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The State Council speeds up the replication of Sanming's experience and promotes the price and price

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The three-medicine (medical, medical insurance, medical) linkage reform that originated in Sanming City, Fujian Province, is now accelerating the pace of promotion to the whole country. The starting point of this reform is to control the price of pharmaceutical consumables.

In the past more than a month, the National Medical Insurance Bureau has intensively introduced three major policies: the treatment of high-value consumables, the adjustment of medical insurance drugs, and the “4+7” volume procurement. This indicates that the drug supplies are “quantitative”. The reform is gradually moving from the pilot in some regions to the whole country.

Recently, Sun Chunlan, deputy prime minister of the State Council and head of the medical reform leading group of the State Council, stressed the importance of promoting the experience of Sanming medical reform and continued to promote the development of medical reform in Fujian when investigating and attending the medical reform promotion meeting in Fujian.

Yang Yanwei, director of the Center for Employment and Social Security Research at Tsinghua University, told reporters that the rate of payment for medical insurance units in China is about 8%, of which 1% is over-medicated and 1% is defrauded. The focus of the future work of the Medical Insurance Bureau.

Accelerate the replication of Sanming experience

Sanming Medical Reform began in 2012 with the focus on public hospitals at the county level and above in the city to carry out three-medicine linkage reform.

Sun Chunlan pointed out that Sanming City has adjusted the pharmaceutical catalogue and compressed drug consumables as a breakthrough point, simultaneously promoted the reform of the three-medicine linkage, innovated salary distribution and supervision and assessment, and promoted the sinking of resources and the transformation of service models.

In the past seven years, Sanming Medical Reform has experienced three major stages: one is to cure chaos and to stop waste, the other is to establish a charter and establish a system, and the third is to cure disease and health.

Zhan Jifu, director of Sanming Medical Reform and Sanming Municipal People's Congress Standing Committee, told reporters that Sanming Medical Reform has undergone heavy reforms to “make money as the center” and then transferred to “taking treatment as the center” and has now entered “health-centered”. .

Zhan Jifu said that taking the drug control fee as the first move is a prominent feature of the Sanming medical reform path. By blocking the waste, standardizing the diagnosis and treatment behavior, and squeezing the “high moisture” of drug consumables, Sanming promotes the “quantity and price” of pharmaceutical consumables, creating space for adjusting the price of medical services.

After the establishment of the National Health Insurance Bureau, a number of medical reform policies, such as the purchase of pharmaceutical consumables, and the removal of the Chinese medicine from the medical insurance catalogue, have absorbed the experience accumulated by Sanming Medical Reform.

The reporter learned that since October 2013, Sanming City has cooperated with all public medical institutions in the city on the basis of centralized bidding and procurement of provincial-level drugs, and implemented joint purchase of medicines (consumables).

According to the "one product two rules", "two-vote system" (that is, the drug is sold from the pharmaceutical factory to the first-level dealer to open an invoice, the dealer sells the hospital to open another invoice), "four universal" (by the generic name, general dosage form The principle of general specifications, general packaging, etc., has completed the purchase of three batches of drugs and six batches of medical consumables (reagents), and formed a relatively complete procurement catalogue of medicines and consumables.

At the same time, the establishment of the drug consumables joint limit purchase "Sanming Alliance", the current members of the 21 provinces in 15 provinces, four national health reform pilot counties (cities), covering nearly 100 million people.

Sun Chunlan said that since last year, Fujian Province has summed up the experience of Sanming medical reform, improved the level of medical insurance fund planning and pushed it across the province, and explored many good practices to provide lessons for the national medical reform. At present, the medical reform has been strengthened in the deep water area, and it is necessary to increase the promotion of Sanming medical reform experience, formulate a work plan according to local conditions, clarify the target tasks and time schedule, and ensure that all medical reform tasks are implemented.

In recent years, the Central Committee and the State Council have repeatedly praised Sanming's medical reform. The State Council has issued a report on the effectiveness of the Sanming Public Hospital reform for four consecutive years. Sanming's medical reform of the "three medical linkages", "two-vote system", "one product and two regulations" and the establishment of medical insurance bureaus and other practices rose to the national top-level design.

Medical insurance fund "cage for birds"

Sun Chunlan emphasized at the on-site meeting of the medical reform that it is necessary to expand the scope of reform of the centralized procurement and use of drugs by the state, eliminate the addition of medical consumables, reduce the high and high drug prices, and rationalize the medical prices and establish new compensation and operation. Mechanism to ensure the sound development of public hospitals.

Yang Yanxi believes that the current medical insurance fund faces the dual challenge of over-medical and fraudulent insurance. In the average payment rate of 8% of the employee medical insurance fund, about two percentage points of space can be saved through the governance of the medical insurance fund.

According to the "Statistical Bulletin on the Development of National Basic Medical Security in 2018", in 2018, the income of employee medical insurance funds was 135.8 billion yuan, an increase of 10.3% over the previous year; the fund expenditure was 107.07 billion yuan, an increase of 13.1% over the previous year.

In recent years, China's medical insurance fund has maintained a situation in which the increase in expenditure is greater than the increase in income. In some co-ordination areas, there has been a situation in which the medical insurance fund has bottomed out and the local finances have been unable to get through.

Zhan Jifu said that the serious loss of medical insurance for employees was an important reason for Sanming's three-care linkage reform. Sanming City failed to pay 208 million yuan in 2011, accounting for 14.42% of the local public finance revenue of the city at that time. The finances were unable to cover the bottom. At that time, the fund owed the medical expenses of 22 public hospitals in the city to 17.484 million yuan.

With the reduction of economic growth support and the continuous increase of medical expenses, the pressure on income and expenditure faced by medical insurance funds is gradually increasing.

The reporter learned in the interview that one of the main lines of reform after the establishment of the National Medical Insurance Bureau is to pay dividends to the reform, to reform, to curb waste, excessive medical care, high drug prices, etc., drug negotiations, "4 + 7" Procurement, high-value consumables procurement, medical insurance catalog adjustments, and crackdowns on fraud can all bring reform dividends.

The drugs (consumables) combined with the limit purchase of Sanming medical reform and the key monitoring of auxiliary medicines all belong to the policy of dividends for reform. These policies have all risen to the national level.

Since 2012, Sanming has focused on the monitoring of 129 nutritional and auxiliary drugs. The monitoring of drug expenditures in the month has dropped by 16.73 million yuan, saving nearly 200 million yuan that year.

On August 20, 2019, in the national medical insurance drug list adjustment, such as alprostadil injection, calf blood deproteinized extracts and other varieties were transferred to the medical insurance drug list, which also indicates that Sanming City's medical reform policy is recognized at the national level. And promotion.

At the beginning of August this year, under the guidance of the National Medical Insurance Bureau, Anhui, Jiangsu and other provinces are embarking on pilot projects for the procurement of some high-value medical consumables such as orthopedic materials and stents, and have achieved good results. The negotiating bargaining results completed in Anhui Province recently showed that the average product price of orthopedic spine materials was 55.9%, and the maximum drop of individual components was 95%.

On September 1st, “4+7” purchases were expanded to the whole country, and 25 winning products were launched in 25 regions including Shanxi, Inner Mongolia, Liaoning, Jilin, Heilongjiang, Jiangsu and Zhejiang. Previous pilot results in the “4+7” region showed that compared with 2017, the median price dropped by an average of 52%, the highest drop of 96%. The procurement cost of drugs for the corresponding varieties in 11 cities is expected to fall from 7.7 billion yuan to 1.9 billion yuan.

A local medical insurance director told reporters that the current situation is that on the one hand, the levy will be reduced, and the burden on enterprises will be reduced. On the other hand, from the central government to the insured, they are required to improve their medical insurance benefits. However, local funds have different needs, and the treatment may be improved. Lead to failure to pay. Take high-priced anticancer drugs as an example. Even after a sharp price cut, some areas are still unbearable.

"At present, we must hope that the funds will be saved through the procurement of drugs and consumables. Otherwise, many measures to improve the treatment proposed by the central government are difficult to implement at the local level," the director said.

Three medical associations need to be "real joint action"

Zhan Jifu said that the seven-year Sanming medical reform has significantly reduced the burden of medical treatment for the people. The average cost of medical insurance for urban workers has dropped from 6,553 yuan in 2011 before the reform to 5,847 yuan in 2018. In the case of the decline in the maintenance ratio of urban workers, the medical insurance fund was reversed from a loss of 208 million yuan in 2011 to a balance of 10 million yuan in 2018, maintaining a surplus for 7 consecutive years, with a cumulative balance of 2.093 billion yuan.

Zhu Minglai, director of the Center for Health Economics and Medical Insurance at Nankai University, told reporters that Sanming’s reform of medicines (consumables) combined with price limit purchases is only one aspect of Sanming’s medical reform. The important feature of Sanming’s medical reform is the establishment of pricing, procurement, and negotiation. Then go to the integrated medical insurance management model.

Zhan Jifu believes that medical insurance is connected to medical care and connected to medicine. It is the main engine of "three medical linkages". In 2013 and 2016, Sanming successively established the Municipal Medical Insurance Fund Management Center and the Municipal Medical Insurance Administration Bureau to fulfill the main functions of the Medical Insurance Bureau, solve the problem of medical insurance “Jiulong Water Control” in the organizational framework, and realize the regulation of hospital operation. The three elements of medicine, price and insurance are integrated.

Sanming not only played a leading role in medical insurance procurement, but also promoted the reform of medical insurance payment methods. Since 2017, the company has taken the lead in implementing the C-DRG (subject to disease diagnosis related group) payment reform. Currently, 796 groups of C-DRG disease groups have been launched, and the first-class and above public hospitals have taken the lead in achieving the same disease, the same treatment, and homogeneity. Same price."

According to the website of the Fujian Provincial Medical Insurance Bureau, Hu Jinglin, the director of the National Medical Insurance Bureau, recently put forward five opinions on the next step of Longyan City's medical security work during Longyan's investigation, “Deepening the Three-Medition Linkage” and “Continuing to Deepen the Anti-fraud Fraud Action” It is two of them.

Hu Jinglin said that it is necessary to deepen the linkage of the three medical professions and achieve the real movement of the real joints. By squeezing the procurement space for pharmaceutical consumables, the prices of medical services will be dynamically adjusted, and the medical income of medical institutions will be continuously improved to ensure a smooth and orderly reform.

Yang Yanxi believes that the National Medical Insurance Bureau urgently needs to establish a mechanism to curb excessive medical care and fraudulent insurance through the joint medical reform. To curb excessive medical treatment, it is necessary to establish a social governance mechanism of “government guidance, exert market pricing, and stakeholder participation”, and establish an incentive payment mechanism for prepayment, balance retention, and reasonable over-spending.

Inhibition of fraud insurance requires the establishment of a self-regulatory mechanism for process monitoring, a constraint mechanism for medical service agreement management, and a three-dimensional full-range intelligent supervision mechanism that combines administrative monitoring and punishment mechanisms. The self-regulatory mechanism of process monitoring must play an absolute leading role.

"DRG is the consensus of doctors. The payment plan based on DRG is a social contract. I hope that the medical insurance bureau will stick to the path of social governance and let the doctors hospital participate in reform and benefit." Yang Yanxi said.

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