It has been half a year since the country negotiated the drug implementation
It has been half a year since the National Medical Insurance Negotiation Drug Catalog was published. How to further leverage the "three medical linkage" reforms (that is, the linkage of medical, medical insurance, and medical reform) through medical insurance, so that people can eat more assured, cheaper, and better quality medicines? Recently, experts and scholars and hospital directors shared their observations and practical cases in a series of online seminars on the "National Medical Insurance Policy Interpretation Forum" hosted by the China Medical, Health and Cultural Association and the Eight Point Health News.
The country negotiates that the medicine enters the hospital smoothly, the people get benefits
In the "three medical" linkage reform, medical insurance plays a lever role of prying and supporting. Taking the drug reform as an example, the first three national drug price negotiations were led by the labor security department or the human resources department, and this time it was led by the newly established medical insurance department.
Among the 97 drugs successfully negotiated and included in the medical insurance, most of them are drugs that have been marketed in recent years and have high clinical value, involving cancer, rare diseases, hepatitis, diabetes, multi-drug resistant tuberculosis, rheumatic immunity, cardio-cerebrovascular, digestion, etc. More than 10 clinical treatment areas. Therefore, many doctors and patients with chronic diseases are very concerned about whether the "national medicine" can be landed in the hospital as soon as possible.
"Some patients with chronic disease medication are still very concerned about this. They have paid attention to policy adjustments online for a long time, which has saved us a lot of mission work." Wu Yingfeng, deputy dean of Xuanwu Hospital of Capital Medical University, said that the state negotiated drug entry The process of hospital use is very smooth, and it does bring benefits and benefits to patients. "Some varieties are reduced in price by more than 60%, and the people feel very good."
"High-cost medicines enter into medical insurance through negotiation, which is helpful to reduce the burden of patients and is also beneficial to the healthy development of the pharmaceutical industry. We will definitely support our hands." For the effectiveness of "national talks on medicines", Yuan Jianlie, Secretary of the Party Committee of Jinhua Central Hospital in Zhejiang Province The feeling is quite deep.
According to him, among the drugs used by Jinhua Central Hospital in 2019, the amount of drugs involved in state negotiations increased to more than 80 million yuan, accounting for about 13% of the total drug price. At present, the hospital has completed the introduction of 97 medicines selected in the "National Talk List", but "objectively there are many kinds of medicines this time, and we also let the experts make some votes."
In the provinces and cities with better medical conditions and relatively sufficient medical insurance funds, the benefits brought to the people by the use of national medical insurance negotiation drugs into the hospital are more obvious. For example, Nanjing City has included anti-tumor "national talk drugs" into the outpatient medical insurance for serious diseases. Zhan Yiyang, deputy director of Jiangsu Provincial People's Hospital, said that this greatly increased the proportion of outpatient medical insurance reimbursement, and the patient's personal burden was further reduced. For the hospital, it is also a good thing. "(In the past) without entering the clinic, some patients would have to be hospitalized, squeezing out hospital resources."
According to Zhan Yiyang, the medical insurance department in Nanjing has adopted a separate accounting method for national talks, which solves the worries of medical institutions, is conducive to the application of "national talks" in hospitals, and is also conducive to the use of good and cheap medicines by ordinary people. It also helps public hospitals improve medical services. According to him, the hospital has established a green channel for procurement in the hospital, and has provided relevant training for medical staff, so that patients can purchase "national talk medicine" if they want to use it.
"China's public hospitals must increase their understanding of medical insurance policies and guide their own medical services," said Zhan Yiyang.
For this point of view, Gu Xuefei, director of the Medical Security Research Office of the National Health and Health Commission's Health Development Research Center, also very much agrees. In his view, during the reform of the "three medical linkages" reform, medical insurance must change from passive payment to strategic purchase, and the national medical insurance negotiation is one of the specific measures.
Gu Xuefei said that under the traditional passive payment model, the medical insurance department mainly pays attention to the balance of income and expenditure of the medical insurance fund, and pays less attention to the quality, efficiency, and fairness of medical services. After transforming into a strategic buyer, the medical insurance department not only considers risks The sharing mechanism should also consider the goals of medical and health resource allocation, health system performance improvement, and population health, and optimize the governance structure through legalization and specialization to achieve a role change.
How to keep the good policies sustainable
From the establishment of the system to the implementation of measures, the national drug price negotiations have broken through many resistances and brought real benefits to the people, but there are still many challenges in the future.
Wang Liming, deputy director of the Second Affiliated Hospital of Dalian Medical University, noted that the implementation of the national medical insurance negotiations has indeed brought down the price of clinical medicine. Many conventional medicines have marked price reductions, and some have even reduced by 80% or 90%. "The patients are indeed affordable." ". However, some doctors also reflected some concerns to him: "The price of "national drug" is too low, will the clinical efficacy be affected, and can the quality of the drug be guaranteed?
In his view, the current national medical insurance drug negotiation and other medical reform measures have greatly intensified the competition of pharmaceutical companies. He suggested that we should pay attention to the quality problems caused by fierce competition. "We must not blindly emphasize low prices, but also consider quality, leaving room for profit and research and development." All medicines that fall into the scope of medical insurance payment should be completed. , Prudent decision, comprehensive consideration of many factors such as price, quality, cost performance, inclusiveness and so on.
As the largest top three hospital in Jiangsu Province, Jiangsu Provincial People's Hospital also attracts patients from other provinces and cities to visit the hospital. Zhan Yiyang said that many patients who came for consultation from other places used "national talk drugs" and had to return to the province to get medical insurance reimbursed. Because the proportion of medical insurance reimbursement for negotiated drugs varies from place to place, it also increases the difficulty and burden of patients seeking medical treatment. "We suggest that the level of medical insurance co-ordination should be improved, at least to the provincial level, and gradually promote the inter-provincial management of medical insurance in different places."
At present, the widely criticized model of "medicating medicine" has been broken, but some issues of policy sustainability have attracted attention. Gu Xuefei believes that after the reform of the medical insurance payment method, in the hospital's income structure, medicines and consumables have become costs. Under this mechanism, it is not the medical service fee but the medical insurance surplus that is the most profitable and the highest gold content for the hospital. The hospital may also reduce the use of medical insurance drugs in order to pursue medical insurance surplus income under the new mechanism.
"Of course, patients should benefit, but shouldn't it be done at the expense of hospital benefits?" Gu Xuefei said, a study he participated in a few years ago also found that reforming the payment method of medical insurance is not enough, and medical personnel need to be collaboratively promoted. Salary system reform.
In fact, reforms in the medical service pricing mechanism, doctor's salary treatment mechanism, and public hospital compensation mechanism are also forthcoming. Lv Furong, deputy director of the First Affiliated Hospital of Chongqing Medical University, called for strengthening the dynamic adjustment mechanism of medical service prices to reflect the labor value of medical personnel and the value of new technologies and new projects.
According to his observations, the current mechanism for adjusting the price of medical services is not the same everywhere. The compensation mechanism for public hospitals in coastal areas is in place, but in less economically developed areas, the corresponding mechanism is not in place. Taking the hospital where he is as an example, after implementing reforms such as zero-plus drugs, volume procurement, and "national talks on drugs", it has lost more than 100 million yuan since 2018.
"Under such circumstances, how to mobilize the enthusiasm of the hospital? In fact, it is quite difficult." Lu Furong mentioned that affected by the epidemic, the overall income of many hospitals has also been greatly reduced, and employee benefits and performance have been greatly affected. Therefore, he suggested that the national level should promptly strengthen the dynamic adjustment mechanism of medical service prices.
China Youth Daily · China Youth Daily reporter Wang Lin Source: China Youth Daily