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    Home > Active Ingredient News > Drugs Articles > The price reform of medical services is coming

    The price reform of medical services is coming

    • Last Update: 2021-05-31
    • Source: Internet
    • Author: User
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    On the afternoon of May 21, the 19th meeting of the Central Committee for Comprehensively Deepening Reform was held.


    Why did we propose to deepen the pilot price reform of medical services again at this time? What are the implications? Here I will chat with everyone.


    What information was fed back to the conference "announcement"?

    The meeting called for strengthening the public welfare attributes of basic medical and health undertakings, deepening the reform of medical service prices, establishing a reasonable compensation mechanism, stabilizing expectations for price adjustments, ensuring the overall stability of the burden on the masses, the affordable medical insurance funds, the sustainable development of public medical institutions, and improving the performance of medical and health services.


    The meeting pointed out that the price of medical services is the most direct and practical interest issue that the people are most concerned about.


    The meeting emphasized that to deepen the reform of medical service prices, it is necessary to standardize the management of medical service price items, establish a target-oriented price item management mechanism, and make medical service price items better priced, better implemented, better evaluated, and more suitable for clinical diagnosis and price.


    It is necessary to strengthen the macro-management of the price of medical services, balance the development needs of medical undertakings and the affordability of all parties, and highlight the key points within the scope of the total amount.


    It is necessary to establish a sensitive and highly dynamic price adjustment mechanism, and clarify the starting conditions and constraints of price adjustments.


    The central government's important arrangements for the price reform of medical services since the new medical reform

    In October 2015, "Several Opinions of the Central Committee of the Communist Party of China and the State Council on Promoting the Reform of the Price Mechanism" was issued.


    Determine the four basic principles of price reform.


    In deepening the price reform in key areas, "straightening out the price of medical services" is included.


    It is proposed to establish a dynamic price adjustment mechanism based on changes in the cost and income structure, and implement the price adjustment policy of the medical service market of non-public medical institutions.


    The prices of medical service items of public medical institutions shall be managed by classification, and the prices of medical service items with relatively sufficient market competition and strong individualized demand shall be subject to market-adjusted prices.


    In July 2016, the National Development and Reform Commission, the Health and Family Planning Commission, the Ministry of Human Resources and Social Security, and the Ministry of Finance jointly issued a notice on advancing medical service price reform (Fagai Price [2016] No.


    Clearly promote the price classification management of medical services.


    For medical services provided by non-public medical institutions, the market-adjusted price policy shall be implemented.


    In June 2017, the Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Basic Medical Insurance Payment Methods (Guobanfa [2017] No.


      However, due to the lack of a unified department to take the lead in this series of reform measures, they have not been fully implemented.

      At this time, what is the meaning of deepening the pilot price reform of medical services again?

      1.
    There are better conditions for price reform.

      One is that space is freed up.
    As stated in the “Through Draft” of the conference, in recent years, the Party Central Committee has deployed and promoted a series of reforms.
    Through the elimination of drug markups, centralized recruitment and procurement of drugs, and strengthening of cost control, the prices of drug consumables have been lowered and the burden on the people has been reduced.
    It also created conditions for adjusting the price of medical services.

      The second is that the model already exists.
    In November 2019, the State Council’s Medical Reform Leading Group issued the “Notice on Further Promoting the Reform of the Medical and Health System in Fujian Province and Sanming City”, aiming to give full play to the demonstration, breakthrough and leading role of typical experience in overall reforms, and promote the direction of medical reform.
    Develop in depth.

      The core of Sanming’s medical reform experience is to deepen the joint reform of the “three medical treatments” of medical care, medical insurance, and medicine in accordance with the idea of ​​vacating cages for birds and the path of vacating space, adjusting structure, and guaranteeing convergence, so as to ensure that the room for lowering drug prices is ensured.
    Based on the benefits of the masses, the focus is to adjust the price of medical services in a timely manner, establish a dynamic adjustment mechanism, optimize the hospital's income structure, and establish a new mechanism for public welfare operation.
    Not long ago, the supreme leader went to Sanming again, and the point was obvious.

      2.
    The reform of the price of medical services has reached a point where it will not work.

      First, the reform of medical service prices has become a shortcoming of the three-medicine linkage.
    In recent years, the "medicine" reform in the three-medicine linkage reform has been advancing rapidly and has achieved remarkable results.
    The "medical insurance" payment system reform will be implemented in a large-scale pilot program (30 DRGs and 71 DIP cities) this year.
    (Price) reform is obviously lagging behind.
    In March 2018, the Medical Insurance Bureau was established and was appointed to coordinate and promote the important task of "three-medicine linkage", and there should be some action.

      Second, general difficulties have emerged in the operation of medical institutions.
    With the rapid advancement of "medicine" reform (purchasing in quantities, negotiating purchases to reduce the price of medicines and consumables), hospitals that previously relied on gray income for survival and development can no longer continue; thunder has achieved brilliant results in combating fraud, and medical institutions rely on medical insurance for food.
    "The days are gone; coupled with the huge impact of the new crown pneumonia epidemic, the operation of medical institutions across the country has generally encountered unprecedented and obvious difficulties.
    Under the situation of huge downward pressure on the economy, it is attempting to relieve it through substantial financial support.
    The difficulty of operating public hospitals is unrealistic, so it is urgent to pour a bucket of “water” on public hospitals that are already thirsty through the reform of medical service prices, so that they can rejuvenate their health as soon as possible, strengthen economic management, and improve the quality of operations on the other.
    , Lay the foundation for high-quality development.

      Therefore, the meeting proposed that the reform of medical service prices should ensure "the overall stability of the burden on the masses and the affordability of the medical insurance fund", while ensuring the "sustainable development of public medical institutions" to "improve the quality and level of medical and health services for the people.
    "

      The price reform put forward for the first time "respect for the professional opinions and suggestions of hospitals and doctors"

      Although the pilot plan has not yet been announced, according to the information disclosed in the "Announcement", this medical service price reform will have the following four characteristics:

      First, the price item highlights the "four changes".
    The meeting emphasized that to deepen the reform of medical service prices, it is necessary to standardize the management of medical service price items, establish a target-oriented price item management mechanism, and make medical service price items better priced, better implemented, better evaluated, and more suitable for clinical diagnosis and price.
    Management needs.

      The second is to pay attention to balancing the "two relations" in price reforms.
    The meeting pointed out that it is necessary to strengthen the macro-management of the price of medical services, balance the development needs of the medical industry and the affordability of all parties, and highlight the key points within the total range, and increase and decrease.
    It is proposed here to "balance the needs of medical development and the affordability of all parties", that is to say, it is necessary to consider both the "needs of medical development" and "the ability of all parties".
    The "all parties" here are obviously the most important It is the patient's medical payment ability and the endurance of the medical insurance fund.

      Third, price reforms should combine the characteristics of medical services to strengthen classified management.
    For general-purpose projects that are commonly carried out, the government must manage the price benchmark; for complex projects that are technically difficult, the government must play a good role, respect the professional opinions and suggestions of hospitals and doctors, and better reflect the value of technical labor services.

      Fourth, price adjustments must be sensitive and responsive.
    The meeting emphasized that it is necessary to establish a sensitive price dynamic adjustment mechanism and clarify the starting conditions and constraints of price adjustments.
    It is necessary to do a good job in price monitoring, evaluation, supervision and inspection to ensure the stable operation of the price mechanism.
    It is necessary to actively and steadily carry out the pilot work, and coordinate the promotion of public hospitals' compensation mechanism, graded diagnosis and treatment, medical control fees, medical insurance payment and other related reforms to form a comprehensive effect.

      Although after the implementation of the reform of the medical insurance payment system, the medical service items will no longer be the basic unit of medical insurance payment, but the medical service items will become an important factor in the total cost of the disease.
    Therefore, a reasonable medical service can be established.
    The price of cost is still very important, and it is the prerequisite for maintaining the healthy survival and development of various market players.
    Therefore, the reopening of the pilot medical service price reform is of extraordinary significance.
    (See the medical profession)

    On the afternoon of May 21, the 19th meeting of the Central Committee for Comprehensively Deepening Reform was held.
    The meeting reviewed and approved five documents including the "Deepening the Pilot Plan for Reform of Medical Service Prices.
    "

      Why did we propose to deepen the pilot price reform of medical services again at this time? What are the implications? Here I will chat with everyone.

      What information was fed back to the conference "announcement"?

      The meeting called for strengthening the public welfare attributes of basic medical and health undertakings, deepening the reform of medical service prices, establishing a reasonable compensation mechanism, stabilizing expectations for price adjustments, ensuring the overall stability of the burden on the masses, the affordable medical insurance funds, the sustainable development of public medical institutions, and improving the performance of medical and health services.
    People's service quality and level.

      The meeting pointed out that the price of medical services is the most direct and practical interest issue that the people are most concerned about.
    In recent years, the Party Central Committee has deployed and promoted a series of reforms.
    Through the elimination of drug additions, centralized recruitment and procurement of drugs, and strengthening of cost control, the prices of drugs and consumables have been reduced, the burden on the people has been reduced, and conditions have been created for adjusting the prices of medical services.
    .

      The meeting emphasized that to deepen the reform of medical service prices, it is necessary to standardize the management of medical service price items, establish a target-oriented price item management mechanism, and make medical service price items better priced, better implemented, better evaluated, and more suitable for clinical diagnosis and price.
    Management needs.

      It is necessary to strengthen the macro-management of the price of medical services, balance the development needs of medical undertakings and the affordability of all parties, and highlight the key points within the scope of the total amount.
    It is necessary to strengthen classified management in accordance with the characteristics of medical services.
    For common projects that are commonly carried out, the government should manage the price benchmarks; for complex projects with high technical difficulties, the government should play a good role and respect the professional opinions and suggestions of hospitals and doctors.
    Better reflect the value of technical labor services.

      It is necessary to establish a sensitive and highly dynamic price adjustment mechanism, and clarify the starting conditions and constraints of price adjustments.
    It is necessary to do a good job in price monitoring, evaluation, supervision and inspection to ensure the stable operation of the price mechanism.
    It is necessary to actively and steadily carry out the pilot work, and coordinate the promotion of public hospitals' compensation mechanism, graded diagnosis and treatment, medical control fees, medical insurance payment and other related reforms to form a comprehensive effect.

      The central government's important arrangements for the price reform of medical services since the new medical reform

      In October 2015, "Several Opinions of the Central Committee of the Communist Party of China and the State Council on Promoting the Reform of the Price Mechanism" was issued.
    The "Opinions" pointed out that the price mechanism is the core of the market mechanism, and that the market determines the price is the key to the market's decisive role in the allocation of resources.

      Determine the four basic principles of price reform.
    One is to stick to market decisions.
    Correctly handle the relationship between the government and the market.
    Any price that can be formed by the market will be handed over to the market, and the government will not intervene improperly.
    The second is to adhere to the combination of decentralization and management.
    The third is to persist in reform and innovation.
    Promote the transformation of price management from direct pricing to standardizing price behavior, creating a good price environment, and serving macro-control.
    The fourth is to insist on steady progress.

      In deepening the price reform in key areas, "straightening out the price of medical services" is included.
    It is clear that it is necessary to focus on the goal of deepening the reform of the medical and health system, and in accordance with the principle of “total volume control, structural adjustment, ups and downs, and gradual implementation”, actively and steadily advance the reform of medical service prices, adjust the prices of medical services reasonably, and simultaneously strengthen prices and medical insurance Policy convergence ensures that the development of medical institutions is sustainable, the medical insurance fund is affordable, and the burden on the masses does not increase.

      It is proposed to establish a dynamic price adjustment mechanism based on changes in the cost and income structure, and implement the price adjustment policy of the medical service market of non-public medical institutions.

      The prices of medical service items of public medical institutions shall be managed by classification, and the prices of medical service items with relatively sufficient market competition and strong individualized demand shall be subject to market-adjusted prices.
    The service items paid by the medical insurance fund shall be reasonably determined by the medical insurance agency and the medical institution through negotiation Payment standard.
    Further improve the drug procurement mechanism and give full play to the role of medical insurance to control fees.
    The actual transaction prices of drugs are mainly formed by market competition.

      In July 2016, the National Development and Reform Commission, the Health and Family Planning Commission, the Ministry of Human Resources and Social Security, and the Ministry of Finance jointly issued a notice on advancing medical service price reform (Fagai Price [2016] No.
    1431).

      Clearly promote the price classification management of medical services.
    Government-guided prices are implemented for basic medical services provided by public medical institutions, and market-adjusted prices are implemented for special-needed medical services provided by public medical institutions and other medical services with sufficient market competition and strong individualized needs.
    Strictly control the scale of special medical services, and the proportion of special medical services provided shall not exceed 10% of all medical services.

      For medical services provided by non-public medical institutions, the market-adjusted price policy shall be implemented.
    For medical services with market-adjusted prices paid by the basic medical insurance fund, the medical insurance agency will comprehensively consider factors such as the cost of medical services and the affordability of all aspects of the society, negotiate with medical institutions to determine a reasonable medical insurance payment standard, and guide the formation of reasonable prices.
    Actively explore the establishment of a mechanism to guide the formation of reasonable prices through the formulation of medical insurance payment standards.
    Expand the scope of fees charged by disease types and service units, and gradually reduce the number of fees charged by items.

      In June 2017, the Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Basic Medical Insurance Payment Methods (Guobanfa [2017] No.
    55) was issued.
    The guidance proposes the comprehensive implementation of a diversified compound medical insurance payment method based on disease-based payment.
    The proportion of payment by project has dropped significantly.

      However, due to the lack of a unified department to take the lead in this series of reform measures, they have not been fully implemented.

      At this time, what is the meaning of deepening the pilot price reform of medical services again?

      1.
    There are better conditions for price reform.

      One is that space is freed up.
    As stated in the “Through Draft” of the conference, in recent years, the Party Central Committee has deployed and promoted a series of reforms.
    Through the elimination of drug markups, centralized recruitment and procurement of drugs, and strengthening of cost control, the prices of drug consumables have been lowered and the burden on the people has been reduced.
    It also created conditions for adjusting the price of medical services.

      The second is that the model already exists.
    In November 2019, the State Council’s Medical Reform Leading Group issued the “Notice on Further Promoting the Reform of the Medical and Health System in Fujian Province and Sanming City”, aiming to give full play to the demonstration, breakthrough and leading role of typical experience in overall reforms, and promote the direction of medical reform.
    Develop in depth.

      The core of Sanming’s medical reform experience is to deepen the joint reform of the “three medical treatments” of medical care, medical insurance, and medicine in accordance with the idea of ​​vacating cages for birds and the path of vacating space, adjusting structure, and guaranteeing convergence, so as to ensure that the room for lowering drug prices is ensured.
    Based on the benefits of the masses, the focus is to adjust the price of medical services in a timely manner, establish a dynamic adjustment mechanism, optimize the hospital's income structure, and establish a new mechanism for public welfare operation.
    Not long ago, the supreme leader went to Sanming again, and the point was obvious.

      2.
    The reform of the price of medical services has reached a point where it will not work.

      First, the reform of medical service prices has become a shortcoming of the three-medicine linkage.
    In recent years, the "medicine" reform in the three-medicine linkage reform has been advancing rapidly and has achieved remarkable results.
    The "medical insurance" payment system reform will be implemented in a large-scale pilot program (30 DRGs and 71 DIP cities) this year.
    (Price) reform is obviously lagging behind.
    In March 2018, the Medical Insurance Bureau was established and was appointed to coordinate and promote the important task of "three-medicine linkage", and there should be some action.

      Second, general difficulties have emerged in the operation of medical institutions.
    With the rapid advancement of "medicine" reform (purchasing in quantities, negotiating purchases to reduce the price of medicines and consumables), hospitals that previously relied on gray income for survival and development can no longer continue; thunder has achieved brilliant results in combating fraud, and medical institutions rely on medical insurance for food.
    "The days are gone; coupled with the huge impact of the new crown pneumonia epidemic, the operation of medical institutions across the country has generally encountered unprecedented and obvious difficulties.
    Under the situation of huge downward pressure on the economy, it is attempting to relieve it through substantial financial support.
    The difficulty of operating public hospitals is unrealistic, so it is urgent to pour a bucket of “water” on public hospitals that are already thirsty through the reform of medical service prices, so that they can rejuvenate their health as soon as possible, strengthen economic management, and improve the quality of operations on the other.
    , Lay the foundation for high-quality development.

      Therefore, the meeting proposed that the reform of medical service prices should ensure "the overall stability of the burden on the masses and the affordability of the medical insurance fund", while ensuring the "sustainable development of public medical institutions" to "improve the quality and level of medical and health services for the people.
    "

      The price reform put forward for the first time "respect for the professional opinions and suggestions of hospitals and doctors"

      Although the pilot plan has not yet been announced, according to the information disclosed in the "Announcement", this medical service price reform will have the following four characteristics:

      First, the price item highlights the "four changes".
    The meeting emphasized that to deepen the reform of medical service prices, it is necessary to standardize the management of medical service price items, establish a target-oriented price item management mechanism, and make medical service price items better priced, better implemented, better evaluated, and more suitable for clinical diagnosis and price.
    Management needs.

      The second is to pay attention to balancing the "two relations" in price reforms.
    The meeting pointed out that it is necessary to strengthen the macro-management of the price of medical services, balance the development needs of the medical industry and the affordability of all parties, and highlight the key points within the total range, and increase and decrease.
    It is proposed here to "balance the needs of medical development and the affordability of all parties", that is to say, it is necessary to consider both the "needs of medical development" and "the ability of all parties".
    The "all parties" here are obviously the most important It is the patient's medical payment ability and the endurance of the medical insurance fund.

      Third, price reforms should combine the characteristics of medical services to strengthen classified management.
    For general-purpose projects that are commonly carried out, the government must manage the price benchmark; for complex projects that are technically difficult, the government must play a good role, respect the professional opinions and suggestions of hospitals and doctors, and better reflect the value of technical labor services.

      Fourth, price adjustments must be sensitive and responsive.
    The meeting emphasized that it is necessary to establish a sensitive price dynamic adjustment mechanism and clarify the starting conditions and constraints of price adjustments.
    It is necessary to do a good job in price monitoring, evaluation, supervision and inspection to ensure the stable operation of the price mechanism.
    It is necessary to actively and steadily carry out the pilot work, and coordinate the promotion of public hospitals' compensation mechanism, graded diagnosis and treatment, medical control fees, medical insurance payment and other related reforms to form a comprehensive effect.

      Although after the implementation of the reform of the medical insurance payment system, the medical service items will no longer be the basic unit of medical insurance payment, but the medical service items will become an important factor in the total cost of the disease.
    Therefore, a reasonable medical service can be established.
    The price of cost is still very important, and it is the prerequisite for maintaining the healthy survival and development of various market players.
    Therefore, the reopening of the pilot medical service price reform is of extraordinary significance.
    (See the medical profession)

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