Health & Beauty

Expansion of consumables centralized procurement, separated from price items

On August 31, the National Medical Insurance Administration, the National Health Commission and other eight departments jointly issued the "Deepening Medical Service Price Reform Pilot Program" (hereinafter referred to as the "Program"). At the same time, the relevant responsible comrades of the National Medical Security Administration answered reporters' questions on the "Deepening Medical Service Price Reform Pilot Program".

The "Plan" pointed out that standardizing the management of medical service price items, and establishing a pricing unit system that conforms to the price law. Make overall plans and take into account the needs of medical development and the affordability of all parties, and regulate the overall level of medical service prices.

Through 3 to 5 years of pilot projects, explore the formation of reproducible and extendable medical service price reform experience. By 2025, the pilot experience of deepening medical service price reform will be extended to the whole country. The medical service price mechanism of classified management, hospital participation, scientific determination, and dynamic adjustment will be mature and finalized, and the function of price leverage will be fully utilized.

Classify and integrate current price items, improve national medical service price item specifications, unify price item codes, and gradually eliminate regional differences. Realize the decoupling of price items from technical details such as operating procedures, diagnosis and treatment sites, enhance the compatibility of current price items with medical technology and medical activities, and reduce the number of items reasonably.

Medical consumables are gradually separated from the price items, the market mechanism is brought into play, and centralized procurement and "zero markup" sales are implemented.

Diagnosis, nursing, beds, and some traditional Chinese medicine services that are widely developed by medical institutions and have a high degree of service homogeneity are included in the general medical service catalog. For complex medical services that are not included in the general medical service catalogue, a price formation mechanism led by the government and hospital participation shall be established, and the professional opinions and suggestions of hospitals and doctors shall be respected.

Pricing should comply with the price rules set by the government, and match the hospital's grade, professional status, and functional positioning. The increased medical service costs of the pricing occupy the total price adjustment. Strictly control the charging items and the proportion of fees in public medical institutions that implement market-adjusted prices, and do not exceed 10% of all medical services. After the trial period of new projects expires, they will be managed as general-purpose or complex projects.

Establish and complete a comprehensive evaluation index system for price adjustments, and calculate the increase in medical and health expenses, the income structure of medical services, the changes in factor costs, the proportion of medicines and medical consumables, the proportion of large-scale equipment income, the average salary level of medical staff, the balance of medical insurance funds, and patients Indicators such as self-payment level and consumer price index are included in the assessment scope, and the triggering and limiting standards for dynamic adjustments are clarified.

In order to implement major reform tasks such as centralized procurement of medicines and medical consumables, respond to major public health incidents, resolve prominent contradictions in medical service prices, and alleviate imbalances in the supply of key specialist medical services, special adjustments to medical service prices will be initiated according to actual needs, with flexibility Select the price adjustment window period, scientifically calculate and reasonably determine the total amount of price adjustment and the scope of the project based on factors such as the income and cost of public medical institutions, and adjust the price as it rises or falls.

Do a good job in the coordination of medical service prices and payment policies, total price management control, total medical insurance budget management, and regional point method coordination. Explore the formulation of medical insurance payment standards.

Establish and improve the management system of medical insurance and medical consumables catalog. Deepen the reform of multiple and compound medical insurance payment methods based on the type of disease and grouping related to disease diagnosis. Explore the implementation of the total medical insurance payment for the close medical complex, strengthen supervision, reserve the balance on the basis of assessment, and share the reasonable over-expenditure. Promote all online procurement of medical consumables, and expand the scope of centralized procurement of high-value medical consumables.

Adjusting prices is not "patching" centralized procurement

The so-called "move cage for bird" is not a simple conversion and diversion, but a scientific reform method to optimize the reform of the medical service supply side.

The Medical Insurance Bureau pointed out in the interpretation of the "Plan" that reforms such as the centralized procurement of pharmaceuticals and consumables have lowered prices and reduced the burden on the people, which also created conditions for adjusting the prices of medical services. However, it is inaccurate to interpret the deepening of the reform of medical service prices as "patching" the reform of centralized procurement of pharmaceuticals and consumables, and to make up for the unreasonable income squeezed out by the latter through the price increase of medical services.

Deepening the reform of medical service prices is to further strengthen the leading role of medical service prices in deepening the reform of the supply-side of medical services by promoting governance innovation, system integration, and improving quality and efficiency. Preventing risks and other aspects play a role. It is not a two-round price increase and price reduction, nor is it a gourd and a left hand to a right hand.

Secondly, centralized procurement with volume has created a favorable opportunity for the reform of medical service prices, but in terms of specific advancement, it is still necessary to "go back to the bridge and back to the road." Specifically, the centralized purchase of quantities is aimed at the "sale with gold" of pharmaceuticals and consumables, with the purpose of purifying the market environment, squeezing out the price moisture, and reducing the unreasonable burden of the people;

The medical service price reform is aimed at its own shortcomings, and aims to build a more scientific and reasonable price mechanism to better exert its leverage function. Centralized procurement, price reduction and fee reduction have alleviated the burden of the people and won a window for reforms in the price of medical services. However, the two reforms have their own internal logic. It is not simple to shift, convert, and shift medical expenses by reducing prices and increasing prices. "Seesaw" relationship.

Third, the specific tasks borne by the price of medical services have changed, and some past practices cannot be mechanically applied. From 2015 to 2019, various localities coordinated to cancel the bonuses for medicines and medical consumables, and simultaneously adjusted the prices of medical services. The elimination of the drug consumables bonus reduces the legal income required for public hospitals to maintain normal operations under the old mechanism. The corresponding space is directly used to adjust the price of medical services, which is to cooperate with the completion of the transition of the public hospitals compensation mechanism.

After entering a new stage, public hospitals have fully implemented the "zero markup" sales of pharmaceuticals and consumables, and centralized procurement and price reductions can save public hospitals procurement costs. The space for medical expenses thus freed up must first release the reform dividend to the people and strengthen the people. The sense of gain and happiness.

Completely cut off the relationship between medical staff salary and department income

The Medical Insurance Bureau pointed out that, based on the survey, all localities have focused on increasing the prices of diagnostic, surgical, nursing, and traditional Chinese medicine services that focus on technical labor in the past two years. Some professional survey reports released recently also show that the average annual cash salary of public hospitals is already higher than the average salary of urban employees.

Regarding how the medical staff care about how to better reflect the value of technical labor, it is necessary to strengthen coordination between the reform of medical service prices and the reform of the salary system of public hospitals, rationally determine the salary level and distribution mechanism of public hospitals, and transmit the reform dividend to the medical staff. It is also necessary to avoid directly linking medical staff salaries with project prices and income-generating capabilities.

The price of medical services is a "measurement" of the value of technical services. In the past, some hospitals mostly relied on medicines and consumables to increase their income. The “income-generating” ability of disciplines dominated by technical and labor services was weak, the status of the hospitals declined, and the development momentum was insufficient. At present, the state has reduced the proportion of revenue from pharmaceuticals and consumables by abolishing the addition of pharmaceuticals and consumables and concentrated purchases in quantities, and gradually optimizes the price of medical services. The medical and medical technology disciplines based on technical and labor services are difficult to develop under the traditional model. Reform It is expected to usher in a period of opportunity later.

In addition, the price of medical services is also a "signal light" for optimizing the allocation of medical resources. For example, in accordance with the system design, the introduction of public hospitals to participate in the price formation of complex projects, the price adjustment will be more flexible and more targeted; for general-purpose projects, the government will strengthen the control of price benchmarks and price adjustment rhythms.

The price classification mechanism can guide high-level hospitals to focus on difficult and risky projects, avoid the siphon effect, and promote hierarchical diagnosis and treatment.

The Medical Insurance Bureau pointed out that the “technical specifications” of the current price items are heavier, and the operating procedures, technical standards, and allowable equipment consumables are included in the content of the items. If you change the operating parts, steps, and methods clinically, you may not be able to find them. To the corresponding price items, and the application for new price items may face the problems of innovation and economy. The long demonstration cycle affects the clinical improvement and innovation.

New medical technologies are relatively free to enter clinical applications, and there is a lack of technical access links similar to drug review and approval. For the same service items, the names, connotations, and boundaries of different regions are not unified, and after they are converted into pricing units, this difference continues. As a result, it is difficult to accurately evaluate the prices between regions, which affects the scientific and effective price management.

Moreover, in the past, it was emphasized that medical consumables should be combined in the price item. The original intention was to indirectly restrict the cost of medical consumables. However, many problems have been exposed in practice. In fact, it is innovative and economical. If the price department allows additional items to be charged, it will increase the patient's unnecessary burden, and if the original item is required to charge, it will be criticized for hindering progress.

The "Pilot Plan" proposes to establish a goal-oriented price project management mechanism, which is to clarify the top-level design and bottom-level logic of the medical service price project from the perspective of patient benefit and follow the direction of "output-oriented, technology-consumption separation" A price item system that has clear connotation boundaries, is suitable for clinical diagnosis and treatment, and is easy to evaluate and supervise.