Let doctors concentrate on treating patients (policy interpretation)
Recently, the National Medical Insurance Bureau and other eight departments jointly issued the "Deepening Medical Service Price Reform Pilot Program" (hereinafter referred to as the "Program"), proposing to explore the formation of reproducible and scalable medical service price reform experience through a three to five-year pilot.
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.
In the next step, the National Medical Insurance Bureau will identify 5 pilot cities, and directly contact for guidance, so as to proceed in a steady and orderly manner.
The "Plan" clearly states that the reform will ensure the overall stability of the burden on the masses, the affordable medical insurance fund, and the healthy and sustainable development of public medical institutions.
Divide medical services into general and complex types to manage
The "Plan" proposes to establish a standardized and orderly price classification formation mechanism.
Divide medical services into two types and implement different pricing mechanisms.
The first category is general medical services generally carried out by medical institutions.
Diagnosis, nursing care, beds, etc. are included in the list of general medical services. A unified benchmark price will be set for such services, and public medical institutions at different regions and levels can float within a certain range.
There is also a type of complex projects, such as difficult and high-risk surgical projects, which require relatively high requirements for the personal capabilities of medical staff and the technical support system of medical institutions.
This type of service is "rules and judges" by the government, and public hospitals are introduced to participate, respect the professional opinions and suggestions of hospitals and doctors, and better reflect the value of technical labor services.
Some medical service prices will straighten out the price comparison relationship.
For example, pediatrics, nursing and other weak disciplines with low prices and insufficient medical supply need policy incentives; difficult and high-risk medical services need to appropriately reflect price differences; traditional Chinese medicine medical services with outstanding characteristics and advantages and obvious functional effects need policy incentives. Inheriting innovation and development; inspection and treatment items with a high proportion of equipment depreciation need to squeeze out water, which is also beneficial to the people.
"These price comparison relationships have been straightened out. Hospitals rely on service quality to attract people, rely on technological value to get rewards, and their dependence on drug consumables income is reduced, which can reduce unreasonable growth in total medical expenses." The relevant person in charge of the National Medical Insurance Bureau said.
Separation of technical consumption is conducive to reflect the value of technical labor for medical staff
The price item is the basic unit of medical service charges.
Some medical institutions split the charging items too finely, and some items include equipment consumables, operating procedures, etc. as the content of the item. If you change the operation slightly in the clinic, you may not find the corresponding price item, and applying for a new price item may face innovation The question of whether sex and economy are sufficient, and the long demonstration cycle affects clinical improvement and innovation, and affects the rational diagnosis and treatment of patients.
Jiang Changsong, an associate researcher at the National Institute of Medical Security of Capital Medical University, said: “In the past, it was emphasized that medical consumables should be combined in the price item and packaged for charging. The problem is, for example, for new consumables and new equipment to sell well, there is a demand for many new medical service price items. In fact, some products are innovative and economical, which increases the unnecessary burden on patients."
The "Plan" adheres to the principle of separating technical labor and material consumption, and returns the medical service price item to its proper appearance as a service pricing unit.
At the same time, the National Medical Insurance Bureau will classify and integrate existing price items, optimize the management of new price items, introduce innovative and economic evaluations, and ensure that patients receive timely medical services with more clinical value and cost-effectiveness.
"Separation of technical consumption is conducive to reflecting the value of medical staff's technical labor; the separation of medical consumables, through medical insurance negotiations and centralized procurement, can reduce hospital operating costs." Jiang Changsong said.
The relevant person in charge of the National Medical Insurance Bureau said that after the reform of the price of medical services, it will become a "measurement" for the value of technical labor services, a "signal" for optimizing the allocation of medical resources, and a "booster" for public hospitals to improve their internal skills, and promote the high-quality development of public hospitals. .
The price formation mechanism of classified management will guide high-level hospitals to focus on difficult and risky projects, and promote hierarchical diagnosis and treatment.
At the same time, public hospitals will be encouraged to carry out "knife inward" reforms in standardizing diagnosis and treatment behavior, controlling costs and expenses, and focusing on "careful" for patients.
Reform is not a unilateral price increase, to ensure the overall stability of the burden of the masses
Does the reform mean that the price of medical services will continue to rise?
Will the medical burden of the masses increase?
The relevant person in charge of the National Medical Insurance Bureau said that deepening the reform of medical service prices is not simply a matter of pricing adjustments, and it is not about replacing reforms with unilateral price increases.
The top priority of the reform is to establish a sound system and system.
"To allow medical service price management to enter a standardized and standardized track, whether adding or subtracting prices, there must be rules to follow; price trends must be correlated with performance indicators for medical cost control and cost reduction; the rhythm of price changes must be allowed. Under the control of start-up conditions and restraint conditions, you can’t increase as you want, and then increase again. To make prices stand up to the test of monitoring, assessment and evaluation, the price should be lowered in time, and the social benefits should be seen if the price rises." The person in charge said.
At the same time, complete supporting measures to ensure the overall stability of the masses’ burden.
Do a good job of assessing the feasibility of price adjustments in advance; analyzing the impact of price adjustments in the event, focusing on groups with special difficulties; when implementing them, coordinate the price of medical services and payment policies, and include the price adjustments in the scope of medical insurance payment according to regulations.
The main contents of the "Plan" include:
Establish 5 mechanisms, namely a goal-oriented price project management mechanism, a more sustainable price management total control mechanism, a standardized and orderly price classification formation mechanism, a sensitive price dynamic adjustment mechanism, and a strict and efficient price monitoring and assessment mechanism .
Strengthen three supports, namely optimizing the allocation of management authority, improving the procedures for setting and adjusting prices, and strengthening management capacity building.
Coordinate and advance four supporting reforms, including deepening the comprehensive reform of public hospitals, improving the comprehensive supervision of the medical industry, improving the government investment mechanism of public medical institutions, and linking up the reform of the medical security system.
"The price of medical services is the most direct and practical interest issue that the people are most concerned about. The whole process and coordinated measures of '5+3+4' make the reform more operable." Jiang Changsong said.
Some people interpret the deepening of the reform of medical service prices as "patching" the reform of centralized procurement of pharmaceutical consumables. The unreasonable income squeezed out by the latter can be made up through the price increase of medical services. The relevant person in charge of the National Medical Insurance Bureau said that this The interpretation is inaccurate.
Centralized procurement, price reduction and fee reduction have alleviated the burden of the common 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 the shifting, conversion and shifting of medical expenses by reducing prices and increasing prices. It is not a simple " "Seesaw" relationship.
"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 freed up by this must first release the reform dividends to the masses and enhance the people's sense of gain and happiness. "The person in charge said that the price of medical services cannot simply be used as a compensation tool for public hospitals, and construction and scale expansion can be blindly carried out by raising prices and increasing income.
Our reporter Li Hongmei