The Twelfth Five-Year Plan is Expected to Completely Eliminate Medications and Advance the Payment System Reform

This year, 300 pilot counties were pushed ahead and strive to be implemented in county-level hospitals in 2013. In 2015, all public hospitals were fully promoted. At the same time, we must comprehensively promote the payment system reform

The reporter learned at the National Health Work Conference in 2012 that during the “12th Five-Year Plan” period, China will strive to completely eliminate medicine for medicine and straighten out the compensation mechanism. This work was listed as the first of several key issues that the health sector needs to further break through in the “12th Five-Year Plan” period.

300 counties this year

At the meeting, Chen Hao made it clear that he strived to steadily and systematically eliminate the drawbacks of using medicines to supplement the medical problems in the "12th Five-Year Plan" period. This year, 300 pilot counties were pushed ahead and strive to be implemented in county-level hospitals in 2013. In 2015, all public hospitals were fully promoted.

Due to the drawbacks of institutional mechanisms, for a long time, medical and health institutions have relied on the profits of drugs to maintain their operations. The profit-taking behaviors such as the prescribing of high-priced drugs, over-examination, and high-end use of high-end equipment have caused public hospitals to gradually deviate from the track of public welfare and become the main cause of expensive medical services.

Many viewpoints hold that: "to supplement medicine with drugs" has promoted the unreasonable increase of medical expenses in China, promoted drug abuse, and distorted the behavior of medical personnel.

Despite its disadvantages, dysentery has never been eradicated because of the interests of various parties. At present, drug income is still an important channel for inadequate hospital compensation.

“We must make a choice: whether it is to continue to maintain this unreasonable mechanism, or is it determined to eliminate the use of medicine to supplement medicine?” said Chen Xi: “In order to safeguard the interests of the public, for the healthy development of health care, and for the long-term construction of the health team, This mechanism will sooner or later be changed. It is much more advantageous and much more beneficial to change and rectify this reform than to change it in the future.

Chen Zhen asked health administrative departments everywhere to follow the deployment and requirements of the “12th Five-Year Plan” medical reform plan, actively seek government guidance, strive to create conditions, implement the cancellation of the drug-related medicine policy, give full play to the role of medical insurance compensation, and steadily promote the reform of medical prices. In order to eliminate the drawbacks of medicine supplementing medicine in a systematic and orderly manner during the 12th Five-Year Plan period.

In fact, three years after the implementation of the medical reform, all provinces and cities are conducting active and beneficial explorations.

In 14 pilot counties in Qinghai Province, with the support of public finances, the use of medicines to supplement medicine was cancelled; in Zhejiang Province, pilot sales of drugs at county-level hospitals were piloted, and the compensation mechanism was refined by straightening out the price system.

After the medical reform in Zichang County gained useful experience, the Shaanxi Provincial Government decided to promote the “experience of the sub-church” in the province. At present, Shaanxi has increased the number of pilot counties to 56 and piloted 110 public hospitals, accounting for 57% of the province. The pilot counties and districts generally stipulated that the county hospital infrastructure construction and equipment renewal requirements shall be fully guaranteed by the county finances, and the county hospitals shall be provided with full public health services by county finance; the county hospitals shall suffer policy losses and large-scale medical treatment. The reduction of equipment inspection costs is partially subsidized by the county finance. At present, 34 counties in the province have introduced or stipulated that 70% of the basic salary of county-level hospitals is borne by the county finances. The basic salary of personnel in 11 counties is in accordance with the 100% budget, and the historical liabilities in 8 counties are reimbursed by the county finance. , 11 counties implemented county-level public hospital drug zero sales.

Chen Hao pointed out that the Ministry of Health will implement the fiscal policy and implement the public finance compensation for public hospitals in accordance with the spirit of the 6th document of the Central Committee of the CPC (ie, the "Opinions of the CPC Central Committee and State Council on Deepening the Reform of the Medical and Health System").

Combine punches

At the meeting, Chen Hao also proposed another key issue for deepening medical reforms that needs to be broken--to comprehensively advance the payment system reform. Chen Hao clearly pointed out that the combination of the project-based payment system and medicine supplementation is the root cause of big prescriptions and indiscriminate examinations. In the future, the reform of the payment system should be taken as the key to the reform of the institutional mechanism and vigorously promoted.

The income of a first-grade care is only 9 yuan a day, and it is less than the one-hour income of urban housekeeping personnel. Last year, the Beijing Municipal Health Bureau's cost accounting of all medical projects in eight municipal large general hospitals showed that the first-level care costs were less than 10% of the actual cost.

Chen Hao said that the price-based pricing mechanism of projects also makes it difficult to reflect the technical value of medical labor. This payment method is a waste of health resources, but also is not conducive to mobilize the enthusiasm of medical personnel. If you do not change the backward payment method such as pay-per-use, even if you cancel the medicine, the big prescription, the big check, etc. will still appear in different forms, and it is difficult to eliminate them.

"So we must have a whole set of combined boxing moves." Chen Hao said.

It is reported that this reform will rationally adjust the prices of technical labor services, and appropriately raise the costs of severely distorted nursing, surgery, and treatment.

According to international and domestic experiences, especially since the new medical reforms, the payment system is an important means to control the cost of medical insurance institutions. Chen Hao said that with the full coverage of China's basic medical insurance system, the conditions for the payment system reform have matured.

Chen Hao requested that the health administrative department should give full play to both the provision of services and the advantages of the new rural cooperatives and take the lead in advancing the reform of the payment system of the new rural cooperative medical system. At the same time, it is necessary to coordinate with relevant departments such as medical insurance and commodity prices, pay close attention to the experience of pilots in various places in recent years, formulate implementation plans, determine the payment methods for adapting to different levels of medical institutions and different types of services, and use the total amount of advance payment, by type of disease, by service unit, Pay per person instead of per project. We must combine the clinical pathway with the reform of the payment system, do basic work such as cost measurement, and ensure that the reform and cancellation of the payment system are promoted simultaneously with medicine and medicine.