National collection of strong "three medical linkage" to break the ice

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"Several Policies and Measures for Further Deepening the Reform of the Medical and Health System with the Centralized Procurement and Use of Drugs as a Breakthrough" (hereinafter referred to as "Several Policies and Measures") was reviewed and approved by the executive meeting of the State Council on November 20 and will be issued soon. This will certainly amplify the effect of the reform, comprehensively promote the deepening of the reform of the medical and health system, promote the linkage of medical care, medical insurance, and medicine, better promote the solution of the problem of medical treatment for the masses, promote the realization of the goal of "three returns", and inject impetus into the implementation of the healthy China strategy.

The problem of 1. drugs is the root of all problems in the field of medicine and health.

       Over the years, China's drug supplies circulation chain is long, drug prices are high, boosting the rising cost of medicine. Before the implementation of the "two-vote system" for drug procurement, there were more than 300 million medical representatives across the country, forming a layer-by-layer subcontracting and grid monopoly high rebate circulation interest chain composed of the national general generation-provincial generation-district generation-county generation-hospital generation, which seriously affected the government image and social atmosphere. The new government to drug reform as a starting point, the absorption of drug consumables joint price limit procurement Sanming alliance practice, the organization of drug access negotiations, "4 plus 7" city procurement pilot, the average price of selected drugs fell by more than 50%. The "Several Policies and Measures" introduced this time include "sky-high" original research drugs and essential drugs that have passed the quality and efficacy consistency evaluation of generic drugs into the scope of centralized procurement, and build a national drug public procurement market with unified coding, standards and functional specifications. The effect of drug price reduction will be more obvious, and the benefit patients will be more extensive. It can be said that the implementation of the pilot and expansion of centralized drug procurement and use organized by the state has become a breakthrough and starting point for promoting the in-depth development of medical reform, which can effectively and effectively promote the "three medical linkage" to break the ice.

The centralized procurement and use of 2. drugs is the engine to promote the "three medical linkage.

The "three-medicine linkage" is the first to treat medicines, and the focus is on deepening and seeking breakthroughs in the "movement" of the "union". Only by squeezing the inflated price and quantity of drugs can the price of medical services be increased through "vacating cages for birds". Enhance the labor value of medical staff, stabilize the main force of medical reform, mobilize the enthusiasm of doctors, and promote the healthy progress of medical reform. One is to crack down on drug chaos. The first is to establish a unified national drug procurement platform, using common names, common dosage forms, common specifications, and common packaging. It is clear that only drugs that meet the conditions can go to the national drug procurement platform, and those that do not meet the conditions are not allowed to go to the platform. The second is to determine the national maximum sales price of drugs on the platform. Thirdly, according to the therapeutic, auxiliary and nutritional classification, the varieties listed in the national medical insurance catalogue are clearly, into the national health insurance catalog and then clear health insurance payment standards. The second is to promote the price adjustment of medical services. On the basis of making room for drugs, it is necessary to dynamically adjust the price of medical services, straighten out the price of medical services that have been distorted for many years, increase the gold content of total medical income, optimize the structure of hospital income, and improve the labor value of medical staff. Let the sunshine treatment of medical staff be greatly improved. The third is to promote the reform of medical insurance payment methods. We should firmly grasp the "bull nose" of medical insurance payment reform, and give full play to the role of medical insurance in blocking waste, saving costs, and curbing excessive medical treatment such as "big prescription", "big inspection" and "big test.

3. Sanming experience has proved that "three medical linkage" is a correct and can be replicated and promoted reform path.

On November 6 this year, the "Notice of the State Council Leading Group for Deepening the Reform of the Medical and Health System" issued on Further Promoting the Experience of Deepening the Reform of the Medical and Health System in Fujian Province and Sanming City specifically summarized the main experience of deepening the medical reform in Sanming City, including establishing an efficient and powerful medical reform Leadership system and organizational promotion mechanism, deepening the linkage reform of medical care, medical insurance, and medicine, innovating salary distribution and strengthening the supervision and management, the upper and lower linkages promote the sinking of high-quality medical resources in 6 aspects; the key tasks for further promoting Sanming's medical reform experience are clarified, with a total of 24 tasks in 7 aspects. The reason why Sanming medical reform can achieve obvious results is that it is very important to make a heavy blow to the corruption of pharmaceutical consumables and dare to "show the sword". Starting from the control of drug fees, we should break the mechanism of using drugs to support medical care, implement the "Sanming Alliance" for the joint price-limiting procurement of pharmaceutical consumables across regions, implement the "one product, two regulations" and "two invoice system", and implement the dynamic adjustment mechanism of drug procurement catalogue, the results of the centralized drug procurement organized by the state were followed up in the first place and all were included in the drug joint price limit procurement catalogue. Strict drug supervision measures were taken to promote the "quantity and price" of drug consumables. In 2018, Sanming's expenditure on drug consumables was 1.002 billion yuan, which did not increase but decreased compared with 1.015 billion yuan in 2011. Based on the average growth rate of Fujian Province, Sanming's cumulative reduction in medical expenditure was 7.3 billion yuan. The space vacated by the drug control fee was used for the price adjustment of medical services seven times, and the pharmaceutical service fee was added, which was fully borne by the medical insurance fund. The medical service fee was increased by 0.283 billion yuan and the pharmaceutical service fee was paid by 44.592 million yuan. Since 2012, by adjusting the price of medical services, the hospital's medical service income has been increased by 3.98 billion yuan, laying the foundation for promoting the reform of the salary system. In the reform of medical insurance, we should start with the "three guarantees in one", promote the links of drug purchase, medication and payment from decentralized management to centralized management, realize the whole process supervision of hospitals, doctors, drug circulation and use, and break the problem of "paying the bill but not ordering. In the medical reform, starting from the optimization of the salary system, the reform of the total salary verification method, only linked to the income of medical services, and decoupled from the income of drug consumables, inspection and laboratory tests, and eliminated the profit-seeking of public hospitals. From the experience of Sanming medical reform, we can see that most of the problems of medical reform have been solved by solving the key of drug procurement reform. The implementation of the pilot and expansion of the centralized procurement and use of drugs organized by the state provides a good opportunity for deepening the reform of medical care, medical insurance and medicine.

To promote the medical reform work, the Party committee and the government must take the political responsibility. The key to the promotion of Sanming medical reform lies in the fact that the "top leaders" of Sanming municipal Party committee and municipal government personally assume the leadership responsibility. Medical reform involves the adjustment of multi-party interests, the transformation of a number of government functions, the protection of basic people's livelihood, the relationship between thousands of households, and the whole body. The reform of the pharmaceutical system is an important link in the "three medical linkage". It is difficult to reduce the falsely high prices of drugs (consumables) by relying only on one Sanming or one province and city, because the whole of China is a unified market and must be done by the unified state. This time, the state organized the centralized procurement and use of drugs. From the reform practice of Sanming City, it has fully proved that this is a correct and replicable reform path. It is for the implementation of the healthy China strategy and the comprehensive construction of value medicine, value medical insurance, and value medical care. The service system is of great significance.