Zhejiang launched the first reform of drug purchase and established a new mechanism of medical insurance payment

Source: on May 19, 2015, in the health sector, there have been many disputes about the abolition and reform of the centralized drug bidding and purchase mechanism With the elimination of most of the drug pricing decision-making dust settled, the call for the reform of drug centralized bidding procurement mechanism is again rising As the first province in China to implement zero difference rate of drugs, on May 18, Zhejiang provincial health and Family Planning Commission asked for public opinions on "innovation of centralized drug procurement mechanism of the whole province" (hereinafter referred to as "draft for comments") It is reported that this is the first province in the country to announce the reform of the centralized drug purchase mechanism after the cancellation of drug government pricing According to the draft, the reform of centralized drug procurement in Zhejiang Province will be launched on July 1, 2015 The reform hopes to determine the drug price through the market mechanism, innovate the payment standard of medical insurance drugs, implement contract management and be supervised by the government Finally, the goal of establishing a new mechanism of drug purchase, a new mechanism of medical insurance payment standard and a new mechanism of drug trade supervision will be realized New mechanism of drug purchase: make clear the integration of bidding and purchase, sales price, classified purchase, quantity purchase, medical and health institutions can directly purchase The administrative department has changed from examination and approval to supervision One of the focuses of disputes about the centralized drug purchase mechanism is the separation of bidding and purchase, and through bidding, medical treatment will be separated The normal market behaviors of health institutions and pharmaceutical companies become administrative approval behaviors The industry generally believes that the right of approval is one of the root causes of corruption in the field of medicine The reform of the centralized drug purchase mechanism in Zhejiang Province starts from overcoming this dilemma According to the draft, drug prices in Zhejiang Province will be negotiated between medical and health institutions and drug manufacturers in accordance with the principle of "purchasing with quantity, exchanging price with quantity, and confirming transaction" Public hospitals at or above the county level can directly negotiate with drug manufacturers on price Public hospitals below the provincial level are encouraged to form purchasing communities with medical consortia, medical groups, etc., give full play to the advantages of batch purchasing, and participate in the price negotiation of drug purchasing Provincial public hospitals are allowed to form a purchasing community with relevant municipal and county (city, district) public hospitals for price negotiation In principle, the basic medical and health institutions run by the government should form a purchasing community of counties (cities, districts) to conduct price negotiation The purchasing community is jointly organized by medical institutions on a voluntary basis The health and family planning administrative departments and relevant departments should strengthen supervision and management and not intervene in specific purchasing affairs It is specified that the balance of some drugs sold according to the payment price of medical insurance shall be subject to the provisions of the financial draft for comments The drugs in the medical insurance catalog shall be settled according to the unified payment standard, and the medical and health institutions shall be sold according to the payment standard of medical insurance; the drugs in the non-medical insurance catalog shall be sold at zero margin according to the actual purchase price If the actual purchase price of medical institutions is lower than the payment standard of medical insurance, the balance shall be turned over to the finance After examining the cost control of drugs and medical consumables and the use of basic drugs in the medical institutions, the joint assessment group composed of relevant departments will reward the medical institutions according to the assessment results, and the reward funds will be arranged by the medical institutions themselves Xiong Xianjun, vice president and Secretary General of China Medical Insurance Research Association, believes that the implementation of the medical insurance payment mechanism depends on whether the medical insurance payment price can get rid of the regulatory model of government pricing Zhejiang Province is clear that the surplus part belongs to finance Who will pay for the part of the actual purchase price higher than the medical insurance price? This is a controversial issue in the industry all the time, but it is not involved in the reform plan of Zhejiang Province The reform of the centralized drug purchase mechanism in Zhejiang Province clearly implements classified purchase in accordance with the specific classification standards determined in the guidance on improving the centralized drug purchase in hospitals issued by the general office of the State Council It is required that medical and health institutions should scientifically and reasonably prepare the drug purchase list of medical and health institutions in the whole province according to 80% of the actual use of drugs in the previous year Innovating the new mechanism of medical insurance payment standard: determining the payment standard, setting up the joint conference system, and establishing the prepayment system of medical insurance expenses To establish a new mechanism of medical insurance payment standard, Zhejiang Province first establishes a joint meeting system of medical insurance payment standard attended by the heads of departments and offices such as the Ministry of human resources and social security and representatives of designated medical institutions, drug manufacturing enterprises and medical insurance participants, which is responsible for the formulation and revision of the measures for the formulation of medical insurance payment standard in Zhejiang Province and the formulation of medical insurance payment standard in Zhejiang Province In December of each year since 2015, the joint conference of medical insurance drug payment standards of Zhejiang province needs to formulate the payment standards of medical insurance drugs for the next year according to the factors such as the weighted average price of drugs generated by the centralized drug purchase platform After the new round of centralized drug purchase, the historical winning drugs will be purchased on the platform according to the original payment standard of medical insurance New drugs are purchased on the platform according to the initial payment standard of medical insurance drugs formed by classified procurement According to the draft, the medical insurance agencies at all levels in Zhejiang Province should allocate the medical insurance expenses of the last month to the designated medical institutions in full in the next month For the designated medical institutions with large payment amount of medical insurance drugs, difficult capital turnover, good hierarchical management and agreement evaluation, the medical expenses within the average amount of two months in the previous year can be prepaid as the working capital Building a new procurement platform, encouraging one vote settlement, Zhejiang Pharmaceutical machinery procurement platform will gradually realize the integration of information flow, business flow and capital flow , encourage the payment method of drug payment to be changed to that the medical and health institutions pay the drug payment to the settlement account first, and then the settlement account pays the drug payment to the production enterprises, so as to realize the direct settlement of drug payment with the drug production enterprises Change the sending direction of drug purchase order Change the way that the original medical and health institutions send orders to the distribution enterprises to directly send orders to the production enterprises The production enterprise is responsible for receiving the order and selecting the distribution enterprise for order distribution Drugs with short supply and small clinical dosage can be ordered to the distribution enterprises Multi ticket system is regarded as the key link to promote the virtual high price of drugs Drugs from the production enterprises to the medical institutions through layers of links, and the profits of the middle links are added to the drug price Zhejiang Province hopes to reduce the drug price effectively by encouraging one vote settlement.