Sanming experience to further promote national medical reform

Recently, the leading group of the State Council for deepening the reform of the medical and health system issued the notice on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City (Guo Yi Gai Fa [2019] No 2, hereinafter referred to as the notice) The notice raised the medical reform experience of Fujian Province and Sanming City to the height of national medical reform, which is of great significance to give full play to the demonstration, breakthrough and driving role of medical reform experience of Fujian Province and Sanming City, and to promote the in-depth development of national medical reform From the perspective of the notice, 2020 may become a watershed for the pharmaceutical industry Pharmaceutical enterprises should be prepared for product transformation from now on to cope with market changes brought by policies Sanming City, Fujian Province, has long been known as the benchmark of medical reform, and its experience of medical reform has also been learned by other places In the view of Zhang shanguo, general manager of Henan Yingguo Enterprise Management Consulting Co., Ltd., it is undoubtedly of great significance to issue the notice in the name of the State Council He said that the core of Sanming medical reform is to balance the relationship between "state + business + hospital + patient", that is, the state has enlarged the efficiency of medical insurance funds, the business has accepted the reality of meager profit distribution, the hospital has accepted the reality of state subsidies, the patient has reduced the cost of medication and medical treatment, and at the same time, the health products such as "drugs + devices + Herbal Pieces + food" have been "one size fits all" "Starting from Sanming again" at least shows that Sanming mode is still a benchmark, and the significance of its base still exists, and the symbolic significance is greater than the promotion significance Xu Yucai, deputy director of Shanyang County Health and Family Planning Bureau of Shaanxi Province, also highly affirmed Sanming medical reform According to the analysis of the situation of the national medical reform, the new medical reform has been continuously promoted for 10 years According to the official evaluation, "significant phased results have been achieved", but it is undeniable that the reform is still very difficult In official terms, it is "the medical reform has entered into the deep-water area and the critical stage, and the interest adjustment is more complex, and the contradiction between the system and mechanism is more prominent" Based on this, it is more important to have firm confidence and dare to break through, and it needs more typical guidance In the process of medical reform, Fujian Province and Sanming City dare to innovate the system and mechanism, break through the interest barrier, strengthen the "three medical" linkage reform, solve many problems pertinently, establish a relatively complete policy system and implementation path, with correct direction, clear path, effective measures and obvious results More importantly, Sanming has embarked on a reform path that does not rely on a large amount of government investment, which is even more precious at present The notice summarizes the main experience of deepening medical reform in Fujian Province and Sanming City, including six items: establishing an efficient and powerful leadership system and organization promotion mechanism for medical reform, deepening the joint reform of medical treatment, medical insurance and medicine, innovating the incentive mechanism for salary distribution, strengthening the supervision and management of medical institutions, reforming and improving the management of medical insurance funds, and linking up and down to promote the sinking of high-quality medical resources In Xu Yucai's view, these six experiences are very important Without an efficient and effective leadership system and organizational promotion mechanism for medical reform, there will often be no one to manage or not to manage, and the reform will not be able to go on, and even impossible to achieve results; without the linkage of medical treatment, medical insurance and medicine, the reform will not be promoted in a coordinated way, and the investment may drift, and the burden of the people will not fall; without the incentive mechanism for salary distribution Without the participation of medical staff, it is almost impossible to carry out the medical reform smoothly; without the reform of medical insurance payment system, there is no enthusiasm and motivation for medical institutions, and all reforms are difficult to continue As for whether these six experiences can be popularized in other places, both experts said that there is no problem in theory, but it is difficult to say in practice Zhang shanguo thinks that Sanming model will undoubtedly encounter various obstacles in the process of copying to the whole country It is easier said than done to dynamically adjust the price + strengthen the reform of the salary system If the price is adjusted dynamically, how? Who will adjust? How much? How to change the salary reform? More or less hair? What is the standard? Is Sanming's standard equal to the national standard? In addition to summing up the experience of Sanming medical reform, the notice also defines the key tasks of further promoting Sanming experience, including 24 tasks in 7 aspects One of the most important is to "strengthen the reform of centralized procurement of drug consumables." We will expand the scope of centralized procurement and use of drugs by state organizations All localities should actively adopt independent or cross regional alliances to carry out procurement with volume and budget for drugs not included in the plan " Does this mean that the new round of belt procurement presents a situation of blooming flowers? In this regard, Zhang shanguo gave a negative answer First, he said, "4 + 7" and "consistency evaluation" have made it impossible for small and medium-sized western medicine enterprises to play Medical equipment + food + herbal pieces are under strict control The only source of profit is proprietary Chinese medicine However, with the continuous transparency of the cost of Chinese patent medicine and the "original control", the manufacturers have become unprofitable, so they will not blindly participate in the volume purchase; secondly, it is possible to cross regional within the province, but cross regional outside the province, because each province's own situation, settlement method, especially the thickness of medical insurance funds are different, so it is impossible for the participants to only look at the medicine without considering their own situation Price Xu Yucai also said: "this situation seems very familiar, and since the new health care reform, how similar to the province as a unit of concentration? It is not only difficult to avoid the recurrence of old diseases, but also the recurrence of new diseases On the one hand, the local purchasing capacity with quantity is not enough, and the notice mentions that "all regions should actively carry out purchasing with quantity and budget for drugs not included", indicating that there will be more varieties with quantity purchased than those organized by the state health insurance bureau On the other hand, it is very likely that the local government will "apply" the model of the National Health Insurance Bureau, but there will certainly be confusion in drug prices Moreover, it is very likely that all localities will "follow the standard" or vigorously promote "only low price is to take" The most terrible thing is that the hospital once again has no medicine available, which poses a potential threat to medical security " The notice also proposed that "comprehensive medical reform pilot provinces should take the lead in promoting payment settlement between medical insurance agencies and drug production or circulation enterprises directly, and other provinces should also actively explore" In Xu Yucai's view, the implementation of direct settlement of payment for medical insurance is undoubtedly to ensure timely settlement of payment in the future, improve the payment collection of drug supply enterprises or production enterprises, and reduce the operating costs of drug enterprises However, the idea belongs to the idea, and the reality to the reality There is a popular saying called "ideal is rich, reality is bony" He has never believed that the government is more efficient than the hospital, especially the Department with more power is more unreliable Therefore, the "reform" of direct settlement between pharmaceutical enterprises and medical insurance may be more convenient in theory than that between pharmaceutical enterprises and medical institutions, but it is likely that there are more uncertainties instead "Let's say that if the medical insurance office directly settles with the manufacturers, such as Hubei and Hunan, which are all county-level standards, how many settlement personnel does the pharmaceutical factory need? If so, why does business always exist? It is because there is no one to handle the "last kilometer" business, and the business of relying on "people sea tactics" and delivery exists There is no middleman to earn the difference It can't be solved by separating businesses Can we separate businesses but manufacturers? The manufacturer is not stupid, even if there is no competitive business, the manufacturer will ask a lot of money If we have to do this, the manufacturers with profits will be lazy to recruit and manage people The labor law restricts the pharmaceutical enterprises, and it is better to appoint commercial workers " Zhang also expressed his concerns Although there are still many uncertain factors, this provision actually means that in 11 pilot provinces of health reform, such as Shanghai, Fujian, Jiangsu and Anhui, the State encourages the implementation of "one vote system" According to Zhang shanguo's analysis, "one vote system" can be implemented in some regions, but it needs three conditions: the medical insurance bureau has money, enough to attract pharmaceutical enterprises to make money by volume, and experts can set prices accepted by all three parties (Medical Insurance Bureau + pharmaceutical factory + patients) Even if it is implemented, it will not be "one size fits all" in the country What I know is that the medical insurance bureaus in some provinces have defaulted on commercial medical insurance payments, which has made it impossible for businesses to operate normally However, once these provinces take the lead in the implementation, it will undoubtedly have a huge impact All pharmaceutical enterprises, whether production enterprises or circulation enterprises, must actively make changes In terms of vigorously promoting the fine management of medical insurance, the circular encourages all localities to actively explore the payment method of medical insurance that can give full play to the advantages of traditional Chinese medicine As for the reasons why the state emphasizes the advantages of traditional Chinese medicine, Zhang shanguo said that the state hopes to prevent people from getting sick, even if they are sick, through the attention to health and the role of traditional Chinese medicine in "treating diseases before they get sick" There are also various appropriate technologies of traditional Chinese medicine that play the same role as taking medicine and surgery Therefore, it is hoped to enlarge medical insurance by including some effective traditional Chinese medicine and traditional Chinese medicine technologies into medical insurance In the case of existing medical insurance funds, more patients can enjoy the benefits of medical insurance Xu Yucai reminded that there is a basic premise here, that is to say, traditional Chinese medicine is simple and cheap, the treatment effect is certain, for the same disease, the cost is lower than western medicine, otherwise there is no reason to emphasize the advantages of traditional Chinese medicine The core is that traditional Chinese medicine must come up with curative effect, that is to say, the notice points out that "exploring the standard of payment for the same disease treated by traditional Chinese medicine and Western medicine" If this comparative advantage is confirmed by clinical medical practice, everything can be done, otherwise, it will be self humiliating On the whole, in addition to absorbing the core part of Sanming medical reform experience, the notice also introduces the latest achievements of national medical reform, such as volume procurement, traditional Chinese Medicine Inheritance and innovation, etc After the implementation of the notice, it will bring great impact on the pharmaceutical industry and the market pattern Many drugs that are under special care may exit the market The whole pharmaceutical industry will inevitably undergo major changes The production enterprises will stop production in limited quantities or even go bankrupt A large number of pharmaceutical agents will be unemployed, and the circulation enterprises will go bankrupt in large numbers A new modern pharmaceutical logistics industry may rise rapidly However, Zhang said the impact is not inclusive, but a small number of enterprises share policy dividends The growth of traditional Chinese medicine unit to nearly 900 billion yuan, while western medicine only has more than 100 billion yuan, indicating that the share of traditional Chinese medicine is indeed growing, but traditional Chinese medicine and traditional Chinese medicine need both materials and talents, which are not available to every pharmaceutical enterprise; moreover, to enter the medical insurance market, it requires a certain investment and a certain period of time, and not all enterprises can adhere to it It is worth noting that the circular puts forward a number of measures to be completed in 2020, such as "in 2020, expand the scope of centralized procurement and use of drugs by national organizations; carry out performance appraisal of public medical institutions at or below the second level; and comprehensively establish key drug monitoring mechanism by the end of December 2020" This indicates that 2020 may be a watershed for the pharmaceutical industry So, what preparations do pharmaceutical companies need to make to cope with the coming changes? Xu Yucai suggested that pharmaceutical enterprises should first prepare themselves for the future It will be hard for them to live in the future, but whether this practice can last for a long time may be a problem, because the law of market economy is very