2014 is a year of overall acceleration of medical reform, and various disputes are inevitable. The process of debate is also a process of timely correction and brainstorming of medical reform. In 2014, the new medical reform faced the problem directly and its purpose was to solve the problem, which impressed the author deeply. Here to sort out the annual nine events or initiatives that have a positive impact on health care reform and represent the mainstream direction of health care reform.
Sanming: Standing on the tuyere
Fujian Sanming medical reform can be said to be at the forefront of reform. Sanming sacrificed a combination of punches to benefit from the waste of various existing medical resources, so that the people, hospitals, and financial parties have all received dividends. It is the first in the country to try out the annual salary system for presidents, let presidents manage public hospitals on behalf of the government, take the lead in trying out the annual salary system for doctors (technicians), and take the lead in focusing on monitoring high-rebate drugs. Also take the lead in the province to the city's public hospitals to implement zero-markup drug sales. Of course, Sanming's "cutting drugs" is too cruel to cause controversy (allowing the second selection of drugs and the second bargaining, 100 many high-priced drugs to be cut off).
[comment] the most valuable experience of Sanming medical reform is that as long as there is determination, confidence, courage and wisdom to solve difficult problems, reform is not so difficult. As long as the general direction and framework are correct, the pace of reform will be accelerated, and even if there are deviations, they will be easy to correct. Reform will definitely produce "pain" or discomfort, and Sanming's drastic measures actually hope to make long-term pain become short-term pain.
The reason why the Sanming model is respected by the National Health and Family Planning Commission is that it conforms to the original intention of the medical reform and shows the "new normal" of the medical industry after the reform ".
For example, the medical insurance system is unified and efficient, public hospitals bid farewell to "medicine to supplement medicine", the price of medical services has been raised, the wages of hospital employees at all levels have been improved, and personnel incentives and constraints are equally important, and equal pay for equal work. Doctors' income is decoupled from business income and linked to their performance, and public hospitals have achieved fine management, alleviating the cost and difficulty of seeing a doctor. As for allowing the second selection and bargaining of drugs, I think this is a helpless move. After all, the virtual high price of drugs and the mixture of drugs are not something that local governments can solve.
Health Planning Commission: No Red Packets
The National Health and Family Planning Commission requires that starting from May 1 this year, medical institutions at or above the second level across the country, within 24 hours of hospitalization, must be communicated by the treating physician and the patient to sign an agreement not to accept or send red envelopes. But some hospitals and doctors have not responded, arguing that the agreement tarnishes the image of doctors.
[Comments] When receiving red envelopes and taking kickbacks became a chronic disease, the relevant departments asked doctors and patients to sign an agreement to refuse red envelopes. It was really helpless, and the result was twice the result with half the effort. The fundamental solution is to learn from Sanming's medical reform. While asking hospitals to refuse red envelopes, they should improve the treatment of doctors and raise the price of medical services. In short, reform cannot go it alone, but should be multi-pronged.
Limit hanging: say "no" to indiscriminate infusion"
Anhui issued a "restriction order" during the year, issuing a list of 53 common diseases that do not require infusion, aiming to say "no" to infusion abusers, and finally achieve the purpose of allowing doctors to return to self-discipline and ensure their rational and scientific use of drugs.
[Comments] The non-standard medical services and even the abuse of drugs or infusions are the enemy of medical quality and the fuse that deteriorates the doctor-patient relationship, which should be corrected. How to turn administrative orders into the driving force of hospital management and doctors' self-discipline is the key. In this regard, the author believes that the need to use two forces: one is the dean's management, and the other is the supervision of the medical insurance department.
How to improve the "two forces"? May wish to give the dean and doctors a raise at the same time, the personal income and business income decoupling, linked to work performance. The medical insurance department should reform and innovate the payment methods of medical insurance (such as single disease payment, clinical pathway payment, etc.), strengthen prescription supervision, and force the standardization of medical services.
Drug price reform: want to say let go is not easy
Near the end of the year, the "Plan for promoting Drug Price Reform (draft for soliciting opinions)", which was solicited by the National Development and Reform Commission from a number of pharmaceutical associations, was widely spread on the Wechat public platform and we media of major media. The "Plan" proposes to cancel the maximum retail price or ex-factory price set by the original government from January 1, 2015. However, while the public is looking forward to a reduction in drug prices, they cannot help worrying about whether the deregulation will be chaotic and whether drug prices will rise instead of falling.
[opinion] the liberalization of drug prices will force the government to return to its original position -- legislation and supervision according to law, create a good environment for fair competition, minimize the operating costs of enterprises, and realize price fluctuations in line with the law of value. For the liberalized drug prices, the effective management methods include: the drug regulatory department evaluates the price rationality of the drugs before the market; the medical insurance department formulates a reasonable drug benchmark price based on market demand and drug value; the National Development and Reform Commission establishes a national price reporting system, It will be conducive to the realization of the combination of "bottom-up" and "top-down" price supervision, and set up a net for lawless people.
Medical equipment: "national army" when the force
Li Bin, director of the National Health and Family Planning Commission, emphasized that the health and family planning administrative departments should formulate plans and policy measures to guide health and family planning institutions to equip domestic medical equipment, establish and improve incentive mechanisms for the active use of domestic equipment, and focus on promoting the application of domestic medical equipment in tertiary hospitals.; It is necessary to give play to the market competition mechanism, promote the overall improvement of the domestic medical equipment industry, and continuously improve product performance. But there are still three hospital directors on the use of domestic equipment is not assured. [Comments] The original intention of encouraging the use of domestic equipment is good, but it is necessary to avoid backfire. First, equipment selection and health insurance pricing should introduce internationally accepted economic evaluation methods to guide fair competition and force companies to improve the cost-effectiveness of their products by improving product quality or lowering product prices (this is Singapore's experience). Second, the government should provide price subsidies for economically disadvantaged groups who need to use expensive inspections. In other words, the demand side is more reasonable. The supplementary provider will affect the rationality of the doctor's treatment plan. Furthermore, it is necessary to strictly regulate the indications for the use of expensive examinations to prevent "making up for medical treatment by inspection". Doctors should be subject to in-hospital supervision, as well as external supervision by the health insurance department. Finally, for large-scale equipment, national-level bargaining and volume procurement can also be implemented. Benchmark price: first try to see the results. The promotion of the "benchmark price" of drugs is one of the priorities of the National Development and Reform Commission this year, and some prefectures and cities have begun pilot projects. However, most places are still confused about how to measure the benchmark price and how to set this standard. Fujian Sanming's benchmark price is based on the lowest price of domestic generic drugs. Considering the public's acceptance and adaptation of drugs, Sanming will temporarily pilot more than a dozen varieties with "little difference between domestic and imported drugs and a lot of price difference", while it will not adopt this method for those original research drugs that are indeed therapeutic drugs. [Comments] In terms of drug benchmark prices, Sanming and Chongqing are already exploring the way. The Sanming model advocates that the portion exceeding the benchmark price is paid by the insured or the patient, while the Chongqing model is paid by the medical institution. The author believes that at the present stage when the hospital reform is not yet in place, it is appropriate to explore the Chongqing model, which is conducive to the active reform of the hospital, cancel the addition and squeeze out the price moisture. However, the disadvantage is that the drug is linked to the doctor's own interests, which will inevitably affect the rationality of the doctor's medication.
Under the premise that the drug price is no longer inflated and the benchmark price of medical insurance payment tends to be reasonable, it is appropriate to use the Sanming model, which is conducive to the return of rational drug use by doctors and patients, and the burden of self-expense is not increased. The top priority is to set a reasonable benchmark price for health insurance payments, supplemented by supporting measures. We can learn from international practice, introduce drug economics evaluation, and determine the benchmark price of drugs according to market demand, drug value and its substitutability. After that, it is necessary to subsidize people with financial difficulties, patients with chronic diseases and the elderly over 65 years old, so as to reduce the pressure of their own expenses and realize the relative fairness of drug supply. Another major advantage of this "supplementary demand side" policy is to allow the implementation of a unified national health insurance payment benchmark price to ensure a stable price order. The level of price subsidies can vary geographically.
Legislation: basic health care
The relevant person in charge of the National Health and Family Planning Commission pointed out that many problems in the medical industry will be resolved in the "Basic Medical and Health Law. The "Basic Medical and Health Law" will clarify the nature of health services, basic systems and how to build a medical and health service system, as well as hierarchical diagnosis and treatment of social concern, which will be stipulated by legal means.
[Comments] All key measures related to the success or failure of the medical reform should be included in the legislative process, so that the people can enjoy the results of the reform early. For example, the addition of hospital drugs not only leads to expensive medical treatment for patients, but also is suspected of price monopoly and profiteering, which is contrary to the "Anti-Monopoly Law", and also makes the return of public hospitals to public welfare become indefinite, which seriously affects the overall situation of medical reform. I believe that the rule of law can protect health care.
PPP: Exploration of political and social cooperation
The Guiding Opinions on the Development of Government and Social Capital Cooperation issued by the National Development and Reform Commission proposes that the government and social capital cooperation (PPP) model is mainly applicable to medical care, tourism, education and training, and health care that are responsible for providing and suitable for market-oriented operations. Wait for public services and infrastructure projects. Through political and social cooperation, the government will change from a direct provider of public goods to a partner of social capital and a regulator of PPP projects. PPP model refers to the government in order to enhance the supply capacity of public goods and services, improve supply efficiency, through franchising, purchase of services, equity cooperation and other ways, with social capital to establish a relationship of benefit sharing, risk sharing and long-term cooperation.
According to reports, Beijing recently proposed for the first time to allow public hospitals to carry out cooperation with social capital in the form of franchising on the premise of ensuring asset safety, medical quality and safety, and having corresponding management capabilities. Franchising is a more common concept in the current business field, it is a contractual way, the franchisor's business resources (including trademarks, corporate logos, patented technology, business management model, etc.) to the use of the franchisee, the franchisee to pay a certain fee to the franchisor business model.
[Comments] Allowing public hospitals to franchise is based on the needs of the country's existing national conditions. As long as the government supervision is good, the franchisor is more rational and well controlled, and can do a good job of supervision before, during and after the event. It is believed that the franchise of public hospitals can realize the "five wins" of both parties, doctors and patients and the government ". For example, the government can quickly clone a well-known hospital that patients can trust without spending money to ease the difficulty of seeing a doctor. Franchisee can generate income, realize brand extension and practice more doctors. The authorized party can shorten the return period of investment, etc.
Insurance companies run doctors: values are becoming more consistent
The State Council issued the "Several Opinions on Accelerating the Development of Modern Insurance Service Industry" to support insurance institutions to participate in the integration of the health service industry chain, explore the use of equity investment, strategic cooperation and other methods to establish medical institutions and participate in the restructuring of public hospitals.
[Comments] The author has always been interested in insurance companies running medical services. This is because the values of insurance companies are consistent with the values of hospitals and patients or insured persons. They all hope that medical services are value for money or of high quality and low price. This can form a virtuous circle. Ultimately achieve a win-win situation for all three parties. Insurance companies can save medical insurance expenses; hospitals can reduce medical costs and improve service efficiency, and patients or insured persons can get value-for-money and satisfactory medical services. Insurance companies can directly control the quality of medical care and medical costs of hospitals to ensure their healthy and sustainable development. If the hospital is successful, insurance companies can get two stable markets, one is the medical market, and the other is the health insurance market. Ultimately, the development of hospitals will drive the development of insurance companies.
In contrast, pharmaceutical enterprises may face a major challenge, that is, the collision of values between enterprises and hospitals. Enterprises hope that hospitals can consume a large number of their own products. If hospitals proceed from the interests of enterprises, they will certainly encourage doctors to abuse drugs or over-treat, thus damaging the interests of patients. However, if hospitals give priority to the interests of patients, it will be difficult for enterprises to take into account the interests of enterprises. Of course, a visionary company will respect the objective laws of the medical industry and go all out to build a hospital brand without short-sighted behavior.