Recently, eight departments including the National Medical Insurance Bureau, the National Health Commission, and the National Development and Reform Commission have issued the "Deepening Medical Service Price Reform Pilot Program" (hereinafter referred to as the "Pilot Program").
The reason why the "Pilot Plan" has received industry attention is mainly because the price of medical services directly affects 1.4 billion people, 7.87 million medical staff and more than 50,000 medical institutions, involving trillions of dollars in benefits each year.
The reform goal clearly stated in the "Pilot Plan" is to explore the formation of a medical service price reform experience that can be replicated and promoted through a three to five-year trial.
By 2025, the reform pilot experience will be extended to the whole country.
The State Council will first select five cities, focusing on pilot projects around total volume control, price classification formation and dynamic adjustment, and monitoring and evaluation.
Provinces (autonomous regions and municipalities directly under the Central Government) where conditions permit may organize to participate in the pilot.
According to industry insiders, the local medical insurance bureau is applying for a pilot reform of medical service prices.
The price item is the basic unit of medical service charges, and has always been the focus and difficulty of deepening the reform.
As early as 2016, the state had already put forward the requirements of a "dynamic adjustment mechanism for medical service prices".
In the same year, various localities began to cooperate to cancel the addition of drugs and medical consumables, and control the procurement costs of drug consumption in public hospitals.
At this stage, the phenomenon that some medical service items are charged too low or too high still exists and needs to be solved urgently. The doctors bluntly stated that the outpatient clinic and treatment costs should be increased.
According to a reporter from China Business News, the general number of outpatient registration in public tertiary hospitals is only 12 yuan, and the deputy director level is 22 yuan.
Since the doctor’s income is a fixed salary, the amount of registration fees and specific clinical operations does not affect the doctor’s actual income.
Including chest piercing, bone piercing and other inspection items, the part involving labor costs will not be included in the assessment of personal workload.
For a long time, the price of treatment fees has seriously deviated from the actual labor cost and cannot reflect the labor value of medical staff.
"The first adjustment of the "Pilot Plan" should be the price of treatment fees. For example, a large rescue fee of 60 yuan requires more than one hour before and after treatment by multiple doctors and nurses. From the value point of view, 60 yuan is difficult to cover the rescue cost. "A senior expert in the medical product industry told a reporter from China Business News.
At the same time, some doctors report that some special examinations have higher fees, such as a certain scale in the Department of Neurology. In fact, this kind of scale can be downloaded and evaluated for free, but the patient will be required to charge the operation in the hospital when seeking medical treatment.
"After the plan came out, after the Development and Reform Commission implemented price reforms and price adjustments, the market supervision department supervised to ensure the implementation of various policies. In fact, private medical institutions have reformed and liberalized pricing a few years ago." The staff of the Local Market Supervision Bureau said.
The reform of the salary system has always been the core of the price adjustment of medical services, and it is also regarded as the "last mile" of the comprehensive reform of public hospitals.
The above-mentioned industry experts believe that the 30% increase in salary reform in general hospitals is the upper limit. After the return of medical staff salaries, the specific increase in medical staff salaries directly tests the hospital's management level.
According to Wu Liang, a senior clinical analyst, doctors' income should be increased, especially for disease screening, risk control, patient education, and disease management clinical activities.
Wu Liang also told the CBN reporter that the "30-day return rate" in the U.S. quality control standard is more scientific. This standard comprehensively assesses the service quality, medical care, nursing, rehabilitation, and even home care of various clinical disciplines in the hospital. Collaboration of various disciplines.
If the disease is not well managed, there will be a greater probability of acute illness and hospitalization again.
On August 31, the relevant person in charge of the National Medical Security Bureau said in response to a reporter's question that from the survey, the localities have focused on increasing the prices of technical and labor-based diagnosis, surgery, nursing, and Chinese medicine services 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.
It is necessary to avoid directly linking medical staff salaries with project prices and income-generating capabilities.
Of course, to ensure the specific implementation of the plan, a series of software and hardware suppliers' service support is also needed.
The introduction of the "Pilot Plan" will benefit companies that help hospitals carry out refined operations, such as Guoxin Health, Neusoft, Donghua Medical, Weining Health, Peking University Medical Credit, Wanda Information, etc.
Industry insiders who are familiar with the hospital's electronic medical record system said that the document will have an impact on DRGS, medical insurance control fees, and hierarchical diagnosis and treatment.
Nowadays, the hospital will calculate the cost of the DRGS department separately when doing cost accounting, and a good job will be directly linked to performance.
According to the reporter's understanding, some companies have developed a sophisticated solution that combines DRG (Disease Diagnosis Related Classification) cost accounting and DRG salary performance management.
However, there will also be several difficulties in the implementation of medical service prices. The above-mentioned industry experts mentioned that the lack of basis for pricing, difficulty in balancing benefits, and uncertainty in the approval of the medical insurance price department will all be the difficulties in the implementation of the plan.
Author: Gu Ying
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