Uncover the truth that the proportion of drugs has been distorted! (attach the policy statistics of the proportion of drugs not accepted)

Recently, there is a word in the industry and Guangzhou GPO equally famous hot, that is, "drug proportion." It is pointed out that the starting point of the design of "drug proportion" itself is beautiful, but it is distorted and distorted by the medical institutions "fighting with heaven and earth" in the actual implementation What is the truth of the proportion of drugs? The author makes the following simple analysis On August 20, 2018, the notice on deepening the reform of medical and health system in the second half of 2018 issued by the general office of the State Council clearly pointed out that we should strengthen the supervision of medical insurance on medical behavior, take measures to solve the problems of "hanging bed" hospitalization, insurance fraud, etc., and scientifically control the unreasonable growth of medical expenses As a very important part of medical behavior, the proportion of drugs is particularly important So, what is the proportion of drugs? In November 2015, the then national health and Family Planning Commission, together with the national development and Reform Commission, the Ministry of finance, the Ministry of human resources and social security, and the State Administration of traditional Chinese medicine jointly issued the notice on printing and distributing some opinions on controlling the unreasonable growth of medical expenses in public hospitals Among them, in order to strengthen the monitoring of medical expenses and facilitate the quantification and comparison of cost control, the opinions on cost control put forward 21 indicators in medical institutions In terms of income structure, the indicators such as the proportion of drug income, inspection and test income, and health material income in medical income are listed in particular, among which, item 14 is "drug proportion" According to the official definition, the proportion of drugs (excluding decoction pieces of traditional Chinese Medicine) = hospital drug revenue / medical revenue × 100%, excluding decoction pieces of traditional Chinese medicine, which is used to reflect the level and income structure of hospital drug expenses Under the new situation, the relevant definition is: drug proportion (excluding Chinese herbal pieces) = (drug income - Chinese herbal medicine income - National negotiated drug income) / medical income * 100% As we all know, medical income includes service income (diagnosis and treatment, nursing, surgery, inspection, inspection and other items) + drug income According to relevant policy requirements, by the end of September 2017, all kinds of public hospitals at all levels in the country must cancel the drug mark up before the end of September, and drugs other than Chinese herbal pieces shall be sold at zero margin According to the requirements of No 7 and No 70 documents, the new procurement system requires to strengthen budget constraints In the future, the expenditure of hospital drugs will not be higher than 25% to 30% of the hospital business expenditure This is to control the drug cost from the budget link, which is conducive to reducing the virtual high price of drugs That is to say, under the huge pressure of the policy and the operation cost of drug transformation, the pharmaceutical part of the business income of medical institutions needs to seriously calculate how to obtain, and at the same time, how to expand the service income In terms of business expenditure, "drug expenditure" should never be less On the one hand, the drug revenue is reduced, on the other hand, the drug expenditure is limited In addition to the provincial bidding price reduction, under the background of prepayment of the total amount of medical insurance, the medical institutions only have to adjust in terms of "numerator" and "denominator" As we all know, it is to increase denominator, increase medical income, reduce drug income through secondary price negotiation, implementation of hospital department two-level assessment management, restriction of outpatient infusion, cancellation of outpatient service in three-level hospital, cancellation of outpatient pharmacy, pharmacy trusteeship or establishment of pharmacy outside the hospital If you don't have a sense of the proportion of controlled drugs, in the past two years The list of drug abuse control and drug use management that has sprung up all over the country is enough to illustrate all this, especially with the continuous promotion of payment by disease in all parts of the country, the evidence of clinical efficacy is not sufficient, the authoritative disease diagnosis and treatment guidelines or evidence-based medicine support are not obtained, the advantages of pharmacoeconomics are not possessed, the clinical use is large, the cost-effective is low, there are many problems in prescription review, and the use of super drugs is unusual On the one hand, it will encounter restrictions when entering the drug purchase catalogue, and on the other hand, it will face the situation of cutting back the price when entering the classified and centralized purchase link Even in order to reduce the "drug proportion", many hospitals have won the bid by starting with procurement All auxiliary drugs will not be purchased, and the limited amount and type of antibiotics will be purchased Some hospitals' proprietary Chinese medicines, even though they have won the provincial, municipal and even regional standards and hospital standards, are almost not within the scope of procurement or rarely used It's not just about the proportion of drugs When the prepayment of medical institutions is close to the top line, especially in the last ten days of each month, the phenomenon of hospital prevarication, less or no examination often occurs in some places Due to the limitation of the proportion of drugs, some medical institutions are fond of patients at their own expense On the one hand, this is "incremental" and does not account for the number of medical insurance expenses On the other hand, this part of patients will bring greater benefits to medical institutions On the contrary, due to information asymmetry, medical insurance patients often fall into the induced trap inexplicably In this regard, I have deep feelings In 2014, the author's relatives accidentally fell down and twisted their waists In the process of a large hospital's specialized medical treatment, the doctor opened his mouth to ask for waist surgery, which cost 20000, at his own expense In a cautious manner, the author immediately went to another large-scale local third class hospital with relatives for treatment After the expert's examination, it was no big problem, only some conventional oral drugs were prescribed A week later, the relative was healthy and walked as usual Through the analysis of the above aspects, it is not difficult to see that the purpose of establishing the proportion of drugs is to restrain the hospital from making profits by selling drugs Nowadays, the function of drug proportion is undoubtedly in a more awkward situation, in which drug addition is cancelled and price reduction is dominated by medical institutions At present, the road is rough Perhaps the relevant departments realized that the role of drug proportion was alienated to some extent, so they did not emphasize the assessment of drug proportion in some special drugs Recently, the National Medical Insurance Bureau negotiated to include 17 kinds of anticancer drugs in the medical insurance reimbursement catalogue According to relevant media reports, compared with the average retail price of these drugs, the average decrease of 17 kinds of drugs was 56.7% The payment standard of most imported drugs after negotiation is lower than the market price of surrounding countries or regions, with an average of 36% According to the report on the national health insurance bureau is coordinating with the national health and Health Commission, and plans to issue relevant documents to promote the implementation of anticancer drugs in the medical insurance catalog: in the short term, anticancer drugs that are initially determined to be successful in this round of medical insurance access negotiations may not be included in the drug proportion assessment; in the long term, around the next step of the normalization adjustment mechanism of the medical insurance catalog, public hospitals need to cooperate We should establish a long-term mechanism for the administration of drugs (especially for the assessment of drug proportion), rather than strive for the "immunity" of the assessment of drug proportion every time we adjust the medical insurance catalogue But there is still uncertainty about when the policy will be introduced Where will the next step of drug proportion go? Let's see Attachment: summary of the proportion of drugs not included in the negotiation among all provinces and countries In this paper, I would like to thank Guo Xinfeng, a medical policy expert, for his valuable guidance, and I would like to thank Yi Lian for the relevant data support.