As the medical reform enters the critical period and the deep water area, the deep-rooted institutional and mechanism contradictions in China\'s medical insurance system have become increasingly prominent. How to further enhance the integrity, systematism and synergy of the reform, and better promote the "three medical linkage" reform of medical insurance, medical treatment and medicine is the current hot spot.
After the adoption of the institutional reform plan of The State Council, a medical related agency directly under The State Council, the National Healthcare Security Administration (hereinafter referred to as the "Medical Insurance Bureau"), has been successfully established, bringing together the medical insurance functions involved in the departments of human resources and social security, health, price, civil affairs, commerce and other departments as far as possible, including the most critical medical price reform and medical insurance payment reform. Hope to give full play to the advantages of optimal combination and improve operational efficiency.
The future helm of the medical insurance Bureau, on the one hand in charge of the annual trillions of medical insurance "money bag", on the other hand will play a major role in the pricing of drugs and medical care, and will be given a great say in the centralized bidding and procurement of drugs and consumables, which will have important significance for the macro-control of the pharmaceutical chain.
Accurate positioning and reasonable grasp of the price scale
The three-in-one medical insurance bureau of pricing, procurement and payment has been entrusted with the important task of coordinating the reform of the "three medical linkage", which will surely accelerate the reform of the medical insurance payment mechanism. Combined with the inclusion of drug and medical price management responsibilities, the largest payer of medical services and drug purchases has real autonomy.
For a long time, in the four main bodies of "medical insurance spenders, medical service providers, policy makers and price makers", the payers do not fully grasp the price composition and the details of the treatment costs. The medical service fee is easy to make the patient overspend because the medical insurance reimbursement party does not know the specific medication. The bureau of medical insurance, which plans the "three doctors" reform, is the biggest institutional breakthrough of reform in our country. Its core is the transfer of pricing power, which not only makes the three insurance responsibilities of "urban residents, urban workers and rural medical treatment" be "managed together", but more importantly, it has the pricing power of drugs and medical service together, so as to control the cost more reasonably.
Now, the Medical Insurance Bureau has taken over an important baton to deepen the new medical reform, marking a major change in the pricing mechanism of medical services. This new organizational management structure at least first integrates the institutions of "management price, management bidding and procurement, management use and management payment" into one, reducing unnecessary management internal friction. "Only when the cage is free can the bird be changed", only when the price of medicine, Eisai, and medical technology examination fees are really reasonable can the medical technology service level be raised. The health insurance Bureau was set up to strengthen health insurance\'s control over prices.
In the future, the protracted problem of "three guarantees in one" can finally be solved, and the medical Insurance Bureau has integrated the original fragmented medical security system and become the largest purchaser. It has pricing power for drugs, medical devices and medical services, which will play an important and decisive role in the development of the medical service system and the allocation of health resources.
The most profound reform is that the Medical Insurance Bureau will supervise the medical service behavior and medical expenses of medical insurance hospitals through the formulation of drugs and the bidding and procurement policy of medical consumables and supervise the implementation. Under this premise, hospitals or medical associations can negotiate drug prices according to Medicare payment standards. It can even entrust third-party platforms and local medical insurance bureaus to conduct drug negotiations. The ultimate goal is to set a reasonable drug price on the basis of the medical insurance payment standard to maximize the benefits.
Integrate equal procurement consultation between supply and demand
For the centralized procurement of drugs in public hospitals, the current problems of bidding price reduction, "second bargaining", and hospital control fees are still hot potatoes to be solved. Before the reform, the NDRC managed pricing, the Ministry of Human Resources and Social Security managed the medical insurance catalog, the Health and Family Planning Commission managed bidding and procurement, and medical insurance paid for it. "Spending money can not set the price, pricing regardless of the use of norms", medical insurance pressure, local medical insurance funds are tight or even unable to pay.
By the medical insurance Bureau to sell the drug bidding procurement, on the one hand reflects the "who pays, who deals" principle; On the other hand, in the face of realistic medical insurance funds, the bid price of drugs will be closely tied to the payment standard of medical insurance to maximize the interests of all parties.
Medical insurance should be regarded as a market subject with complete rights. As a buyer, medical insurance can negotiate prices with the production and distribution enterprises of the drug seller, the hospitals of the medical service seller, and the commercial insurance companies of the supplementary medical insurance seller, greatly improving the bargaining power of medical insurance as a payer.
In the future, the negotiations of medical insurance countries will certainly be strengthened, and the landing of medical insurance negotiations will enhance its strong position in drug pricing and bargaining. As a "big buyer", the Medical Insurance Bureau will also play a heavy role in promoting the "two-vote system" of drugs and accelerating the unified procurement system, curbing the potential rent-seeking power in the bidding process, and forcing those artificially high drug prices to squeeze out water.
It is not difficult to foresee that under the perfect "information network" and the unified "power network", it is difficult to engage in "small actions" on the price. The use of drugs in each province and region will also be more transparent, which indicates that drug prices will be more reasonable and market-oriented.
Accelerate the transformation of the industry to promote the upgrading of pharmaceutical enterprises
In the past, the centralized drug bidding procurement system in many places was actually "only bidding, not procurement", which can only be called "centralized drug bidding". Now the reform of medical insurance payment is accelerating, single disease payment and DRG (disease diagnosis related group) payment will be promoted, if the reform of medical insurance payment can be carried out smoothly, pharmaceutical companies will usher in a big reshuffle era.
It can be expected that the position of medical insurance in the future drug, medical service pricing and procurement prices will be strong, and the medical insurance Bureau will become a "big payer" and "super purchaser". At the same time, higher requirements have been put forward for the bargaining power of newly established institutions.
And no matter how the institution reforms, things or things, the next step, the medical payment standard will become the key drug price and consumable price negotiation lever. In the past, the monopoly status and pricing role of the provincial drug and consumables bidding and procurement platform were either gradually weakened in the transformation of institutional reform and administrative functions, or transformed into a third-party service platform to seek development in the competition.
The domestic competition of the same variety of products is still very fierce, but the number of bids is limited, the medical insurance catalog is limited, there will be some pharmaceutical companies will be washed away, there will be pharmaceutical companies to take this sudden rise, the pattern becomes larger and stronger.
In the future, in the pharmaceutical and medical consumables bidding and procurement platform, the origin, scale, style can be diversified, provincial gathering platform, drug exchange, cross-regional procurement alliance or medical union for self-use, as long as the unit price meets the medical insurance payment standard, the bidding and procurement process is open and transparent, in line with the rules, there are laws and regulations to obtain survival and development space.
"Whoever picks it well, let it be picked." The final payer sets the negotiating rules and regulates the price range, which is also in line with international practice.
Clarify the logic and reconcile the parties
"Three medical linkage" is an important way to solve the "expensive" and "difficult to see a doctor", this time to start the "three medical linkage" with medical insurance as the reform lever still needs specific analysis to clarify the logical relationship between the policy and the solution of "expensive" and "difficult to see a doctor".
Scientific allocation of resources
Whether the payment price can control the hand of medical institutions to prescribe drugs and prescribe inspection lists, and whether it can effectively reduce the medical costs of the people is worth pondering. In particular, the price competition of homogenized products is fierce, and enterprises must also have profit margins.
It is suggested that the national level fully implement the government\'s investment policy for public hospitals in accordance with the planning and medical resource allocation requirements in the form of legislation, and according to the economic development level of eastern, central and western provinces, the corresponding proportion of financial subsidies at all levels should be clarified, and a classified assessment mechanism should be established to establish the orientation of reform to help development. At the same time, a strong accountability and accountability mechanism and a reward mechanism will be established to guide local governments to allocate resources more scientifically, rationally and effectively.
How to keep all stakeholders happy
Medical reform should satisfy all stakeholders, not only medical institutions, but also the country and the public, so that pharmaceutical companies can participate together. We should not only perceive the medical reform from a theoretical perspective, but also listen to the voices of relevant industries, enterprises and the general public in practice, and truly understand whether the "difficulty of seeing a doctor" and "expensive" of the people at this stage have really been solved. Let the medical reform bring new medical style to the people, promote the development and progress of science and technology, and promote the process of new medical reform with a more professional spirit.
Full range of full cycle health services
Local prices are cross-referenced, but the medical level, drug use level and economic level are different. Can the drug structure of Fujian meet the needs of the North, Shanghai, Guangzhou and Jiangsu and Zhejiang regions? From the perspective of planning, problems such as insufficient total medical and health resources, shortage of high-quality resources, unbalanced distribution and unreasonable structure are still prominent.
From the perspective of reform, greater courage and wisdom are needed to break through dangerous shoal, move cheese, chew hard bones, and accelerate the realization of medical supply and effect to maximize and minimize risks and costs. We will effectively solve the problem of unbalanced and inadequate development in the medical and health fields, and provide all-round and full-cycle health services for the people.
We will carry out deep-seated institutional reform
The establishment of new functional institutions is not a simple sum and concentration of the original functions, but needs to be re-established on the basis of fully clarifying the boundaries of government, society and market. Specifically, the first is to clarify government responsibilities and boundaries, and give full play to the role of market mechanism in building a multi-level medical security system; The second is to break the administrative monopoly, realize the internal and external two-way opening of the medical service field, and promote the marketization of medical services and drug prices; The third is to break the centralized government management mode of social medical insurance, allow commercial insurance companies to compete with various social organizations, and realize "public-private cooperation"; Fourth, although the newly established medical insurance Bureau can realize the concentration of medical insurance related functions, it is more necessary to consider the establishment of a sound check and balance mechanism to crack the situation of "ideal fullness and realistic bone sense".
At the same time, our concern should not only be limited to the division and function division of institutions, but also how to establish external constraints and checks and balances on power.
Brief summary
In short, under the new pattern, the medical insurance Bureau needs to give full play to the role of third-party control and strengthen regulatory governance. Use modern information technology means, especially blockchain technology, to promote the construction of medical insurance intelligent monitoring system, and strengthen the analysis and application of big data such as medical prices, bidding, and procurement. Establish medical insurance real-name system binding and medical consultation settlement, strengthen medical insurance control in an all-round way, and jointly crack down on medical insurance violations, discipline and law, and purify the medical insurance operation environment.
Information source Medical Economic News