Three strategies for DRG Enterprises

▍ special writer: Zhang natural On October 23, the National Health Insurance Bureau held the interpretation meeting of "technical specifications for DRG grouping and payment of national medical insurance" and "scheme for DRG grouping of national medical insurance (chs-drg)", officially announced the birth of CHS (China Healthcare Security) - DRGs and its technical specifications and grouping scheme, so as to promote the control of medical insurance fees Diagnosis related groups (DRG) is a system that divides patients into several diagnosis groups according to age, disease diagnosis, complications, treatment, disease severity, outcome and resource consumption The so-called post payment means that the medical insurance party pays to the medical institution after the expenses are incurred, represented by the payment system according to the service items; The so-called prepayment, that is, before the medical expenses occur, the insurer pays the medical expenses to the medical institutions in advance according to certain standards, such as total prepayment, payment by head, payment by disease, etc Under the post payment system, medical expenses are paid according to the number of services, there is no limit to medical behaviors, and health expenses are easily out of control; Prepayment is to determine expenses in advance Medical institutions can carry out diagnosis and treatment within the scope of expenses, keep the surplus and overspend for their own account, which can effectively control medical insurance expenses DRG belongs to the prepayment system Under the DRGs payment mode, if the treatment cost exceeds the disease payment standard, the hospital will lose money, so the hospital must adopt the most reasonable treatment process, and actively avoid large prescriptions, repeated examinations, etc 1 The history of China In 2004, the former Ministry of Health issued the notice on carrying out the pilot work of DRG charge management, marking the beginning of China's exploration of DRG payment method, and since then, the number of pilot hospitals and diseases has been continuously expanded On June 5, this year, 30 pilot cities were determined to be the first show of DRG by the newly established national health insurance bureau Last week, the technical specifications for DRG grouping and payment of national health insurance was released《 The grouping scheme of chs-drg indicates that DRG will become the main driver of medical insurance fee control 2 American history The first generation of DRGs in the United States was developed by Yale University in 1976, with 383 disease groups; the second generation of DRGs increased to 467 DRGs in six years, and the fourth generation to 1350 DRGs 3 Comparison of the number of diseases in the group The combination of DRGs and prepayment system has become the mainstream medical insurance control mode in developed countries, which can achieve effective medical insurance control It effectively classifies most diseases and visits, for example, Germany has the largest number of 986, and China currently has 367 （1） Medical treatment 1 Decrease in hospital expenses In 1983, when the United States began to pay by disease, the cost / cost ratio of Medicare inpatient treatment continued to decline, indicating that the payment by disease has played a certain role in controlling the price of medical services and inhibiting excessive medical treatment In the early 1990s, due to the change of the US government's rate management mode, the expense / cost ratio picked up again 2 Shorter hospital stay After DRGs, the average length of stay in the United States decreased from 10.4 days in 1980 to 6.7 days in 1995 After the introduction of DRGs group system, the average hospitalization days of the three hospitals of Beijing Medical College decreased continuously By 2008, the average hospitalization days of the three hospitals of Beijing Medical College was 8.78 days, which was leading in the country （2） Medicine 1 Proportion of generic drugs increased The proportion of us generic prescriptions has increased from 19% in 1984 to 90.3% in 2017, mainly due to two reasons: ① In 1984, the United States introduced the act of encouraging the use of generic drugs to simplify the approval process of generic drugs and other measures to continue to increase the use of generic drugs; ② In 1983, the implementation of DRGs in the United States also promoted the use of generic drugs Under the same guarantee of treatment as generic drugs, medical institutions must have the incentive to purchase cheaper generic drugs 2 Decrease in the proportion of foreign drugs Like DRG, the total prepayment system is also a kind of prepayment, which can control the growth of medical insurance expenses to some extent, but it is not as refined as DRG Under the total prepayment system, when there are both original research products and domestic imitated products, the hospital also has certain power to purchase imitated drugs with lower price According to the statistical data of sample hospitals, influenced by the total prepayment reform, the market share of major domestic foreign-funded enterprises in Shanghai has decreased from 41% in 2009 to 38.5% in 2012q3, which is in contrast with the trend that the market share of foreign-funded enterprises in China is still rising, and this effect will be more significant after the implementation of DRG 3 Decrease in the proportion of auxiliary drugs DRG belongs to the prepaid system, which can encourage hospitals to use drugs with high clinical value and high cost performance, while some drugs with low cost performance will be limited Previously released key monitoring categories will bear the brunt The sales volume of these 20 key monitoring categories has dropped from 55.3 billion yuan at the peak in 2016 to 36.3 billion yuan last year With the promotion of DRG payment method, the drop is down The degree will inevitably continue to increase 1 Try to enter the clinical pathway medication guide The premise of DRG implementation is the establishment of clinical pathway and other standards The so-called clinical pathway can achieve the purpose of standardizing medical behavior, reducing costs and improving quality by establishing and formulating special documents, education programs, patient surveys, discussion of focus issues, independent observation, standardization and so on for a certain group of patients with predictable treatment results or a certain clinical symptom The clinical pathway also regulates the corresponding drugs The drugs that enter the clinical pathway medication guidelines will be used first of all, so whether the drugs can enter the medication guidelines will become the focus of enterprise competition in the future As of July 23, 2017, China has developed 1212 clinical pathways Table 2 gives an example of some products that enter the 2016 clinical pathway 2 Accelerated conformity assessment Although the 4 + 7 price reduction and huge evaluation cost have made pharmaceutical enterprises feel chilly, under the DRG payment mode, only the varieties that have passed the consistency evaluation have more opportunities to replace the original research drugs with high price, so pharmaceutical enterprises have to accelerate the process of consistency evaluation In January 2019, the number of applications for conformity assessment reached a peak of 207 Later, due to the excessive price reduction of 4 + 7, the enterprises hesitated to make conformity assessment, so the number of applications dropped sharply However, in view of the official firm attitude to volume procurement, the enterprises accelerated the progress of conformity assessment, and the number of applications in October has recovered to 97 3 Adjust product structure In recent years, with the restrictions on antibiotics, infusion and auxiliary drugs imposed by the state, its sales have been greatly affected For example, the sales proportion of traditional Chinese medicine (mainly affected by traditional Chinese medicine injection), infusion, auxiliary drugs and antibiotics in hospitals with more than 100 beds in the second quarter of 2019 has decreased by 3.9%, 1.3%, 4.9% and 1.1% respectively compared with Q2 in 2015, while the proportion of therapeutic drugs has increased 11.1% In order to control costs, the trend will be intensified after DRG is implemented Therefore, local pharmaceutical companies need to adjust product structure, abandon "non therapeutic drugs" and focus on the development and sales of therapeutic drugs.