Zhan Jifu responds to four questions about Sanming's medical reform: the disappearance of cheap drugs is wrong, not limited price purchase

Source: global network 2016-04-29 Sanming City, Fujian Province is the first prefecture level city to carry out comprehensive reform in all public hospitals At the 21st Meeting of the Central Committee's deep restructuring this year, General Secretary Xi listened to the report on Sanming's medical reform and gave full affirmation During the two sessions, the most popular word is "medical reform" When it comes to medical reform, one word is "Sanming medical reform mode" The State Council recently made a decision to select some pilot provinces to promote Sanming experience and practice What's good about "Sanming medical reform model"? Let's take a look at the following data: 129.97 million: this figure is the current balance of Sanming employees' health insurance co-ordination fund in 2015, while in 2011, this figure is more than negative 208 million yuan Sanming medical reform has not only reversed the situation that the income is not equal to the expenditure, but also enhanced the sustainability of medical insurance fund 25.74%: This is the proportion of drugs in Sanming City in 2015, reaching the standard that the proportion of drugs proposed in the State Council's medical reform opinion dropped below 30% Generally speaking, the proportion of drugs is the proportion of the cost of buying drugs in the total cost of patients in the process of seeing a doctor In 2011, the proportion of drugs in Sanming City was 46.77%, and the drug cost was 900 million 148 yuan: the medical expenses of the common people dropped significantly The average hospitalization expenses of 22 hospitals above the county level in the city were only 5174.3 yuan, the average hospitalization days were 8.34 days, the proportion of drugs was 25.74%, and the average outpatient expenses were only 147.94 yuan 50%: Sanming City has implemented a target annual salary system for doctors, referring to the international practice that doctors' income is generally 3-5 times of the average social income Under the total wage, doctors, nurses and administrative and logistics teams account for 50%, 40% and 10% respectively These shiny medical reform transcripts have to be amazing: Sanming medical reform has successfully achieved "multi win" for patients, doctors, hospitals and the government! But this "multi win" is not recognized by everyone, and Sanming medical reform model faces affirmation and doubt Today, with these questions and different voices, we interviewed Zhan Jifu, the member of the Standing Committee of Sanming Municipal Committee, the Minister of publicity and the leader of the leading group of Sanming municipal medical reform, to see how he interpreted these questions! Zhan Jifu is the member of the Standing Committee of Sanming Municipal Committee, the Minister of publicity and the leader of the leading group of the leading group of Sanming municipal medical reform According to the traditional practice of the division of labor of Sanming municipal government, education, science, culture, health, social security and social assistance are in the charge of two municipal leaders respectively, and the specific management functions are scattered to the Health Bureau, Personnel Bureau, development and Reform Commission, Finance Bureau, etc After the beginning of the reform, Sanming centralized the relevant government departments of "Sanyi" to Zhan Jifu, the then vice mayor, and gave him full authorization No other leaders intervened in specific affairs Sanming City medical reform leading group issued more than 90 documents, all issued by him alone One question: does the government's leading medical reform violate the policy of "simplifying administration and delegating power"? Some people believe that Sanming medical reform is solved through strong government and iron fist reform, not through marketization Sanming medical reform model can't solve the current medical problems, such as monopoly of medical market, doctors can't practice freely, poor reliability of medical services, etc., and even the reform vigorously promoted by the government leads to the expansion of government's power, which will reverse the market opening and other issues This is contrary to the "simplification of administration and decentralization" advocated by the state In Zhan Jifu's view, "in Sanming medical reform, the government started from the goal of providing basic medical security for the common people, rather than the power policy, which is consistent with the responsibility of the government to take the lead in the reform, which is said by General Secretary Xi The government serves the people, and the government itself must undertake certain security responsibilities, such as providing basic education, basic public security, basic medical security, and even basic housing security for the people It's said that medical reform is difficult What's the difficulty? It's hard to control water in Kowloon It's hard to break the interests of all departments, and they pass the buck to each other Therefore, the first step of Sanming medical reform is system reform Zhan Jifu stressed that "Sanming City first straightened out the leadership system, put matters related to medical treatment, medical insurance, medicine and other fields under the management of one person, broke the situation of multi head joint management, and truly achieved the linkage of three medical services Then, straighten out the rights and responsibilities between the government departments and public hospitals The government departments should return the power within the hospital walls to the president, and the government must shoulder the responsibility " "Sanming medical reform takes public hospitals as the main body and cannot completely follow the market route, so the cost of medical treatment for the common people may be higher And what the government guides the medical reform to play here is the role and function of security, providing basic medical security for the common people Because medical medicine is a special industry, and the relationship between doctors and patients is the relationship of life Therefore, it is not a simple commodity trade, it cannot follow the market route, and it is necessary to maintain the public welfare of public hospitals According to Zhan Jifu, the government is responsible for the capital construction, equipment purchase, key discipline development and public health service input of Sanming public hospital After investigation, the historical debt of public hospitals before the reform was integrated into the unified management of government debt As for the personnel appointment, daily operation and other matters of public hospitals, Zhan Jifu believes that they should be returned to public hospitals, in which the government can play a management and supervision role Sanming City has incorporated the work of medical reform into the performance evaluation of governments at all levels, and established a performance evaluation system for presidents The government actively undertakes the corresponding responsibilities, while public hospitals can return to the public welfare Of course, in the internal reform of public hospitals, such as the doctor's salary system and drug purchase, we all let the market go and set prices according to the supply-demand relationship of the market " Zhan Jifu said Second, many doctors and nurses have lost their enthusiasm because of unfair distribution of annual salary system? As for the serious loss of medical staff in Sanming City and doctors' complaints about the unfair salary system circulated on the Internet, Zhan Jifu confidently said: "before the Sanming medical reform in 2011, the total wage of 22 public hospitals was 380 million yuan, with a per capita wage of about 40000 yuan, while in 2015, the total wage of doctors was 895 million yuan, with an average wage of nearly 9 Ten thousand yuan, this salary may not be comparable with Beijing and Shanghai, but it has changed a lot for Sanming In fact, the flow of medical staff is very normal, and it has always been a problem It is normal to have such concerns, but I can be sure to say that after the Sanming medical reform, the inflow of doctors is far more than the loss of doctors I have a detailed data here From 2013 to 2015, there were 96 brain drain in Sanming municipal medical and health units In these three years, 502 people, 421 people and 406 people were recruited, 1329 people in total These inflow figures are a good illustration " The reform of doctor's salary system is an important part of the medical reform, because the main body of the hospital is the medical staff If they can't guarantee their salary, how can they mobilize their enthusiasm? "The medical reform needs to establish a new mechanism, a public welfare operation mechanism with incentives and constraints, so that cost control, quality improvement and service improvement become the internal motivation of the president and medical staff of public hospitals, and fundamentally solve the incentive problem of medical staff." Zhan Jifu said Therefore, Sanming city implements the target annual salary system for the president and medical staff The annual salary of the president is allocated by the financial department and is not related to the hospital income For the president, the main indicators reflecting the direction of running the hospital are the average cost per time, the proportion of drugs, the rate of hospitalization, etc., while the medical staff assess the workload, medical ethics and medical style " Has the final say that the public hospital directors are too powerful Basically, a person has the final say, and he buys the medical equipment and gets a rebate, and a lot of gray income But the doctors' salaries are related to the income of the departments Only by opening more drugs and checking the income of the departments, can we get more bonuses and take medicine rebates, which makes the doctors lose the essence of seeing a doctor For example, the doctors are still open to the doctor How many antibiotics are resistant to antibiotics? These are very frightening " "Now we have reversed the incentive mechanism for medical staff by canceling the drug mark up, rectifying the order of drug use and increasing the legitimate income of medical staff Now let the doctor's former gray income become sunshine salary, with a slight increase in salary, you can let the doctor focus on seeing a doctor and return to the role of seeing a doctor " According to Zhan Jifu, the hospital's income has nothing to do with the doctor's salary The doctor's salary is based on the work point system The work points of different positions are different, which can narrow the salary gap between departments This is done according to the market mechanism Three: can't patients buy cheap drugs? Is it the side effect of limited price purchase of drugs? On the report card of Sanming medical reform, we can see that the medical expenses of the patients have been significantly reduced It is reasonable to say that the patients should be the most satisfied party However, due to the limited price purchase of drugs, in fact, many commonly used good drugs can not be bought in the hospital Therefore, the patients also have many complaints Speaking of drug price reform, Zhan Jifu believes that the problem of drug rebate is not only the problem of drug markup, but also the problem of drug circulation "In the 1990s, drug transaction fees were at best a towel and a small household appliance; now, drug circulation is full of illegal acts." Zhan Jifu stressed that due to the ticket passing and money laundering, there is a space for drug grey income For the shortage of cheap drugs, Zhan Jifu thinks that the shortage of cheap drugs is not only now, but also all the time It is not because they are cheap that they disappear It is because the correlation coefficient between drug quality and price is less than 0.5 The medical representatives feel that there is no profit and they are not actively promoting In addition, many low-cost medicine doctors have no rebate to take, so they prescribe less in their prescriptions, resulting in low market sales and large waste after mass production of pharmaceutical enterprises Therefore, low-cost medicine gradually disappears, and doctors are going to prescribe high-cost medicine An important part of Sanming medical reform is to break the pattern of supporting doctors with drugs, to move the grey interest chain of drugs, and to reduce the inflated drug price "The reason why there is so much water in medicines is that most of them are pharmaceutical companies in the process of drug bidding and purchase, not directly connected with pharmaceutical companies The profit of the transit of pharmaceutical representatives in the middle is very large They also need to give doctors kickbacks on medicines, so that doctors can't concentrate on treating diseases and randomly prescribe high-priced medicines; And some cheap drugs produced by pharmaceutical companies are given to them at the factory price The profit space is very low The drug agents are not willing to promote more, the doctors get less kickbacks, and they are not willing to prescribe such drugs Therefore, cheap drugs are less and less These people have medical backgrounds, occupy their profit space, make them unprofitable, purify or even disappear the industry, and maybe return these people to the doctor's position " Zhan Jifu said frankly Four questions: some pharmaceutical companies complain about the limited price purchase of drugs in Sanming medical reform, or even give up Sanming market? Zhan Jifu, leader of Sanming medical reform leading group, thinks: "reform is the adjustment of the whole interests, which is very difficult", "what is difficult in medical reform is not investment, not plan, but determination" Whose cheese did Sanming medical reform move? Among them, there are health department and human resources society