The promotion of pharmaceutical enterprises must change the way of medical insurance payment and reform the withdrawal of a large number of drugs from the hospital market

Recently, sepiland learned at the "third DRG payment conference in China" sponsored by the development research center of the National Health Commission that the reform of medical insurance payment mode and the promotion of DRG grouping will be implemented in three phases of three years 2019 is the top design stage of DRG, 2020 is the simulation operation stage, and 2021 is the actual payment stage In December 2019, the national grouping will be improved, and pilot cities will prepare and successively carry out simulation operation; in 2020, the simulation operation will be completed, and the eligible start-up actual payment will be made, and the national system will be officially launched; before June 2020, the simulation operation supervision and inspection will be carried out; from July to December 2020, the DRG model operation evaluation will be further improved; in December 2020, the simulation operation situation will be reviewed and the next step will be deployed In January may 2021, a typical experience exchange meeting will be held; before the end of June 2021, the investigation will be supervised to promote the implementation of the work; before the end of September 2021, the special evaluation of the pilot work will be launched to put forward suggestions for improvement and the next step plan; before December 2021, the pilot work situation and the next step arrangement will be reported to the State Council According to the guidance of the general office of the State Council on further deepening the reform of payment methods of basic medical insurance (GBF No 55, 2017), payment by disease should be emphasized, and some regions should be selected by the state to carry out the pilot payment by disease diagnosis related groups, and various payment methods such as payment by person and payment by bed should be improved By 2020, the reform of medical insurance payment mode will cover all medical institutions and medical services, and multiple and compound medical insurance payment mode that adapts to different diseases and service characteristics will be widely implemented nationwide, with the proportion of payment by project significantly reduced On November 15, the State Council issued the notice of the leading group of the State Council on deepening the reform of the medical and health system on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City Once again, the notice clearly requires that we vigorously promote the fine management of medical insurance - to promote the reform of multiple composite medical insurance payment mode based on payment by disease Actively explore the effective way of fine management of medical insurance, and implement the national pilot of group payment by disease diagnosis according to the national unified technical specifications and group scheme Encourage all regions to actively explore ways of medical insurance payment to give full play to the advantages of traditional Chinese medicine in combination with the actual situation In 2020, the comprehensive medical reform pilot provinces and regions should establish a collective negotiation mechanism between medical insurance agencies and medical institutions DRG, or diagnosis related groups, is short for DRG According to the age, gender, length of stay and clinical diagnosis of patients, the patients were divided into diagnosis related groups with similar clinical symptoms and resource consumption, and the price, charge and medical insurance payment standard were determined based on the group In June this year, four departments, including the National Health Insurance Bureau, identified 30 cities as pilot cities of DRG payment countries, and required to carry out work in accordance with the three-year three-step promotion strategy of "top-level design, simulation operation and actual payment" The 30 pilot cities are: Beijing, Tianjin, Handan, Linfen, Wuhai, Shenyang, Jilin, Harbin, Shanghai, Wuxi, Jinhua, Hefei, Nanping, Shangrao, Qingdao, Anyang, Wuhan, Xiangtan, Foshan, Wuzhou, Danzhou, Chongqing, Panzhihua, Liupanshui, Kunming, Xi'an, Qingyang, Xining, wupanshui Lumuqi City, Urumqi City (directly under the Corps, 11th division, 12th Division) According to saibelan, Ying Yazhen, vice president of the National Medical Security Research Institute of Capital Medical University, pointed out that DRG payment method is a relatively mature payment method, which will make the payment of medical insurance more in line with the actual situation of medical services, is conducive to the coordinated management and joint reform of medical insurance and medical care According to Ying Yazhen, the core mechanism of DRG is the incentive and restraint mechanism and cost control mechanism for medical institutions, the negotiation and negotiation mechanism, and the incentive and risk sharing mechanism of "surplus retention, over expenditure reasonable sharing" Ying Yazhen further said that if the reform does not touch the interests of medical institutions and medical personnel, it is difficult to get a response The 10 words "surplus retention and over expenditure reasonable sharing" are very key and the core of the reform Only when this is effectively implemented, can we really mobilize the reform enthusiasm of medical institutions, According to Ying Yazhen at the meeting, DRG payment country pilot goal is a win-win situation among medical insurance, hospitals and patients - strive to achieve medical insurance fund not overspend, more efficient use, more accurate management; hospital diagnosis and treatment is more standardized, expenditure is compensated, technology is developed; patients get high-quality medical services, reduce the burden of medical treatment, and settlement costs are more convenient Medical insurance, hospital and patient win-win situation, what is the future of pharmaceutical enterprises? Zhang Zhenzhong, honorary director of the Research Center for health development of the national health and Health Commission, believes that GBF's 2015 No 38 guiding opinions of the general office of the State Council on the pilot of comprehensive reform of urban public hospitals is the most important document in the field of public hospital reform so far, aiming to break the profit-seeking mechanism of public hospitals The release of this document is an important back of the pilot of DRG payment based reform Jing The purpose of DRG is to control medical insurance expenses, budget management of medical expenses, change the behavior of hospitals and doctors, resource allocation and performance evaluation Zhang Zhenzhong explained at the meeting that the reason why DRG based payment can change the behavior of hospitals is that it changes the pricing unit: from post payment system to pre payment system; from project based pricing to package pricing by disease diagnosis related groups; change the cost structure: make drugs, consumables, inspection and testing become the cost of disease treatment; change the income generation mode The revenue of the hospital has changed from the mode of selling medicine consumables, carrying out inspection and inspection to the mode of controlling cost In June 2017, the general office of the former national health and Family Planning Commission issued the notice on carrying out the pilot work of payment and Collection Reform in groups related to disease diagnosis, and officially launched the c-drg payment and collection reform pilot work in Shenzhen, Sanming and Karamay According to Zhang Yuanming, deputy leader of Sanming leading group of medical reform, Sanming DRG reform has realized the optimization of hospital income structure, and adjusted the proportion of income in three items: drug consumables, inspection and testing, and medical services Wu Ming, vice president of China Society of health economics, also pointed out at the meeting that the reform of payment mode is the core to promote the linkage of three medical services DRG is one of the prepayment methods to minimize the dissimilation of doctors' behaviors Hospitals have changed from increasing business income to controlling cost With the establishment of the medical insurance bureau and the implementation of DRG, the guiding and restricting role of medical insurance funds will be fully exerted About one third of the invalid medical expenses will be expelled from the hospital, while unnecessary drugs, consumables and inspections will lose the hospital market Zhang Tingjie, a senior person in the industry, told cypress blue that with the implementation of DRG, expensive drugs, devices and examinations will be greatly affected Further, under DRG, the medication structure and habits of the medical system will change, and the relevant promotion departments of pharmaceutical enterprises must make corresponding changes to adapt to the arrival of this system Zhang Zhan, the central affairs of Qilu pharmaceutical policy and regulation department, also told saibelan that pharmaceutical companies have always been paying high attention to DRG, because DRG will have a great impact on innovative drugs and generic drugs, and have a greater impact on generic drugs, because there are a large number of generic drugs in the market, and the competition between them is also fierce.