradually improve the coverage rate of rational drug use assessment at all levels of medical institutions within the jurisdiction. By 2021, the assessment coverage of primary health care institutions, secondary medical institutions and third-level medical institutions will reach 10%, 30% and 100%, respectively;These indicators, in the view of the above two experts, are not a problem to achieve on schedule. Zheng Pei explained that because the main work of the National Health and Safety Commission is the administration of medical institutions at all levels, the number of third-level medical institutions is limited, concentrated in the first, second and third-tier cities, the number of second- and first-class hospitals is large, for a while and a half also can not be supervised. "Thieves first king", first take down the third-level hospital, the remaining second- and first-level hospitals, with the close-knit medical system forward, in the unified drug use of the medical union under the increase, coverage by 2023 to meet the requirements without any problems.However, Zhang Shanguo stressed that in this process should pay attention to two major aspects of things: first, the construction of primary and secondary medical institutions to be in place, to solve the problem of talent input and the level of diagnosis and treatment and services, otherwise, no one to the grass-roots and secondary medical institutions, will still be to the third-level medical institutions influx;In addition, it is worth noting that the main body of this assessment is not limited to the health sector. The examination shall be conducted by way of self-examination by medical institutions and data information assessment by the administrative department of health and health. The provincial health administrative department shall, according to the self-examination and self-assessment available to medical institutions, collect key data of medical institutions' assessment indicators online through the information-based platform, and organize or entrust third parties to carry out verification and analysis.For medical institutions can be entrusted to a third party assessment, Zheng Pei pointed out that there are two advantages, first, can make up for the lack of assessment personnel at all levels of health care committees can not meet the coverage requirements on time; In Zhang Shanguo's view, in the current stage of Chinese society, entrusting third-party assessment, will have a certain role, but certainly will not have much effect. No one wants to go head-to-head with government departments, and in the final analysis, it is fundamental to strengthen the supervision of the health sector and the implementation of the health sector's assessment of rational drug use. Make an inappropriate example: third parties are democracy, and health care is centralized.

from "simple rough" to more scientific and humanFrom the "Notice" of the integration level, this reasonable drug assessment involves a wider range of more influential. So, does this mean that China's rational drug use assessment has been systematic? In response, Zheng Pei said: "From the "notice" requirements alone, the main purpose of this time is to urge the beginning of 2020 health care reform policies smoothly and quickly landing, far from the rational drug system. Reasonable drug use assessment involves all aspects, for the drug catalog provisions and assessment is only one aspect. Others also involve specific new drug research and development market situation, patient disease situation, medical insurance funds allocation, hospital equipment advanced, as well as the level of doctor's diagnosis and treatment. Zhang, a government official, agrees, stressing that rational drug use is only the goal, and that it requires a market-oriented mechanism and administrative guidance. At present, the guidance of administrativeization is a chapter law and a prototype, but the market-oriented mechanism has not yet been fully built. The real rational drug use, is to start from the needs of patients, according to the patient's economic situation, to give different solutions, in matters of life and death, the state to take into account fairness, personal economic ability, assuming that there are more excellent products and treatments than the above four categories of products? It cannot simply be defined that all diseases can be fully covered as long as they are based on the drug plus health insurance. Personally, I would like to express that true rational drug use also needs to be based on the changes and needs of disease, and constantly expand the product category and treatment methods.In the first half of 2019, China's public hospital end-market drug sales amounted to 609 billion yuan, accounting for 67.0% of the three terminal drug sales, according to the Forward-Looking Industry Research Institute. Zheng Pei believes that after the National Health and Safety Commission to implement a reasonable drug use assessment of public hospitals, the proportion of the three terminals will change, grade hospital terminals because of reasonable drug assessment, will allow prescription outflow to the out-of-hospital retail terminals, but the entire medical terminal and retail terminal ratio has little impact. Because health care funds are not short of money, but "cage for birds", the amount of drug sales in the hospital will decline during the transition period, but with the use of basic drugs and "national talk" drugs, will soon resume. Retail market share will increase under prescription outflows, but product structures will be adjusted and some general medicines will be replaced.Zhang Shanguo thinks that the market will not change much, especially the share of hospitals will not change too much. "DTP, which started being hotly hyped three years ago, did not drain hundreds of billions of dollars from experts' expectations, and the proportion of hospitals fell from 68 percent to 67.4 percent, a decrease of only 0.6 percent," he said, using examples. But it will have a huge impact on the retail market, some of the treatment products forced out of the hospital will be added to the retail market, with capital, talent and brand advantages, the terminal of small and medium-sized pharmaceutical companies to form a crush. "the "drug proportion" assessment, affecting the development of many pharmaceutical production enterprises. Now, all public hospitals should establish a more scientific and humane rational drug use assessment mechanism, but also on the future survival and development of pharmaceutical enterprises have what impact? Zhang Shanguo said that the impact is mainly concentrated in two aspects: first, western pharmaceutical enterprises are basically no play, especially neither shortlisted "4 plus 7", and no products through the consistent evaluation of Western pharmaceutical enterprises, can only rely on network advantages and scale difficult to survive; Pharmaceutical enterprises, especially preparations, drink tablets, fine Chinese medicine and food enterprises, there is still a little space, but the need to do a good job of product interpretation and disease analysis and efficient promotion, especially brand building, in a sense, sales changes will be great, but the precipitation of the brand will be a long time!Finally, Zheng Pei concluded that from the simple rough "drug proportion" assessment to a more scientific and humane "reasonable drug use" assessment, can be said to be an important sign of progress in medical reform. The biggest impact on pharmaceutical companies is to change the past by generic drugs, auxiliary drugs to promote sales, to "685-based drugs" and innovative drugs as the main sales varieties. This is a historic change, pharmaceutical companies can seize the opportunity through the following ways: First, capable enterprises to adjust the direction of research and development, from generic drugs to innovative drugs; (Medical Observer)