The formation mechanism of medical insurance payment price and the speed of market adjustment of medical consumables will be accelerated
Last Update: 2020-06-19
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Following the issuance of the Interim Measures for administration of drugs used in basic medical insurance (Draft for comments) on April 28, on June 8, 2020, the state health insurance bureau issued the Interim Measures for administration of medical consumables used in basic medical insurance (Draft for comments) (hereinafter referred to as the "measures")The method gives detailed guidance on the adjustment path of medical consumables catalogue and medical consumables medical insurance payment standard, and clarifies several principles similar to drugs: establish a national unified medical consumables catalogue of basic medical insurance, take negotiation and centralized purchase as the formation mechanism of medical insurance payment standard, and determine the minimum median price of medical consumables of the same category and similar functions< br / > the method specifies the access management of medical consumables, which is updated regularly and adjusted dynamically, < br / >This means that in catalog management, the above four factors are taken as the core of trade-off, in which the key to choose between clinical value and medical insurance fund bearing capacity is to achieve a dynamic balance in an ideal state< br / > is emphasized in basic principleIn the establishment of medical insurance payment price, we also carry out a comprehensive evaluation on the premise of clear clinical value, and determine it according to the functional orientation of medical insuranceThe affordability of health care is still the key to the assessment, but it also emphasizes the whole life cycle cost, which means it will incline to exclusive varieties< br / > in the determination of the catalog, in addition to the part not included in the medical consumables catalog at present, it also emphasizes the scope of directly calling out the catalog, one of which is worthy of attention: < br / >This means that if the clinical value of medical consumables is not prominent, safety problems or too expensive, it will be listed in the possibility of transfer out< br / > according to the medical insurance treatment list system launched in 2019, not only the drug catalog will be unified nationwide, but also the medical consumables will follow suitAfter the medical consumables catalogue is unified nationwide, the coding and use of consumables will also be unified nationwideBased on the three unifications of catalogue, coding and use, the use of recruitment and acquisition and medical institutions will also be easier to supervise, changing the regulatory dilemma caused by the lack of unification in the past< br / > in terms of payment standard of medical insurance, the method gives clear principles: exclusive access through negotiation, non exclusive access through centralized purchase< br / > < br / > < br / / > it is worth noting that for exclusive varieties, if the negotiation is unsuccessful, they will be directly transferred out of the catalog, even if they were originally in the catalog, which will put great pressure on consumables manufacturersDifferent from the non exclusive varieties, even if they fail to win the bid in the centralized purchase, they can still get medical insurance compensation on the premise of accepting the payment price of medical insuranceIf the negotiation of exclusive varieties fails, they can only get outBecause the payment price of medical insurance will also be determined by the centralized purchase price, but because consumables are different from generic drugs, there is no consistency evaluationThe method emphasizes the same category and similar functions, but how to determine the final payment standard of medical consumables for medical insurance needs to wait for the rules to be issued< br / > in addition, method < br / >With the promotion of DRG reform, consumables are one of the main expenses of hospitalizationThe price of medical consumables entering the consumables catalogue through centralized purchase and negotiation is lowerUnder the package payment, if the hospital chooses centralized purchase and negotiation consumables, it is easier to meet the requirements of compensation, and it is also conducive to the implementation of payment reformAccording to Article 16, < br / > the reform of medical consumables will be similar to that of drugs, and the key is to compact the hospital dosage< br / > finally, the supervision of medical institutions, doctors and enterprises will be strengthened day by dayAmong them, the supervision of medical institutions will not only strengthen the use and payment of consumables, but also extend to the front end, requiring the hospital to submit the purchase, sale and storage data on a regular basisThe hospital will face a comprehensive data review, and the difficulty of avoiding supervision will increaseFor enterprises, a credit system similar to that of pharmaceutical enterprises will be established, and the dishonest enterprises will be punished< br / > what is worth emphasizing here is that the method mentions: < br / >With the reform of DRG and the decrease of the price of medical consumables, hospitals and doctors have the motivation to induce patients to use self paid consumables with higher incomeHow to regulate the use of self paid consumables will be one of the main areas of continuous game between medical insurance and medical institutions in the future< br / > generally speaking, the payment reform of medical consumables is about to start, and the basic path is consistent with that of drugsHowever, due to the lack of consistency evaluation of consumables, the formulation and promotion of standards will take a certain time, and the promotion speed is relatively slowHowever, with the pilot of centralized purchase in some provinces and the upcoming launch of national centralized purchase of consumables, the reform of consumables payment system will have a great impact on relevant enterprises How to establish effective response strategies and promote their own transformation will be the key to the development of enterprises.
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