Focus on public hospital fee control: the bottom of the pot, stimulate the endogenous power to control fees.


Release time:

2017-07-13

If only through assessment, accountability, etc., symptomatic treatment of the cost increase of public hospitals is carried out, the profit-seeking nature of public hospitals will not be completely eliminated, and may even be counterproductive-in order to "reach the standard", individual hospitals may even have prevarication and serious illness., Insufficient treatment and other phenomena. A number of experts said that fee control should not only treat the symptoms and carry out policy intervention on the unreasonable growth of medical expenses, but also comprehensively manage and draw salaries from the bottom to stimulate the endogenous motivation of medical institutions to control fees.
 
Reforming the compensation mechanism is a must.
 
Rao Keqin, vice president of the Chinese Medical Association, said frankly that straightening out the compensation and incentive mechanism and breaking the profit-seeking mechanism are the deep-seated reasons for the unreasonable increase in costs. He pointed out that in the process of economic transformation, my country has failed to adjust the financing compensation policy in the planned economy era in a timely manner, the payment system and price mechanism are not sound, and the proportion of drugs, consumables and inspection costs is too high, resulting in the weakening of the public welfare of public hospitals. Profit motivation is becoming more and more prominent.
 
Zhong Dongbo, deputy director of the Beijing Municipal Health and Family Planning Commission, believes that the profit-seeking mechanism is the overall source of many problems in my country's public hospitals. The "targeted therapy plan" he gave suggested a comprehensive implementation of three reforms: the reform of the financial subsidy mechanism, the reform of the price of medical services, and the reform of the doctor's salary system. He emphasized that financial subsidies are not only support measures, but also control measures. If government compensation is not in place and public hospitals are allowed to be responsible for their own profits and losses and develop independently, society will pay greater economic and social costs. Abolishing the drug mark-up, the price increase of consumables, the high-cost pricing mechanism of large-scale medical equipment, raising the price of technical labor items, and straightening out the price comparison relationship of different medical service items are the necessary options to straighten out the compensation mechanism.
 
"The core of fee control is to establish a scientific payment mechanism, which includes both payment to medical institutions and payment to doctors." Gu Xuefei, deputy director of the Medical Security Research Office of the Health Development Research Center of the National Health and Family Planning Commission, said that the payment to the institution includes medical insurance payment and financial investment, and the payment to doctors is salary. In order to put an end to over-medication and over-treatment caused by non-standard diagnosis and treatment, it is necessary to establish a personnel salary system in line with the characteristics of the medical and health industry, and it is strictly forbidden to set income-generating targets for medical personnel. it is not allowed to link the personal salary of medical personnel with the hospital's business income such as drugs, consumables, examination and treatment of large-scale medical equipment.
 
"The income linkage mechanism directly drives the doctor's pen." A doctor who did not want to be named said. This is also the reason why many interviewees regard changing doctors' behavior as the key to controlling fees. Gu Xuefei pointed out that under the mechanism of differential compensation and project-based payment by medical institutions, the more the number of medical services provided, the higher the return to hospitals and doctors, and once the number of outpatients and inpatients declines, it means that hospital income will decline. Incentives, hospitals will not have the motivation to control fees. In this regard, Youxi County Hospital in Sanming City, Fujian Province provides a solution. Yang Xiaoneng, president of the hospital, said that since 2013, Youxi County has implemented an annual salary system for doctors (technicians). In 2015, all on-the-job nursing, pharmacy, and administrative logistics personnel in the hospital will be included in the target annual salary management and passed the work point system assessment. After the reform, the proportion of pharmaceutical consumables in 22 hospitals above the second level in the county has dropped to less than 40%. (Next to 3rd Edition) (Next to 1st Edition)
 
The implementation of the "three medical linkage" can no longer be delayed
 
Strengthening the linkage of medical care, medical insurance and medical policies is the overall idea that runs through the new round of medical reform, and it is also the key to cost control. Yu Dezhi, director of the Anhui Provincial Health and Family Planning Commission, pointed out that an important reason for the rapid increase in medical expenses in public hospitals is that the role of medical insurance in guiding and restricting medical institutions has not yet been played. Only relying on the external supervision of the administrative department often get twice the result with half the effort. It is necessary to tighten the "bull nose" of the reform of the medical insurance payment method to curb the impulse of hospitals to over-provide medical services.
 
Professor Xiao Qinglun of Harvard School of Public Health also highlighted the importance of health care reform. He pointed out that international experience has shown that the reform of payment methods has been more effective in saving medical expenses. If measures such as hierarchical diagnosis and treatment, public hospital reform and payment method reform are coordinated, China is more likely to establish a high-quality, cost-controllable medical service supply system.
 
Although high hopes are placed on the role of medical insurance reform, Zhang Yuhui, an associate researcher at the Health Development Research Center of the National Health and Family Planning Commission, said that China's current decentralized insurance system is not conducive to its cost control function and should be integrated as soon as possible. In terms of specific reform methods, he suggested strengthening the revenue and expenditure budget of the medical insurance fund, establishing a compound payment method based on disease type, head-by-head and service unit, gradually reducing payment by project, improving and implementing the negotiation mechanism between medical insurance agencies and medical institutions, and conducting strict economic evaluation and review on the entry of high-value drugs and consumables into the medical insurance catalogue.
 
A more prominent problem in my country's medical expenses is that the proportion of drug expenses is too high, and excessive medical treatment and waste mostly occur in the pharmaceutical field. Jin Chunlin, executive deputy director of the Shanghai Health Development Research Center, pointed out that most localities have implemented drug bidding and centralized procurement measures, but the effect is not obvious, because drug reform is a complex project that must be carried out in an all-round and entire industry chain. At present, although the growth rate of drug costs in various regions has slowed down, the absolute value is still increasing. This can only be explained by changes in the drug structure, that is, deliberate use of price-reducing drugs or excessive use of drugs. Therefore, to systematically reform the drug system, it is necessary to strictly manage drug approval access from the source, carry out drug consistency evaluation, force the ex-factory price on all drug packaging, reduce circulation links, strictly implement the "two-vote system", and release dividends that save the total cost of drugs.
 
Prevent chronic diseases, reduce cost growth pressure.
 
Zhang Yuhui pointed out that a considerable part of the unreasonable increase in medical expenses is caused by the neglect of prevention, and increasing investment in prevention can greatly reduce the pressure on the growth of medical expenses. At present, the cost of chronic disease treatment has become the main driver of the growth of medical expenses in China. By 2030, the cost of chronic disease treatment will be as high as 7462.74 billion yuan, accounting for 77.3 percent of all treatment costs. Based on this, we should strengthen the prevention and control of chronic diseases, increase government investment, ensure the full provision of public health services, and control the unreasonable growth of medical expenses from the source.
 
The grassroots is the main body of chronic disease management, and the lack of ability is its biggest weakness. Therefore, in order to change the current situation of emphasizing medicine and neglecting prevention, it is also necessary to encourage high-level general practitioners and Junior College doctors to carry out health management services and general outpatient services at the grass-roots level. Rao Keqin pointed out that at present, from a horizontal perspective, various subsystems such as medical, health care, and prevention institutions are independent of each other, and the cooperation mechanism is not sound. From a vertical perspective, the cooperation between different levels of institutions in the same subsystem is not enough, the coordination is not strong, the service lacks continuity and coordination, the medical institutions are in a competitive relationship, and the development of weak grass-roots institutions is difficult. In this regard, he suggested that an integrated medical and health service system with complete system, clear division of labor, complementary functions, close collaboration, and efficient operation should be established, and a "trinity" of professional public health institutions, comprehensive and Junior College hospitals, and primary medical and health institutions should be established. Disease prevention and control mechanism.
 
Yu Dezhi pointed out that the key is to let all kinds of institutions at all levels form a community of interests. In order to realize the integration of medical care and prevention through the formation of a health consortium, it is necessary to put part of the medical insurance expenses in front, so that the sinking of high-quality medical resources will change from "I want to do it" to "I want to do it". For example, starting with the implementation of the reform of the medical insurance payment method of "total management, balance retention, and reasonable over-expenditure sharing", medical and health institutions at all levels can form a community of interests, so that the better the prevention and the less the medical cost, the higher the interests of the medical community, it will force the medical community to do a good job in residents' health promotion and preventive health care, take the initiative to send good doctors to the grassroots, and really manage residents' health.
 
In order to provide health management services and create a reasonable medical order, family doctors will become the main force in the future. Many experts said that in order for residents to gradually develop the habit of seeking medical treatment at home and realize the first consultation at the grassroots level, it is necessary to benefit both doctors and patients. It is necessary to pay attention to the sense of gain of the people and mobilize the enthusiasm of doctors. For example, after undertaking contracted services, the workload of grassroots doctors has increased a lot, so the income should be increased accordingly. For contracted residents, the content of the service package should be as rich as possible, reflecting the advantages of signing a contract in terms of medical treatment, referral, medication, reimbursement, etc., so that the reform dividend really falls on the people. (Chief reporter Han Lu, our reporter Yao Changfang)