Expanding the scale of mining and collecting pilot assessments, and adjusting th
Copyfrom£º Release time£º2019-06-13 The editor£º
National New Office Briefing: Expanding the scale of mining and collecting pilot assessments, and adjusting the medical insurance catalogue to focus on drug economy
At 15:00 on June 10, the State Council Information Office held a regular briefing on the State Council policy. Wang Hesheng, deputy director of the National Health and Health Commission, deputy director of the Secretariat of the State Council's Medical Reform Leading Group, and relevant officials from the Ministry of Finance, the Ministry of Human Resources and Social Security, and the National Health Insurance Bureau attended and introduced the key tasks of deepening the reform of the medical and health system in 2019. The situation, and answered the reporter.
Research and development of 15 documents
Promote the implementation of 21 specific tasks
Recently, the General Office of the State Council issued a key task for deepening the medical reform in 2019. "The document clarifies the key work contents of the two aspects: First, it is necessary to study and formulate documents, mainly to encourage the imitation of drug catalogues, standardize the use of medical consumables, and further deepen medical reform, Internet medical treatment fees and medical insurance payments, etc. The 15 documents; the second is to promote the implementation of the key tasks, mainly to solve the problem of ugly medical problems and strengthen hospital management, and put forward 21 specific tasks, including promoting the national organization of centralized procurement and use of drugs pilot, promoting high value The reform of medical consumables, the consolidation and improvement of the national essential medicine system, and the promotion of the reform of medical insurance payment methods, etc.. Wang Hesheng pointed out that the next step of the annual reform tasks should be fully included in the accounts, quarterly notifications, and the implementation of responsibility.
Wang Hesheng pointed out that in 2018, a series of reform measures were implemented around the five basic medical and health systems and the establishment of a high-quality and efficient medical and health service system, and achieved significant phase results.
First, the construction of the graded diagnosis and treatment system was promoted in an orderly manner. We will start the comprehensive performance appraisal of medical associations, standardize the signing services for family doctors, comprehensively push open telemedicine, and improve the county's service capacity. 84% of county-level hospitals reach the second-level and above.
Second, the modern hospital management system was gradually established. Strengthen the party building of public hospitals, select 148 hospitals to carry out pilot projects to establish and improve modern hospital management systems, promote the reform of personnel compensation system, initiate performance appraisal of tertiary public hospitals, and further improve medical services.
Third, the universal health insurance system is more perfect. We will improve the medical insurance management system, improve the level of medical insurance, and carry out pilot projects in countries that are paid for by disease diagnosis. Health and poverty alleviation was implemented in depth, and the scope of special treatment for major illnesses was expanded to 21 species.
Fourth, the drug supply security system is increasingly perfect. The number of essential drugs increased to 685, the shortage of supply of medicines was strengthened, zero tariffs on imported drugs were implemented, 17 kinds of anticancer drugs were greatly reduced in price and included in the national medical insurance catalogue, and the average price of 25 selected drugs in the national drug centralized procurement pilot decreased by 52%.
Fifth, the comprehensive supervision system was speeded up. A total of 308,000 units of “double random” random inspections were conducted, and the proportion of random inspections accounted for 10%. We launched a special campaign against fraudulent fraudulent access to medical insurance funds, strengthened price supervision and anti-monopoly law enforcement in the medical field, and established a comprehensive joint disciplinary system for medical crimes.
Sixth, a quality and efficient medical and health service system is being established. Increase financial input, promote public health work, promote prevention and control, and study healthy China actions. The development of health industry and society to run medical treatment, the number of private hospitals accounted for more than 60% of the total number of hospitals. Promote the development of "Internet + medical health", promote the combination of medical care, and deepen the coordination of medical education.
Taking collection as a breakthrough
Squeeze out the high drug price
Also attending the briefing were: Fu Jinling, Director of the Social Security Department of the Ministry of Finance, Liang Wannian, Director of the National Health Protection Commission, and Xiong Xianjun, Director of the Medical Services Management Department of the National Medical Insurance Bureau. They jointly participated in the reporter's question.
¡¡ CCTV Financial Reporter of the Central Radio and Television General Station: As a key work of this year's medical reform, what are the key considerations for the comprehensive reform of public hospitals?
Wang Hesheng: The comprehensive reform of public hospitals has entered a new stage. To continue to deepen the reform, we must do a good job in two aspects: First, according to the top-level design determined by the Party Central Committee and the State Council, we will promote the "three-medicine" linkage reform and adhere to the "cage change for birds". The line of thought and the path of “tethering space, adjusting structure, and ensuring convergence”, taking the national organization of centralized drug procurement and use as a breakthrough, to increase the reform of drugs and high-value medical consumables, squeeze out the high price of water, The space is used to adjust the price of medical services in a timely manner, establish a dynamic adjustment mechanism that is conducive to medical services to rationalize the relationship between prices and optimize the income structure of hospitals.
Summarize and evaluate the local exploration and practice of the value of pharmaceutical services, and promote rational use of drugs. We will further promote the reform of the salary system of public hospitals, formulate guiding documents, implement the two permitted requirements, and further mobilize the enthusiasm of the majority of medical personnel. It is also necessary to improve the investment policy of the public hospital government, remove the worries of hospital reform and development, carry out pilot projects based on disease diagnosis and related sub-groups, continue to promote the reform of multi-component medical insurance payment methods based on disease types, and mobilize hospitals to reduce costs and save The endogenous power of the cost.
The second is to carry out pilot projects to establish and improve the modern hospital management system. Implement the Dean's Responsibility System, ensure the correct direction of hospital reform and development, and achieve standardized, refined and scientific hospital management. Comprehensively carry out the performance appraisal of three-level public hospitals, promote the hospital to achieve "three transformations, three improvements", that is, the development mode from the scale expansion to the quality and efficiency, improve the quality of medical care; from the extensive management to the fine management To improve efficiency; in the direction of investment, from the development of investment hospitals to the expansion of distribution, improve treatment.
¡¡ China News Service reporter: In 2019, the key tasks of deepening medical reform were put forward to establish a high-quality and efficient medical and health service system with Chinese characteristics. Excuse me, what are the specific considerations for this?
Liang Wannian: The National Health and Health Commission is working with relevant departments to study the quality and efficiency of the medical and health service system. In order to better promote the construction of this system, we have done related work in the early stage:
First, the organization carried out some basic research to clarify the connotation and extension of the high-quality and efficient medical and health service system, which is the difference between this system and the existing medical and health service supply system. Which system and traditional system need to be changed, What is to be innovative. On the whole, it is still about the multi-level and diversified needs of the people in the new era for health care, to better meet and solve the problem of unbalanced and inadequate development in the medical and health supply side system;
Second, the organization has carried out some international relevant experience research. Fully draw on some good practices from the international community and combine the reality of our country to design and organize a new system that meets the needs of the Chinese people and meets the needs of ordinary people.
The third is to thoroughly summarize the practices made by all parties in China, such as Zhejiang, Shanxi, Anhui and other places to do some exploration of this system construction, summarizing their practical experience and main path. On this basis, we must focus on five aspects of innovation in the system structure.
The first is to implement structural reforms on the supply side, improve the service system, and improve the capacity and accessibility of the entire system. Make this system more complete;
The second is to make this system oriented to the health needs of residents;
Third, on the basis of rationalizing the external operation mechanism and internal management system of this system, we should make full use of modern information technologies such as the Internet, big data, and artificial intelligence to improve the standardization, refinement, and informationization of medical and health institutions and the entire system. Management level;
The fourth is to actively explore a variety of integrated service models that use family doctors' primary health care institutions and district and county hospitals as health platforms to achieve effective integration of “medical” and “defense” in this system, and effective integration of upper and lower medical and health institutions. The combination of "medical" and "nurturing" is effective, and the combination of Chinese and Western medicine is effective. These four combinations are very crucial;
Fifth, through the establishment of a refined management system, a reasonable operating mechanism, and a sound regulatory mechanism, a policy environment of equal rights, fairness, transparency, and rationality is established for the high-quality development of this system.
New medical insurance catalog adjustment
Pay more attention to drug economy
Reporter of the Central Radio and Television General Station Guoguang: In terms of reducing the cost of medicines, especially after the establishment of the Medical Insurance Bureau, what are the plans for 2019? Thank you.
Xiong Xianjun: The high price of some medicines and the high cost of medicines are very important factors for expensive medical treatment. In order to effectively reduce the cost of medicines and ease the burden of medicine for the people, the National Health Insurance Bureau in 2018 mainly carried out the following work:.
First, according to the adjustment of tax policy, 14 kinds of pre-national anti-cancer drug insurance payment standards were adjusted, with an average decrease of 4.86%. Second, at the same time, special negotiations on the admission of anti-cancer drugs for medical insurance were carried out, and 17 drugs were included in the medical insurance catalogue. All localities are required to implement new pricing and reimbursement policies by the end of November 2018. As of March this year, the national medical institutions and pharmacies purchased a total of about 6.28 million anti-cancer drugs (pieces/pieces) negotiated at 17 countries, and the total purchase amount reached 2.234 billion yuan, compared with the pre-negotiation price. , saving procurement costs of 3.181 billion yuan.
Recently, we have seen some media reports that anti-cancer drugs can not be bought and not reported in hospitals after they are admitted to medical insurance. We noticed that the relevant data cited in the article was in mid-December last year. Objectively speaking, there was indeed a problem that anti-cancer drugs could not enter the hospital or could not be reimbursed. The party group of our bureau attached great importance to this. In November last year, together with the Health and Health Commission, it issued the "Notice on Doing a Good Job in the Implementation of Anti-cancer Drugs in 17 National Medical Insurance Negotiations", requiring all localities to attach great importance to strengthening management and conscientiously doing network procurement and Medicare payment, while explicitly requiring all localities not to rely on the "cost control", "drug share" and the basic drug list of medical institutions, affecting the supply of anticancer drugs and the rational use of drugs. Since 2019, we have strengthened dispatching and urged the provinces to report progress on a monthly basis. From the current situation of reporting in various places, the progress of this work is relatively smooth. As of the end of March, the cumulative reimbursement reached 209,400 person-times, and the reimbursement amount reached 1.085 billion yuan. Of course, there is no imbalance in various regions.
Second, the provincial-level special procurement of anticancer drugs was carried out, and the average price dropped by 10.21%. In order to carry out centralized drug procurement pilots in a timely manner, focusing on the decoupling of volume and price in the centralized procurement field, regional barriers, and the shortage of “three medical linkages”, centralized drug procurement was concentrated in four municipalities and seven large urban public medical institutions. Realize the price change. A total of 25 drug purchases were successful in the pilot procurement, and the purchase price dropped by an average of 52%. The pilot effect of reducing the burden and efficiency was significant, and it is estimated that the drug cost will be 5.8 billion. Among them, about 2.3 billion yuan for patients to save medicines.
In addition, we have also adopted a special campaign to combat fraud and fraud, standardizing the diagnosis and treatment of medications at the grassroots and social organizations, and have also played a positive role in reducing the burden of medication for patients. This year, we will do the following work to reduce the cost of medicines:
First, the 2019 national medical insurance drug list adjustment work will be carried out, and more medicines with high clinical value and good drug economy will be included in the catalogue to better meet the reasonable clinical drug needs of the majority of insured personnel and effectively reduce the burden of patients' medication. At the same time, the drug catalogue is negotiated for entry, and the price of medicines is effectively reduced by market-based pricing.
The second is to further expand the scale of centralized procurement. Through the evaluation of the national organization of centralized drug procurement and use pilots, continue to strengthen the monitoring and guidance of the pilot situation, start the pilot assessment, summarize the pilot experience, optimize and improve the centralized drug procurement system, research and expand the pilot work, and further expand the region. More drugs will participate in centralized procurement, so that more patients can enjoy the policy benefits of centralized procurement.
Health insurance fund income
Accounting for 51.5% of public hospital medical income
Economic Daily News reporter: This year, Article 22 of the key tasks of medical reform clearly proposed to improve the government's investment policy in public hospitals. What considerations does the Ministry of Finance have in this regard, and what supporting policies will be introduced?¡¡
Fu Jinling: First of all, about the government investment in public hospitals. In 2013-2018, the direct investment of governments at all levels in public hospitals increased from 129.7 billion yuan to 270.5 billion yuan, an average annual increase of 15.8%. At the same time, the government also indirectly supports the development of public hospitals through subsidies for medical insurance funds. In 2018, the income of public hospitals from various types of medical insurance funds reached 1,233.9 billion yuan, accounting for 51.5% of the medical income of public hospitals. The above two incomes have become the main source of income for public hospitals, providing a solid guarantee for their healthy operation.
However, with the rapid development of public hospitals and the deepening of reforms, there have been some new situations and new problems in the operation of public hospitals. This year's key tasks of medical reform are proposed to improve the government's investment policy in public hospitals. Our main considerations are as follows: First, expenditures for infrastructure construction and equipment purchase that meet the regional health plan and are submitted for approval according to procedures are borne by the government at the same level. Second, the key discipline development and talent training projects organized by the state are jointly shared by the central and local governments; local key government development and personnel training projects are carried out by local governments. Third, public hospitals provide public health services and undertake government-executive tasks. They can be paid by the government to purchase services in accordance with the principle of “who buys and pays”. Fourth, the central government will further increase support for public hospitals in poverty-stricken areas, promote the equalization of medical services, and strive to make the people in poverty-stricken areas see the disease and see the disease.
Secondly, it is related to the results of fund allocation and performance evaluation. In line with the concept of “costing must be effective, invalid must be accountable”, the performance management of public hospitals is continuously strengthened, and the mechanism of fund allocation and performance evaluation results is gradually established to promote the efficiency of hospital operation and the use of financial funds. In 2019, when the central government allocated public hospital comprehensive reform subsidy funds, it further increased the weight of performance factors and stimulated the local government's enthusiasm for promoting public hospital reform.
Two-way referral first appeared
“Lower up and down”¡¡
China Daily reporter: One of the key work of medical reform in 2019 is to build a city medical group in 100 cities and build a county medical community in 500 counties. What considerations do you have for this work?¡¡
Wang Hesheng: In 2018, the National Health and Health Commission issued a series of documents to further standardize the construction and development of the medical association. Overall, the construction of the medical association has been rapidly advanced. By the end of 2018, all provinces in the country had issued plans for the development of medical associations, and all tertiary public hospitals participated in the construction of medical associations. A total of 1,860 urban medical groups were established, 3,129 county medical communities, 2,428 cross-regional specialist alliances, and 5,682 telemedicine collaboration networks in remote and impoverished areas. The construction of the medical association has achieved positive results.
First, two-way referrals are promoted in an orderly manner. 98.4% of the urban medical groups and 91% of the county medical community established a “green channel” for two-way referral within the medical association. In 2018, there were 19.38 million cases of referrals to medical institutions nationwide, including 12.35 million cases of patients, up 15% year-on-year, and 8.83 million cases of patients, up 83% year-on-year. It can be said that it was the first time Change, decrease, and increase.
Second, medical resources are further developed. In 2018, the lead hospital directed grassroots medical institutions to carry out 4,941 new technologies and new projects, a year-on-year increase of 24.9%.
Third, the flow of people in the medical association is active. In 2018, higher-level medical institutions sent 150,000 professional and technical personnel to the grassroots, and grassroots medical personnel went to higher-level medical institutions to study 180,000 person-times, an increase of 11% and 64% respectively.
In the next step, we will accelerate the construction of the medical association and increase efforts to promote the sinking of quality medical resources and the shift of work focus.
First, do a good job in building urban medical groups in 100 cities. Learning from the experience of Shenzhen Luohu and other places to promote the development of the medical association to a close direction. In accordance with the principle of “planning development, divisional package, prevention and control, and industry supervision”, a gridded layout is implemented to manage the medical association. Overall planning, focusing on the development of a close-knit medical group. The partitioned package segment divides the service area into several grids according to the distribution of medical resources, and each grid is managed by a medical association. The combination of prevention and treatment shall be the overall responsibility of the lead hospital and bear the disease prevention and control work. Industry regulation transforms the traditional regulation of a single medical institution into a regulation of the medical association and the medical community.
The second is to build a county medical community in 500 counties. On the basis of summarizing the typical practices of Anhui Tianchang, Zhejiang, Shanxi and other places, the National Health and Health Committee and the Chinese Medicine Bureau issued the "Notice on Promoting the Construction of a Closely County Medical and Health Community". It is planned to select 500 work bases across the country. The county with strong sense of reform and innovation has launched a pilot project of a compact county health community. Through pilots, we will further improve grassroots service capabilities, improve the overall performance of county health care services, and better promote the grading diagnosis and treatment system and healthy China.
Home>NEWS > Industry information >
Pay attention to our