17 pilot cities to evaluate the effectiveness of public hospital reform

Source: 21st century economic report 2012-02-15 the "red head" of the reform of public hospitals will finally be unveiled, but how the "bride" looks, no one has the bottom of their hearts On February 13, the Ministry of Health announced the start of the evaluation of the pilot reform of public hospitals, and formally moved to the last piece of the ice in the reform The Ministry of health made it clear that the purpose of the assessment was to "lay the foundation for the formation of the basic way to promote the reform of public hospitals throughout the country" On February 4, 2010, the guiding opinions on the pilot reform of public hospitals was formally discussed and adopted by the Standing Committee meeting of the State Council At the same time, 17 pilot cities were also settled Now two years later, the three-year plan of a new round of medical reform is coming to an end, and the core of public hospital reform is just beginning to touch Local reform may be carried out more quickly Wang Hua, director of Tongji Hospital Management Research Institute affiliated to Huazhong University of science and technology, told reporters: "in non pilot cities, many hospitals have also carried out reforms, of course, at some technical level, such as clinical pathway, evaluation, etc., which has a significant impact on hospital construction." At present, there is still no consensus on the compensation mechanism that involves fundamental interests However, it is reported that Beijing, one of the pilot cities, is ready for all the "zero plus" of public hospitals, and according to people familiar with the matter, "Beijing Union Medical College Hospital started the zero plus pilot in September and October last year." Whether the great cause of medical reform can be achieved overnight after this assessment is a topic that many public hospitals are concerned about According to the arrangement of the Ministry of health, the Ministry of health sent seven people and horses to 17 pilot cities for the evaluation of the pilot reform According to the formulation of 2010, each province, autonomous region and municipality directly under the central government selected 1-2 cities as the pilot cities for the reform of public hospitals, while the state selected 16 representative cities within the scope of the pilot cities, as the pilot cities for the reform of public hospitals under the guidance of the state Since then, Beijing has also been included In addition to provincial pilot cities, at the end of 2010, Ma Xiaowei, Vice Minister of the Ministry of health, said that there were actually 47 pilot cities in China But this time, the provincial pilot cities are not included in the evaluation, Wang Hua said: "the pilot cities in Hubei Province are not selected in Wuhan, the provincial capital, but in the second tier cities in the province." And 17 national pilot cities are not completely pilot the same project According to the arrangement of the Ministry of health, the key pilot public hospitals in Shanghai, Beijing, Anshan, Wuhu, Baoji and Ezhou are planned and arranged, and the total amount of medical insurance and new rural cooperative medical insurance is paid in advance and settled in time; the residents in Shanghai and Tianjin are mainly trained in standardization; the community health service hospitals in Shenzhen are managed; the pilot legal person governance mechanisms in Zhenjiang, Weifang and Shenzhen are implemented; Beijing, Anshan, Wuhu, Ma'anshan pilot compensation mechanism, etc.; Kunming is facing diversified medical services In the pilot cities, the reform has been carried out smoothly For example, in Kunming, a pilot city with diversified medical services, its affiliated No.1 municipal hospital and Yunnan provincial urban investment company jointly established the Ganmei medical investment management company Yunnan Urban Investment [7.131.57% share research report] invested 450 million yuan to hold 60% of the shares Kunming first hospital realized the expansion of the hospital with the capital advantage of urban investment Tongce medical [20.57-0.24% share bar Research Report] is also a big winner of Kunming medical reform In November 2010, Tongtai, a subsidiary of Tongce, invested in the restructuring of Kunming dental hospital, invested 25.39 million yuan to control 58.59% of the shares of Kunming dental hospital, and successfully entered the Yunnan market In April 2011, Tongce invested 300 million yuan into Chenggong Hospital of Kunming maternal and child health hospital, holding 80% Of course, the success or failure of the pilot has a lot to do with the openness of the local government Huang Yuhua, Secretary of the board of directors of Tongce medical, said: "the company is actively discussing plans with local governments Kunming has very good medical service resources, and the government supports the reform of public hospitals, which is what we value " Corresponding to this, the "pilot program" launched by a pilot city of a provincial public hospital in Central China clearly states: "by 2015, strive to achieve social capital accounting for 15% of the overall medical service market." Similarly, Liu JinFang, member of the CPPCC Committee of Huizhou City, also disclosed that the newly-built medical institutions in the local area did not adopt the way of involving social capital in the bidding procurement, thus reducing the investment channels of private hospitals "Some private hospitals have been established in Huizhou, but the living environment is 10% poor." For the differences between the pilot cities and non pilot cities, between the national pilot cities and the provincial pilot cities, Wang Hua thought it was very normal: "it is impossible for China to solve all problems with a set of medical reform programs In the future promotion of public hospital reform program, the model may not be the only one, each region adopts its own suitable model to promote " Beijing is ready for zero mark up to tackle the separation of medicine The government will subsidize the lost mark up income of the hospital On November 29, 2011, Li Keqiang, vice premier of the State Council, pointed out: "in 2012, the reform of public hospitals will shift from partial pilot to comprehensive promotion Adhere to the public welfare nature of public hospitals, and reform the mechanism of supplementing medical treatment with drugs " At present, there is a 15% mark up for the sale of drugs in hospitals above the second level, which is considered to be the main reason for doctors to prescribe more drugs and cost more to see a doctor On January 5, Chen Zhu, Minister of health, clearly stressed at the 2012 national health work conference that "we should abolish the phenomenon of supplementing medicine with drugs and steadily push forward the reform of drug prices." At the same time, Chen Zhu also pointed out at the 2012 work conference of Drug Administration: "the catalogue of essential drugs must be expanded to cover three hospitals." All of the above statements are considered as the embodiment of the determination of the Ministry of health to reform the compensation mechanism of public hospitals, while the theorists have put forward many opinions on the income of hospitals and doctors after the cancellation of the bonus, including the government's full subsidy, the increase of drug service fees, etc But discordant voices have emerged In the process of implementing zero difference rate in basic level hospitals, people from Hebei health system said: "after implementing zero difference rate drug sales in some basic level hospitals in Hebei Province, the actual factory price of pharmaceutical enterprises also increased accordingly, and in disguised form, 15% of the difference was included in the drug price." In 2011, China's drug sales have ranked the third in the world The industry generally forecasts that it will reach US $50 billion, of which about 72% are sold in public hospitals It is roughly estimated that if the bonus income is cancelled, the funding gap of the national health care system will reach about 40 billion yuan In 2008, before the 850 billion yuan input of the new medical reform, the budget of medical and health expenditure of the central government was only 83.15 billion yuan And 40 billion yuan is only net plus income If we take into account all kinds of legal commercial discounts and commercial bribery in the gray area, the actual profits of the hospital in drug sales will be several times more than 40 billion yuan Once the connection between hospitals and drug sales is cut off, how to encourage doctors to actively participate in the reform is the real problem to be faced "At least Beijing is ready for zero plus," said the person familiar with the matter The government will subsidize this part of the hospital's lost bonus income Whether the specific subsidy is in the name of the pharmaceutical service fee or the direct subsidy of the bonus loss is not known at present " On February 11, it was reported that the Ministry of Commerce had begun to investigate the possibility of community hospitals divesting pharmacies As the basic medical institutions have generally implemented zero plus, the actual disturbance effect of this action will not be great The socialization of pharmacies means that doctors' prescriptions will not be linked to their income, either bright or dark If this move is pushed to hospitals above three levels, it will be the most effective way to realize the separation of medicine