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Basic medicine "double line assessment"! Comprehensively strengthen the use of management!

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On September 5, the official website of the Liaoning Provincial Health and Welfare Committee released the “Implementation Opinions of the General Office of the People's Government of Liaoning Province on Improving the National Essential Medicine System” (referred to as “Opinions”), clearly emphasizing the establishment of the core drug awareness of the national essential drugs in treatment. Adhere to the dominant position of the national essential drugs, strengthen the management of the use of essential drugs in medical institutions, and continuously improve the use of basic drugs in medical institutions.




Strict management at the grassroots level




Strengthening the use and management of equipment is undoubtedly a policy main line of the basic medicine policy in the new era. This point has also been highlighted in the "Opinions" issued by Liaoning Province. The policy emphasizes that the national essential medicines catalogue is the basis for the use of medicines at all levels of public medical and health institutions, to achieve full deployment of medical institutions at all levels and to give priority to the use of national essential medicines; public medical institutions are rationally equipped with national basics according to functional positioning and scope of diagnosis and treatment. Drugs to ensure the basic needs of clinical drugs.




In terms of specific measures, Liaoning Province not only strictly implements the “National Essential Drugs List”, but also proposes that the provincial and following principles should not be supplemented, and intensify efforts to reform and improve the national statistical assessment methods for the use of essential drugs:




Implement a two-line statistical assessment of the ratio of the proportion of use and the proportion of purchases, with the proportion of the proportion of use and the proportion of purchases supplemented;




In addition to the provisions of the State, in principle, the number of non-public primary health care institutions and village clinics in the national basic drug system management is proportional to the number of national essential drugs (the number of national essential drugs purchased by medical institutions) The proportion of the total amount of drug purchases, the same below) should be more than 80% (including 80%, the same below), the proportion of purchases (calculated by the proportion of the national essential drug purchases of medical institutions in the total amount of drug purchases of the institution, the same below) More than 60%;




Secondary general hospitals and Chinese medicine hospitals should reach more than 65% and more than 35% respectively;




The tertiary general hospitals and Chinese medicine hospitals should reach more than 53% and more than 20% respectively;




The proportion of national essential medicines used in specialist hospitals and maternal and child health hospitals should be above 53%, and the proportion of purchases can be reduced by 5% compared with the same level.




In fact, in January this year, the National Health and Health Commission and the State Administration of Traditional Chinese Medicine jointly issued the "Notice on Further Strengthening the Management of the Use of Essential Medicines in Public Medical Institutions", officially proposing that "public medical institutions should scientifically set indicators for the use of essential drugs in clinical departments. The proportion of basic drugs used and the proportion of prescriptions should be increased year by year."




As we all know, since the release of the new edition of the National Essential Drugs List at the end of last year, the inclusion of drugs has not only increased the number of varieties, but also structurally considers the basic drug needs of common diseases, chronic diseases, heavy burdens, major diseases and public health. The scope of disease diseases has expanded, and the proportion of clinical institutions in use at all levels has increased.




The grassroots market accelerates shuffling




The top-level policy is to wave the baton, and the policies are implemented in various places. Since the beginning of this year, the local basic drug system has been followed up throughout the country. Except for the minority provinces and regions, most provinces strictly implement the National Essential Drugs List.




Clinical use of the port, the provinces in the basic drug use management system attitude is very clear, "priority use" becomes "primary use", and the basic drug use situation is included in the medical institution prescription review content, take the doctor interview, etc., no Reasonable reasons are not preferred to take the basic drugs, such as interviews, publicity, notification and criticism, and linked to the performance appraisal of medical staff.




It is worth noting that Liaoning issued the "Opinions", which puts more emphasis on the connection of medicines between lower and lower medical institutions:




Medical institutions at all levels should focus on the management of the use of essential drugs in the country. On the basis of full use of national essential drugs, the types, dosage forms and specifications of drugs used in higher and lower medical institutions should be regulated, from primary medical institutions and above. At the same time, medical institutions will make efforts to increase the proportion of national essential drugs used in medical institutions at the second level or above. The basic drug use lists between medical and health institutions at different levels, especially between the medical institutions and the medical and health institutions within the medical community. Unity and unification, achieve linkages between the upper and lower, unified centralized procurement, guarantee the needs of the first-level diagnosis, two-way referral, and grading diagnosis and treatment of the primary level, and promote the use of national essential drugs.




In the first half of this year, a number of policy announcements were intended to support the construction of primary health care:




In May, the National Health and Health Commission issued the “Guiding Plan for Piloting the Construction of a Close-Level County Health Care Community”, clearly proposing to strengthen the county-level medical visit rate and encourage grass-roots medical and health institutions to develop new technologies and new projects.




In June, the National Health and Health Commission issued the Notice on Printing and Distributing the List of County-Level Hospitals in the Comprehensive Stage of Comprehensive Capacity Enhancement of County-Level Hospitals, and determined the comprehensive improvement of the comprehensive capacity of county-level hospitals in the second phase of 500 county-level hospitals and 500 counties. Level Chinese medicine hospitals, these 1,000 county-level hospitals have the opportunity to upgrade to the top three hospitals.




The in-depth advancement of graded diagnosis and treatment, the transformation of the medical ecology in the grassroots counties, the acceleration of the sharing of high-quality medical resources, and the uniformity of the “collection” of drugs that are unified, up and down, and unified procurement have become clearer.




Insiders pointed out that the region that has already announced the implementation of the new version of the base drug list will face a greater pressure on shuffling. "With the reconstruction of the primary health care system and the pattern, products that have previously entered the regional base drug market through unfair means will eventually lose market competitiveness under the core value of 'clinical needs'."




Implementation Opinions of the General Office of the People's Government of Liaoning Province on Improving the National Essential Drug System




The municipal people's governments, the provincial government departments, and their respective agencies:




In order to implement the "Opinions of the General Office of the State Council on Improving the National Essential Drug System" (Guo Dang Fa [2018] No. 88), we will further promote the implementation of the national essential medicine system, improve the drug supply security system, ensure the basic use of drugs, and reduce the use of drugs by patients. Burden, building a healthy Liaoning, with the consent of the provincial government, the following implementation opinions are proposed.




First, the overall requirements




Fully implement the spirit of the Party's 19th and 19th Central Committees and the 3rd Plenary Session of the Communist Party of China, take Xi Jinping's new era of socialism with Chinese characteristics as the guide, adhere to the people's health as the center, and strengthen the national essential drugs to "emphasize basic, prevent and control, and guarantee supply." The functional positioning of “priority use, quality assurance, and reduction of burden” shall be strictly implemented in the “National Essential Drugs List”, and the provincial and following principles shall not be supplemented. We must improve policies from the production, circulation, use, payment, and monitoring of national essential drugs, fully promote the construction of a drug supply security system, and strive to ensure that drugs are safe, effective, reasonably priced, and adequately supplied, alleviating the problem of “expensive medical treatment”. Promote the use of drugs in the upper and lower medical institutions, assist in the construction of graded diagnosis and treatment systems, and promote the transformation and upgrading of the pharmaceutical industry and structural reforms on the supply side.




Second, effectively guarantee supply and distribution




(1) Improve the effective supply capacity. The implementation of the national essential medicine system as an important part of improving the pharmaceutical industry policy and industry development plan, encourage technological advancement and technological transformation of enterprises, guide qualified enterprises to carry out international registration and certification, and improve the ability of national essential medicine production and supply support. To carry out a survey on the status quo of production enterprises, for the national essential drugs that are in short supply in the market due to factors such as clinical necessity, small amount or low transaction price, and insufficient production power of enterprises, the government can set up a platform to determine reasonable purchase prices and fixed-point production through market matching. Measures such as unified distribution and inclusion of reserves ensure supply. (Responsible unit: Provincial Department of Industry and Information Technology, Provincial Medical Insurance Bureau)




(2) Improve the centralized procurement mechanism. Fully consider the special commodity attributes of medicines, give play to the role of the government and the market, adhere to the direction of centralized procurement of online medicines by province, implement a platform, link up and down, combine management, classify procurement, open and transparent, strengthen supervision, improve and perfect A government-led, full-fledged market mechanism, with medical institutions and pharmaceutical manufacturers as the mainstay, to meet the clinical needs as the core of the centralized procurement mechanism for drugs. Implement the drug classification procurement policy, and implement the network procurement according to the clinical dosage, purchase amount and number of production enterprises. Direct net purchases are made for drugs negotiated through the state and drugs produced at designated locations. In accordance with the principle of the same price in the same city, the implementation of joint bargaining by medical institutions based on the city, promote the centralized procurement of public medical institutions, guide the formation of reasonable prices, and promote the price of drugs. Encourage joint bargaining at the municipal level, encourage cancer and other specialized hospitals to carry out cross-regional joint procurement, and promote the unified market and unified prices in the province. (Responsible unit: Provincial Medical Insurance Bureau, Provincial Government Procurement Center)




(3) Improve the distribution and supply mechanism. As the first responsible person to guarantee the supply and distribution of essential drugs in the country, production enterprises should earnestly perform the contract, especially to ensure the distribution of drugs in remote and inaccessible areas. Establish and improve the assessment, interview, punishment and restriction mechanism and credit system of distribution enterprises, implement provincial and municipal grading supervision, regular assessment and final elimination mechanism, and establish drug distribution with clear powers and responsibilities, openness, transparency, supervision and operation. Management mechanism. We will implement full-time information disclosure on all aspects of distribution and strengthen social supervision. (Responsible unit: Provincial Medical Insurance Bureau, Provincial Government Procurement Center)




(4) Promote the settlement of medicines on time. The medical insurance agency shall, in accordance with the agreement, timely allocate medical insurance funds to the medical institution. The medical institution shall settle the payment in time in strict accordance with the contract; if it delays the payment, it shall be notified of the notification and ordered to rectify within a time limit. (Responsible unit: Provincial Medical Insurance Bureau, Provincial Health and Safety Committee)




(5) Strengthening the early warning response to shortages. Improve the monitoring mechanism for shortage of drugs, early warning, grading response and supply guarantee. On the basis of carrying out three-dimensional monitoring of drug production and distribution enterprises and shortage of drug information in medical institutions, we will strengthen multi-source information collection such as drug research and development, production, circulation, and use, and improve the collection, reporting, analysis, and consultation systems for shortage of drugs. Liaoning Province's shortage of drug information database implements dynamic management, and regularly releases "Liaoning Province Drug Shortage Early Warning". Give play to the role of the provincial linkage mechanism for the supply of short-term drug supply guarantees and the guidance of expert groups for the shortage of drugs at the provincial and municipal levels, comprehensively study the potential shortage factors and trends, identify shortage risks as early as possible, classify and respond to different reasons, and coordinate consultations. Adjustments, interviews and rectifications, invitations to tender, matching bargaining, drug reserves, fixed-point production, emergency production and other measures to ensure the supply of the pharmaceutical market. For the monopoly raw materials market and pushing up drug prices to lead to drug shortages, suspected of forming a monopoly agreement and abuse of market dominance, conduct anti-monopoly investigations in accordance with the law, and increase penalties. Due to the shortage of medication caused by the enterprise, the enterprise shall bear the liability for breach of contract, and the relevant unit shall promptly include the record of loss of trust. Incorporate the shortage of drugs required by the military into the national emergency drug emergency protection system, establish a military-land coordination coordination mechanism for the shortage of urgently needed drugs through military-civilian integration, strengthen information sharing and supply and demand docking, improve emergency support and sustained support capabilities, and ensure urgent shortage of troops. Emergency combat stocks supply of medicinal materials. (Responsible units: Provincial Health and Safety Committee, Provincial Department of Industry and Information Technology, Provincial Medical Insurance Bureau, Provincial Market Supervision Bureau, Provincial Committee of Military and Civil Affairs, Provincial Military Region)




Third, full equipment priority use




(6) Strengthening the use and management of equipment. The National Essential Drugs List is the basis for the use of pharmaceuticals at all levels of public medical and health institutions, to achieve full deployment of medical institutions at all levels and to give priority to the use of national essential drugs. It is necessary to establish the core drug awareness of the national essential drugs in treatment, adhere to the dominant position of the national essential drugs, strengthen the management of the national essential drugs in medical institutions, and continuously improve the use of basic drugs in medical institutions. Public medical institutions are rationally equipped with national essential drugs according to functional positioning and scope of diagnosis and treatment to ensure the basic needs of clinical drugs.




We will reform and improve the statistical appraisal method for the use of basic drugs in the country, and implement a two-line statistical appraisal of the ratio of the proportion of use and the proportion of purchases, which is mainly based on the proportion of use and the proportion of purchases. In addition to the provisions of the State, in principle, the number of non-public primary health care institutions and village clinics in the national basic drug system management is proportional to the number of national essential drugs (the number of national essential drugs purchased by medical institutions) The proportion of the total amount of drug purchases, the same below) should be more than 80% (including 80%, the same below), the proportion of purchases (calculated by the proportion of the national essential drug purchases of medical institutions in the total amount of drug purchases of the institution, the same below) More than 60%; secondary general hospitals and Chinese medicine hospitals should reach more than 65% and more than 35% respectively; tertiary general hospitals and Chinese medicine hospitals should reach more than 53% and more than 20% respectively; special hospitals and maternal and child health hospitals national essential medicines The proportion of equipment used should be more than 53%, and the proportion of purchases can be reduced by 5% compared with the same level.




Public medical institutions should regard the use of essential drugs in the country as the key content of prescription reviews, and inform the basic drugs that are not preferred for the country without justified reasons. Physicians, pharmacists and management personnel will increase the training of national essential medicine systems and clinical application guidelines and formula collections for national essential medicines, and improve the rational use and management of national essential medicines. Encourage other medical institutions to use national essential medicines. (Responsible unit: Provincial Health and Safety Committee)




(7) Do a good job in connecting medicines with medical institutions at lower levels. Medical institutions at all levels should focus on the management of the use of essential drugs in the country. On the basis of full use of national essential drugs, the types, dosage forms and specifications of drugs used in higher and lower medical institutions should be regulated, from primary medical institutions and above. At the same time, medical institutions will make efforts to increase the proportion of national essential drugs used in medical institutions at the second level or above. The basic drug use lists between medical and health institutions at different levels, especially between the medical institutions and the medical and health institutions within the medical community. Unity and unification, achieve linkages between the upper and lower, unified centralized procurement, guarantee the needs of the first-level diagnosis, two-way referral, and grading diagnosis and treatment of the primary level, and promote the use of national essential drugs. (Responsible unit: Provincial Health and Safety Committee)




(8) Establish a priority use incentive mechanism. The health and finance departments should link the use of essential national medicines to the allocation of subsidies for the implementation of the national essential medicines system at the grassroots level. Continue to deepen the reform of medical insurance payment methods, and establish and improve the incentive and risk sharing mechanism between “salary retention and reasonable over-spending” between medical insurance agencies and medical institutions. In accordance with the unified national deployment, medical institutions and medical personnel will be guided to rational diagnosis and treatment and rational use of drugs by formulating payment standards for medical insurance. The provincial centralized procurement platform for pharmaceuticals and medical consumables should mark the national essential drugs, prompting medical institutions to prioritize procurement; the medical institution information system should also mark the national essential drugs to ensure that doctors give priority to use. Medical and health institutions at all levels shall, in accordance with the national essential drug system and other drug use management regulations, formulate methods for the clinical application of the national essential drugs of this institution, scientifically set the national essential drug use indicators of clinical departments, and include them in the assessment. In the process of developing and implementing clinical pathways and guidelines for treatment, priority should be given to national essential medicines. Give full play to the role of pharmacists