The five cities will implement the first round of medical service price adjustments, and doctors' salaries are the focus of the reform
The value of doctors' labor services is the core cost of medical services. In the new round of medical service price adjustment, the enthusiasm of medical personnel to participate in the reform should be mobilized by emphasizing technical labor services, and the resistance to reform should be reduced.
It has been one year since the "Pilot Plan for Deepening the Reform of Medical Service Prices" formulated by eight departments including the National Medical Insurance Administration, and five cities will successively implement the first round of price adjustments for medical services.
Judging from the implementation plans announced by pilot cities such as Suzhou and Ganzhou, the establishment of mechanisms such as total volume control, classified pricing, and dynamic adjustment are the main contents of the first round of medical service price adjustments.
At the same time, the adjustment of medical service prices will be coordinated with the deepening of the comprehensive reform of public hospitals, standardize the diagnosis and treatment behaviors of public medical institutions and medical staff, and reasonably determine the salary level of public hospitals.
Zhang Xiao, director of the Medical Insurance and Social Security Research Center of Southeast University, told Yicai that the reform of medical service prices has been going on for years, but the past reforms have not responded to the most basic question of how to determine the value of a doctor's labor.
The value of doctors' labor services is the core cost of medical services. In the new round of medical service price adjustment, the enthusiasm of medical personnel to participate in the reform should be mobilized by emphasizing technical labor services, and the resistance to reform should be reduced.
Recently, the National Medical Insurance Bureau said in response to the suggestion of the deputies of the National People's Congress that the National Medical Insurance Bureau has further proposed that the price adjustment of medical services should highlight the support for the value of technical labor services.
In the next step, the National Medical Insurance Bureau will continue to guide all localities to implement the dynamic adjustment mechanism for medical service prices, so as to better reflect the value of technical labor services while taking into account the burden of patients' expenses.
The first round of medical service price adjustment is ready
In May 2021, the 19th meeting of the Central Comprehensive Deepening Reform Committee reviewed and approved the "Pilot Program for Deepening the Reform of Medical Service Prices"; on August 31, 2021, eight departments including the National Medical Insurance Bureau issued the "Pilot Program for Deepening the Reform of Medical Service Prices". , it is clear that through 3 to 5 years of pilot projects, we will explore the formation of replicable and scalable medical service price reform experience; in November 2021, Ganzhou, Suzhou, Xiamen, Tangshan, and Leshan will become pilot cities.
The State Council has included the promotion of the reform of medical service prices in the "Key Tasks for Deepening the Reform of the Medical and Health System in 2022".
The task is clear. All provinces will issue documents related to the establishment of a dynamic adjustment mechanism for medical service prices by the end of June 2022, and transfer medical service prices to the catalogue of cost supervision and price hearing before the end of the year.
On July 1 this year, the National Promotion Conference on Deepening the Pilot Reform of Medical Service Price Reform was held in Xiamen, deploying and promoting the first round of medical service price adjustment, which marked that the national deepening medical service price reform pilot project has officially entered the implementation stage.
The National Medical Insurance Administration requires each pilot city to grasp the key links and basic requirements of the reform pilot implementation stage, and carefully organize the implementation of the first round of price adjustment.
At the end of 2021, Leshan City formulated a pilot implementation plan for deepening the reform of medical service prices, clarified that the operating rules will be determined in the first quarter of 2022, the price adjustment will be substantially started, and the implementation will be implemented in the second quarter; Suzhou, Ganzhou and other pilot cities also announced in the first half of this year. The specific implementation plan; Xiamen has formulated four detailed operating rules for the mechanism and related supporting policies, and all preparations are in place; the preliminary reporting, review, and investigation of the medical service price reform in Tangshan have been completed, and the follow-up work is in progress middle.
The price of medical services refers to the charging standards for medical service items provided by medical institutions to patients, including outpatient, inpatient, and various examinations, treatments, tests, and surgeries.
The price of medical services is an important price for people's livelihood, involving 1.4 billion people, 7.87 million medical personnel, more than 50,000 medical institutions, and an annual interest scale of several trillion yuan.
The relevant person in charge of the National Medical Insurance Bureau stated when the reform was launched last year that the price of medical services involves profound adjustments of various interests, and it cannot be moved or tampered with.
Deepening the reform of medical service prices is not simply a matter of price adjustment, nor is it a unilateral price increase to replace the reform.
It is necessary to make the price trend related to the performance indicators of medical expense control and cost reduction.
Recently, the National Medical Security Administration's reply to the recommendation No. 2195 of the Fifth Session of the 13th National People's Congress re-emphasized the four main contents of the reform of medical service prices. The third is to dynamically adjust the price of medical services, and the fourth is to standardize and manage the price of medical services.
Industry insiders believe that because the price of medical services is related to people's livelihood, the total amount control has been emphasized in the past, but the new medical price reform faces the requirement of certain growth in the medical and health industry itself, so that the macro management of prices and the development of the medical industry and the social affordability and other macro factors.
Suzhou's plan proposes that a natural year is used as a price adjustment cycle, and the total income of medical services (excluding income from drugs and health materials) of public medical institutions in the region is used as the base to scientifically set the growth coefficient.
The Ganzhou plan proposes that during the pilot period, the city's public medical institutions will use the 2021 annual service income (excluding medical income from drugs, consumables, inspections, and laboratory tests) as the historical base, which can be used for medical service price adjustments from 2022 to 2025. The total amount is controlled at a level that does not exceed 10% of the historical base.
Ganzhou’s plan also mentions that it will change the previous practice of using the price reduction of medicines and consumables as the source of the total price adjustment of medical services, eliminate the “seesaw” relationship between the price of medical services and the price reduction of medicines and consumables, and distribute the dividends of price reductions of medicines and consumables to patients first. Conduction.
Highlight the value of technical labor services
my country has not yet formed a pricing mechanism for medical service items centered on the value of technical labor services, risk level, and technical difficulty. After the cancellation of drug mark-up income, the operating income of public hospitals has been impacted, and the problem of unreasonable prices of medical service items has become more prominent. Prices deviate significantly from project cost and technician value.
This is also the reason why the adjustment of medical prices is very sensitive, but it "cannot move".
Zhang Xiao said that the price of medical services is dominated by the government, which reflects the responsibility of the government. With the continuous increase of medical and health expenses and medical insurance investment, there are structural problems in medical prices. Now the government needs to adjust the structure. One of the important directions is to emphasize technical labor, that is, to improve the treatment of doctors.
In mid-July, the National Medical Insurance Bureau issued the "Notice on Further Doing a Good Job in the Management of Medical Service Prices", which particularly emphasized that the adjustment of medical service prices should highlight the support for the value of technical labor services.
The notice proposes that it is necessary to fully listen to the professional opinions and suggestions of medical institutions and medical personnel, and give priority to the selection of prices that have not been adjusted for a long time from the treatment category, surgery category and traditional Chinese medicine category, and the value of technical labor services is the main (technical labor services in the price composition account for 60%). The price items above) are included in the price adjustment range. In each price adjustment plan, the number and amount of the technical labor value-based items account for more than 60% of the total, objectively reflect the technical labor value, and prevent being bundled by inflated prices for equipment and materials .
The pilot plans of the eight departments and the implementation plans of Suzhou, Ganzhou and other places clearly stated that it is necessary to deepen the comprehensive reform of public hospitals and standardize the diagnosis and treatment behaviors of public medical institutions and medical personnel.
Reasonably determine the salary level of public hospitals, reform and improve the assessment and evaluation mechanism, realize the transparent and transparent salary of medical staff, strictly prohibit the issuance of income-generating indicators, and must not directly link the salary of medical personnel with the income of departments and personal business.
Author: Guo Jinhui