Document issued by Hebei health and Health Commission: "four medical linkage" comprehensive control of drug costs

Medical network, May 26 - recently, Hebei health and Health Commission issued the notice of the leading group of deepening the reform of medical and health system of Hebei Province on printing and Distributing Several Policies and measures to further deepen the reform of four medical linkage and improve the mechanism of interest regulation and control with centralized purchase and use of drugs as a breakthrough (hereinafter referred to as the notice)< br / > < br / > the notice proposes the "four medical linkage" of medical treatment, medical insurance, medicine and medical price, and takes measures to control the cost through comprehensively deepening the reform of centralized purchase and use of drugs and linkage, strict drug purchase and sale tax management, launching DRG actual payment in 2021, strengthening the monitoring of key drugs and strengthening the monitoring of drug price< br / > < br / > different from the "three medical linkage" of medical insurance, medicine and medical treatment, Hebei creatively added "medical price" to propose four medical linkage, which is undoubtedly worthy of attention< br / > < br / >We will expand the pilot implementation scope of the first batch of centralized drug purchase and use, expand the 25 drugs purchased in the first batch to designated private medical institutions and troops < br / > and explore the coverage of large-scale chains < br / >In 2020, we will continue to do a good job in the centralized procurement and use of drugs in accordance with the unified national plan(the Provincial Medical Security Bureau, the Provincial Health Committee and the provincial drug regulatory bureau are in charge, and the leading unit ranks first, the same below) < br / > < br / > < br / / > according to the national requirements, deepen the strategic cooperation with the Medical Security Bureau of Sanming City, Fujian Province, organize the Sanming procurement alliance city of our province, and actively participate in the non-conforming evaluation of drug centralized volume alliance procurement organized by Sanming CityWe will continue to do a good job in the centralized procurement and use of outpatient drugs for hypertension and diabetes among urban and rural residents in Hebei Province(in charge of Provincial Medical Security Bureau, provincial health and Health Commission and provincial drug administration) < br / > < br / > < br / / > punish the dishonesty of drug purchase according to lawWe will improve the market clearance system, take measures to compensate, punish and withdraw enterprises that fail to guarantee the quality and quantity of drugs in their procurement, and do a good job in alternative and emergency support to ensure the quality and supply of drugsFor the enterprises that have price alliance or price manipulation, such as bid encirclement, collusion, and malicious disconnection, the qualification of centralized procurement and network hanging shall be cancelled according to laws and regulations, and the industry competent department shall push the relevant dishonest information to the national credit information sharing platform (Hebei)(the Provincial Medical Security Bureau, the provincial market supervision bureau, the provincial government service management office and the Shijiazhuang central sub branch of the people's Bank of China are respectively responsible, with the participation of the provincial drug administration) < br / > < br / > < br / > to reform the drug payment settlement and payment systemStarting from the reform of centralized purchase of drugs for hypertension and diabetes outpatient service of urban and rural residents, we will carry out direct settlement between medical insurance agencies and drug production or distribution enterprises, gradually expand the scope of direct settlement, and ensure that the payment to enterprises does not exceed 30 days from the acceptance of goodsIn areas where conditions are not available for the time being, medical insurance agencies shall prepay medical insurance funds to medical institutions as working capital for centralized drug purchase(in charge of Provincial Medical Security Bureau, provincial finance department, provincial health committee and provincial drug administration) < br / > < br / > < br / / > strengthen the real-time monitoring and management of purchase drug paymentWe will continue to improve and expand the functions of the provincial drug equipment procurement platform, strengthen the real-time monitoring of the payment for drugs purchased, and regularly disclose the payment for drugs in each city in an appropriate wayFor the medical institutions that fail to pay the drug payment on time without proper reasons, the warning shall be given by means of early warning interview, etc., and the medical insurance expenses of the designated medical institutions shall be postponed if the payment is still not collected within 5 working days after the warningThe person in charge of the medical insurance agency that fails to pay the medical insurance fund on time without justifiable reasons and the person in charge of the medical agency that fails to pay the drug payment on time shall be criticized in the whole provinceWe will strengthen auditing and supervision over the payment for drugs by medical insurance, the settlement of medical expenses, and the payment for drugs by medical institutions(the Provincial Medical Security Bureau, the provincial health committee, the provincial administration of traditional Chinese medicine and the provincial audit office are respectively responsible for) < br / > < br / > < br / / > strict drug purchase and sale tax managementThe implementation of the two vote system shall be subject to normal supervisionWe will strengthen the invoice management of pharmaceutical production and distribution enterprises and medical institutions, intensify the inspection of tax evasion in accordance with the law, and crack down on drug enterprises' tax evasion by falsely increasing promotion fees and service fees through intermediary organizations(the provincial drug administration, the provincial taxation bureau and the provincial market supervision bureau are respectively responsible for) < br / > < br / > < br / / > deepening the reform of medical insurance payment modeWe will accelerate the establishment of multiple and complex payment methods for medical insurance, guide medical institutions to take the initiative in cost control, give priority to the use of drugs, consumables and technologies with high quality and low price, and save medical expensesGuide Handan city to do a good job in the national pilot work of DRG payment, formulate technical standards such as DRG grouping system and rate weight calculation, improve DRG payment information system, further improve medical insurance payment policy, handling management process and fixed-point management agreement, start simulation operation in 2020, and start actual payment in 2021We will vigorously promote payment by disease and pay by bedEncourage all regions to actively explore ways of payment to give full play to the advantages of traditional Chinese medicine(in charge of Provincial Medical Security Bureau, provincial finance department, provincial health committee and provincial administration of traditional Chinese Medicine) < br / > < br / > < br / / > optimize the medication structure of medical institutionsImplement the drug catalogue of basic medical insurance, work injury insurance and maternity insurance of our province (2019 version)We will promote medical institutions to establish a drug use model dominated by essential drugs, give priority to the use of national essential drugs and Medicare listed drugs, optimize and adjust the drug use list in a timely manner, and increase the proportion of essential drugs usedAccording to the adjustment of the national basic drug catalogue, gradually realize the proportion of basic drug allocation in basic medical and health institutions run by the government, secondary public hospitals and tertiary public hospitals, in principle, no less than 90%, 80% and 60% respectively(the Provincial Medical Security Bureau, the Provincial Health Committee and the provincial administration of traditional Chinese medicine are respectively responsible for) < br / > < br / > < br / > strengthening the monitoring of key drugsMedical institutions should establish and improve the monitoring, evaluation, abnormal early warning system and key monitoring drug management system for clinical drug use, and strengthen the whole process management of selection, purchase, dispensing, use, monitoring, evaluation and prescription review and comment of key monitoring drugs such as auxiliary and nutritional drugs Adopt negative list, public announcement, interview and other methods, strengthen supervision, put the key monitoring drug clinical use into the scope of rational drug use assessment, and the assessment results are linked with the verification, evaluation and performance assessment of medical institutions If the medical insurance department finds any prescription that may affect or lose the expenditure of medical insurance fund, it shall timely handle it in accordance with relevant regulations and agreements, so as to urge the medical institutions to strengthen internal management and standardize diagnosis and treatment behaviors (in charge of the provincial health committee, the provincial administration of traditional Chinese medicine, and the Provincial Medical Security Bureau) < br / > < br / > < br / > strengthen the supervision of medical service behavior Establish and improve the monitoring index system of medical service behaviors of medical staff, such as drug use (consumables), inspection, test, etc., include drug use rate, positive rate of large-scale equipment inspection, average cost per time, proportion of inspection and test costs, etc into the scope of big data comparison management, strictly investigate and deal with super common drug behaviors such as big prescriptions, and restrict or cancel the prescription right for doctors who violate the regulations, If the case is serious, the practicing certificate shall be revoked, the relevant responsible person of the medical institution shall be interviewed, and the case shall be handled according to the law and regulations (the provincial health and Health Committee, the provincial administration of traditional Chinese medicine and the provincial medical security bureau are responsible for the establishment of price restraint mechanism For drug enterprises with abnormal price increase or frequency, large price difference between regions, serious poor distribution or continuous multiple early warning, cost investigation, letter consultation and interview, public exposure, suspension of Internet connection, dishonesty punishment and other measures shall be taken, and punishment shall be carried out according to laws and regulations We should strengthen the supervision of drug price behavior, strictly investigate and deal with price monopoly behavior in accordance with the law, standardize the clear price of drugs, receive tips through the 12315 hotline, and effectively maintain the price order in the drug market (the Provincial Medical Security Bureau and the provincial market supervision bureau are responsible for) < br / > < br / > it is not hard to see that in the second half of the new crown epidemic, the medical policies of each province are frequent, and price reduction, cost control and structural adjustment are still the core themes < br / > According to the national plan to comprehensively deepen the centralized procurement and use of drugs, explore the deployment of centralized procurement of medical consumables, seize the opportunity of reform, adhere to the reform path of making room, adjusting structure and ensuring the connection, properly handle the interests of the government, hospitals, medical personnel and patients, and comprehensively promote the reform of four medical linkage Starting from expanding the centralized purchase and use of drugs, we should reform the drug purchase mechanism, reduce the false high price of drugs, and make room for deepening reform and interest regulation We will steadily adjust the price of medical services, support the embodiment of the value of technical services, optimize the income structure of medical institutions, and enhance the sustainable development capacity of hospitals Adjust the benefit guidance mechanism, improve the internal assessment salary distribution method of medical personnel within the approved total performance salary, guide medical personnel to actively carry out health education, health management, disease prevention and treatment and other services, so that no illness, less illness, less hospitalization and less money become the common goal of medical students and the masses We will improve the policy on medical insurance benefits, adjust the proportion of medical insurance reimbursements in a timely manner, establish and improve the guidance mechanism for hospital cost control and the use mechanism of medical insurance funds, and ensure the sustainability of medical insurance funds We will implement financial investment, strengthen industry supervision, promote joint reform, consolidate and improve the operation mechanism of medical consortia, guide the sinking of high-quality medical resources, promote the transformation of the service model from the focus on treatment to the focus on health, and better solve the problem of medical treatment for the masses < br / > < br / > We will expand the pilot implementation scope of the first batch of drugs purchased and used in a centralized way, expand the 25 kinds of drugs purchased in a centralized way to designated private medical institutions and military hospitals, and explore the coverage of large chain drugstores In 2020, we will continue to do a good job in the centralized procurement and use of drugs in accordance with the unified national plan (the Provincial Medical Security Bureau, the Provincial Health Committee and the provincial drug regulatory bureau are responsible, and the leading unit ranks first, the same below) < br / > < br / > (2) organize the centralized purchase and use of drugs in our province According to the requirements of volume procurement, bidding procurement integration, quality priority, quantity assurance and payment collection, we will carry out centralized procurement and use of drugs in our province All relevant departments and medical institutions shall not influence the reasonable use and supply guarantee of the selected drugs on the grounds of cost control, drug proportion, and requirements for drug varieties, specifications and quantities of medical institutions According to the national requirements, deepen the strategic cooperation with Sanming Medical Security Bureau of Fujian Province, organize Sanming procurement alliance city of our province, and actively participate in the procurement of non-conforming evaluation drugs in Sanming City We will continue to do a good job in the centralized procurement and use of outpatient drugs for hypertension and diabetes among urban and rural residents in Hebei Province (in the charge of Provincial Medical Security Bureau, provincial health committee and provincial drug administration) < br / > < br / > (3) actively explore the centralized purchase and use of medical consumables According to the national plan, we will explore the centralized procurement of medical consumables All relevant departments and medical institutions shall give priority to the use of medical consumables purchased in a centralized way According to the framework agreement on centralized procurement cooperation of medical consumables in Beijing, Tianjin and Hebei, according to the division of labor in the joint procurement agreement of medical consumables in Beijing, Tianjin and Hebei, cooperate in the joint procurement work (each responsible for two categories of procurement), and share six categories of medical consumables with Beijing and Tianjin