Liu Yandong: Drug procurement decentralized to local and hospital

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At 3 pm on October 16, 2014, Liu Yandong, member of the Political Bureau of the CPC Central Committee and Vice Premier of the State Council, hosted a national symposium on the reform of urban public hospitals in Conference Room 3 of the State Council. Jiang Xiaojuan, Deputy Secretary of the State Council, Li Bin, Secretary of the Party group and director of the national health and Family Planning Commission, responsible comrades of relevant departments of the State Council, vice governor of Zhejiang Province, deputy mayors in charge of Shenzhen City, Guangdong Province, Baoji City, Shaanxi Province and Zhuzhou City, Hunan Province, directors of medical reform offices of Beijing, Shanghai and Luoyang City, Henan Province, and directors of public hospitals of Ma'anshan City, Anhui and Zhanjiang City, Guangdong attended the meeting.
The symposium mainly focused on the problems in the reform of urban public hospitals and how to find a breakthrough in the next reform; after urban public hospitals eliminate the use of medicines to supplement medicine, governments at all levels implement investment responsibilities, compensation capabilities and sustainability of medical insurance; how to solve medical institutions and Medical staff unreasonable profit-seeking problems.
How to correctly position urban public hospitals, how to deal with the relationship between urban public hospital reform and county-level public hospital reform, how to improve the corporate governance structure of urban public hospitals, and how to establish a salary system for medical staff that adapts to the characteristics of the industry. Finally, Vice Premier Liu Yandong made an important speech. The spirit report of Vice Premier Liu Yandong's speech is as follows:
1. to accurately grasp the situation of urban public hospital reform
Since the pilot reform of urban public hospitals was launched in 2010, some progress and initial results have been achieved. Mainly reflected in:
(I), the drug addition is gradually canceled, the financial compensation mechanism has been initially established, and the price of medical services has been reasonably adjusted. By adjusting the price of medical services and establishing a financial compensation mechanism, public hospitals can digest and make up for the reduced income due to the cancellation of drug additions, breaking the "medicine supplement" system and forming an income growth mechanism.
(II), the pilot cities have explored the reform of the system and mechanism and achieved initial results. For example, the comprehensive reform in Zhejiang Province, the reform of medical service fee in Beijing, the reform of corporate governance structure of public hospitals in Zhuzhou City, and the desalination of establishment management in Ma'anshan.
The (III) is that the people have enjoyed the benefits of reform. The increase in the average cost of public hospitals in all pilot cities is lower than the national average, the out-of-pocket proportion of patients has been reduced, and the enthusiasm of various localities to participate in the reform has been further improved.
However, through the pilot reform of urban public hospitals in the past few years, no pilot city in the country can provide a model and experience that can be promoted on a large scale, and there are still the following problems.
The (I) is that the unreasonable profit-seeking mechanism of public hospitals has not been completely eliminated, and the problem of "difficult and expensive medical treatment" still exists. In some places, there are still phenomena of "checking and supporting doctors" and "consumables to support doctors", and the rise in medical expenses has not been effectively curbed.
(II) is the path of reform, breakthrough and entry point is still not clear. It is not clear what the reform of public hospitals should look like, and the top-level design of the reform also needs to be studied.
(III), some pilot cities have a wait-and-see attitude, and substantive reforms are slow to advance. When facing the difficulties in the reform, they are afraid of taking risks when adjusting the interest pattern. They only pay attention to the construction of hospital hardware facilities and are only limited to canceling the drug addition reform. However, the comprehensive supporting reforms such as hospital internal management, drug procurement and salary system are not strong enough, the progress is not fast, the evaluation and supervision mechanism is not perfect, and the accountability mechanism is lack, up and down linkage is not enough.
The (IV) is that the comprehensiveness of the reform is not strong, the superimposed effect of policies has not been released, the situation of "three medical linkage" has not been realized, and the joint force of reform has not been fully formed. At present, the medical reform has entered a critical period, but the follow-up policies have not been followed up in time. The pilot cities have not formed experiences and practices that can be fully promoted, and have not produced "seeds" that can be sown ".
In the face of these problems, we can't avoid them. It's not a bad thing to have problems. It just shows that these difficulties and problems will appear in the process of public hospital reform. If these difficulties and problems are not solved well, they may fail. We should be tolerant of the failure in the reform, but we can't make subversive mistakes.
The reform of urban public hospitals is a complex project, a worldwide problem, and the most difficult "hard bone" in all reforms ". Only by revealing contradictions and correctly understanding contradictions can contradictions be resolved and reform can move forward. Therefore, we should not only see the contradictions, but also be full of confidence to further deepen the reform of public hospitals.
Give 2. play to the initiative of the central and local governments
When the reform reaches a critical point, it depends not only on the top-level design of the Central Committee and the State Council, but also on the bold practice of local governments. The top-level design needs to cross the river by feeling the stones and be tested by local practice.
The (I) is to give full play to the local initiative. 30 years of reform and opening up, local practice has accumulated a lot of successful experience. There is no retreat for reform, and the pilot cities of public hospital reform should dare to take on the responsibility and be the vanguard. The Central Committee of the Communist Party of China and the State Council have decided to carry out the pilot work of medical reform with the province as the unit this year, focusing on the overall problems and achieving overall innovation with regional breakthroughs. In particular, the authority of price, distribution and procurement should be delegated to local governments and hospitals as much as possible.
The (II) is to further strengthen the top-level design. The reform of urban public hospitals is complex and systematic, so it is necessary to study and formulate comprehensive supporting reform policies at the macro level. The Medical Reform Office of the State Council shall, in conjunction with relevant departments, issue drug procurement policies as soon as possible, conduct special investigations and studies on issues in the fields of medical insurance payment system, social capital-run medical services, and drug formation mechanisms, and form operable policy documents to prevent simplification in the reform process. And the loss of state-owned assets. In formulating a reform plan, we must fully listen to the opinions of all parties, enhance the pertinence of the reform, not advance alone, form a joint force, and increase overall coordination.
3. strengthen the investigation and study of major issues
Research is a basic skill. The reform of urban public hospitals is very complicated and cannot be pretentious. In the process of formulating and implementing the reform plan, investigation and research must be placed in a prominent position, and the quality and supervision of the reform must be strictly controlled. To achieve success in the reform, the experience formed must stand the test of time. In the next stage, efforts should be made to complete the following three tasks:
(I) is the goal of reform and breakthrough. Our reform should continuously meet the diverse needs of the masses and further improve the health of the masses. To establish a patient-centered, which is the fundamental embodiment of public welfare.
We need to be clear in the reform, the reform in the end to achieve what kind of goal? What are the key reforms? Where is the breakthrough? How to integrate and rationally allocate the scale and efficiency of medical resources? How to expand the coverage of quality resources? How to prevent the disorderly expansion of urban medical resources? What is the relationship between the development of medicine and health industry? All localities must adhere to the problem-oriented approach and conduct in-depth analysis of these problems. In response to these problems, it is necessary to clarify the order of reform measures, distinguish priorities, and make precise efforts.
The (II) is the problem of the relationship between the reform of urban public hospitals and other reforms. In particular, how to establish an operational hierarchical diagnosis and treatment system? What is the position of urban public hospitals in hierarchical diagnosis and treatment? The relationship between urban public hospitals and county-level public hospitals? The relationship between urban public hospitals and social capital to run hospitals? Is it incremental reform or stock reform? All localities should seriously study, analyze and solve these problems to form a replicable and sustainable new reform model.
(III) is a matter of financial input and reform and development. To achieve the above reform goals, the sustainability of funds is an important goal. How much money does the reform really need? Can the finances cover the bottom line? We have to be clear about these. With the trend of aging population in our country, how much investment can social medical services bring? What proportion does it account for in the planning layout? How much room is there for the adjustment of medical service prices? How much is the decline of the false high drug prices?
We all need to seriously investigate, study and calculate the above problems to ensure that the medical insurance funds do not go through the bottom. We should be particularly cautious about the introduction of social capital to participate in the property rights reform in the reform of public hospitals, carefully calculate, do a good job of forward-looking analysis, and have a clear idea.
In the investigation and research, we should play the role of front-line medical personnel and social think tanks, put forward suggestions in line with China's national conditions, and form a thorough analysis of the investigation report. There will be many contradictions in the reform. How to distinguish the priorities and priorities of the contradictions is a strategic problem, and the difficulty lies here. We must grasp the pace of reform, fully mobilize the enthusiasm of all parties, and believe that we will be able to find a Chinese-style solution to medical reform.