Changes and Countermeasures Faced by pharmaceutical industry under DRG mode

Source: medical geography 2018-01-24 (the picture is from the Internet) in June last year, the guiding opinions of the general office of the State Council on further deepening the reform of payment methods of basic medical insurance explained the main contents of payment methods such as payment by disease and payment by disease diagnosis related group (DRG) DRG mode, as a pilot mode of payment mode reform, has been widely concerned by the industry On January 20, at the 2018 China pharmaceutical industry new year outlook conference jointly sponsored by the Management Committee of Jiangbei new district, Nanjing, e pharmaceutical manager magazine and China Medical and health industry investment 50 forum, officials and entrepreneurs of the development and research center of the national health and Family Planning Commission discussed the design and implementation of DRG model and its possible impact on the pharmaceutical industry Payment reform can reallocate health resources, control unreasonable cost growth, and combine with supporting measures to help achieve the goal of health reform Reasonable payment methods can encourage service providers to regulate the behavior of medical personnel, optimize hospital processes, and improve efficiency However, the pharmaceutical industry will also be indirectly affected, and the internal structure will be adjusted, such as the replacement of traditional technology and high-tech, the change of consumption of therapeutic drugs and auxiliary drugs Under DRG mode, the economic risks of medical service providers and medical payers can be relatively balanced However, limited by the reasons of difficult operation, complex procedures and high management costs, DRG mode is mainly applicable to secondary and upper medical institutions At present, it seems that the coexistence of multiple hybrid payment methods (total prepayment, per bed day, per performance, etc.) with DRG payment reform as the core will become the development trend of hospital inpatient payment in the future At this stage, when the national health and Family Planning Commission held the DRG payment reform pilot kick-off meeting in Shenzhen, it introduced the "3 + 3" DRG pilot model, namely three cities and three hospitals, including Sanming City in Fujian, Shenzhen City in Guangdong, Karamay City in Xinjiang, Union Hospital Affiliated to Fujian Medical University, the first hospital in Fuzhou and the first hospital in Xiamen
According to the official, at present, Sanming City's c-drg (national DRG) collection and payment platform has been put into operation since January this year; Shenzhen city's terminology docking is basically completed, and platform construction is in progress, ready to start pricing and payment measurement; Karamay City's terminology docking is basically completed, and platform construction is in progress; and three hospitals' terminology docking is also basically completed, and price system is in progress Payment calculation of Medicare The official also answered questions raised by entrepreneurs on the spot about possible problems in DRG operation How to solve the problem that the hospital excessively reduces medical cost because of pursuing profit? Compared with other payment methods, DRG mode can enhance the standardization of information, improve the efficiency and transparency of hospitals, and record what medicine doctors prescribe and what treatment they do, the official said At present, the inpatient treatment in the pilot area needs to follow a certain clinical path, and doctors should provide some basic medical consumables to ensure the treatment effect For the consideration of expenses and treatment results, there are many indicators as the basis for judgment If a certain indicator is inconsistent, it may be treated as an extreme value and entered into other payment channels for review How can innovative products and technologies enter the new payment system? According to the official, the inclusion of innovative products does not lie in the payment system itself, but in one aspect that supporting measures need to be improved When any new product or technology enters the market, it will take time to evaluate its safety, efficiency, effect and cost New products and technologies will not be easily included in the payment system, and additional payment may be made at the initial stage After the cost effect is discussed and approved by experts, it can be considered to re price and package payment The traditional pay as you go model is easy to stimulate doctors to induce demand and provide excessive services The official said that changes in the behavior of hospitals and doctors caused by the reform of payment methods will change the current abnormal marketing system and mechanism of drugs and consumables, and direct selling and new hospital based unit direct selling, direct purchasing or group purchasing will gradually take shape DRG mode starts from the mechanism, takes the income and payment as the starting point to carry out comprehensive reform, reverse the compensation mechanism, change the hospital's profit-seeking behavior, and under the overall package payment, let the drug consumables, inspection and testing change into the cost of medical services, rather than the means of income generation This kind of payment and assessment mechanism with medical quality and safety as the core can promote hospitals to actively use high-quality drug consumables and reagents According to the official, the promotion of DRG mode will cause structural adjustment within the industry Some high-priced, low cost-effective, non therapeutic drugs and consumables will be significantly affected, while the use of cost-effective drugs and consumables will be significantly increased (cost effectiveness analysis is one of the most widely used pharmacoeconomic methods to calculate the cost of each unit of treatment effect of different schemes or therapies based on specific clinical treatment purposes.) In general, China's payment system reform is from post payment system to pre payment system, from purely used for medical insurance fee control to the overall allocation of health resources in the country or region, from extensive supervision to fine, evidence-based supervision The industry should have a clear understanding of the short-term and long-term development and change, and make a positive response The official believes that industry organizations can play a greater role in establishing clear top-level design and planning for industry development Pharmaceutical enterprises should pay more attention to the research and development of innovative products to meet the changing needs of doctors and patients At the same time, enterprises should provide more cost-effective therapeutic drugs and consumables according to the characteristics of the new payment method In addition, enterprises should actively explore a variety of production and business models to adapt to future development Finally, pharmaceutical enterprises can actively participate in the medical and health reform, enhance their voice, and make contributions to the healthy development of the pharmaceutical industry