"Double limit" of decoction pieces of traditional Chinese medicine to alleviate the high cost of medical treatment

In September 2012, the Zhejiang Provincial Department of health, the Provincial Department of human resources and the Department of Social Security jointly issued the notice on strengthening the management of the use of Chinese herbal pieces, which requires that "every prescription of Chinese herbal pieces should be controlled within 20 flavors in principle; the average cost of Chinese herbal pieces in the third level hospital should not exceed yuan, that in the second level hospital and all other medical institutions should not exceed yuan, and that in general prescription should not exceed yuan in principle The cost of each post shall not exceed yuan; strictly manage the prescription issuing and dispensing, implement the prescription comment system, and strengthen the supervision of the clinical application of Chinese herbal pieces " "Double limit" to control the cost of traditional Chinese Medicine At the same time, the notice also proposed that: the treatment prescriptions for all kinds of medical insurance diseases such as malignant tumors can be appropriately relaxed to 25 flavors; the prescription of decoction pieces of traditional Chinese medicine generally does not exceed the dosage of 7 days, and can be extended to 2 weeks for some chronic diseases, geriatric diseases or special conditions, and the disease types can not exceed 1 month at most; the regulations on average cost and cost of each poster should be adjusted according to the fluctuation factors of drug price Since the "double limit" in Zhejiang Province controlled the cost of Chinese herbal pieces, in the first quarter of 2013, compared with the first three quarters of 2012, the cost of 10 hospitals in the provincial 13 hospitals decreased, the largest drop was from yuan to yuan in the Provincial Cancer Hospital; the cost of 4 hospitals including Zhejiang first hospital, Zhejiang second hospital and Zhejiang Tongde hospital decreased from more than 40 yuan to less than yuan; the other 5 hospitals decreased by more than 10% Statistics show that there is a big difference in the cost control of Chinese Herbal Pieces in all cities of the province In Hangzhou, the average cost of traditional Chinese medicine in the main city and district level hospitals was relatively high, which has decreased significantly: the average cost of medical institutions in Jianggan District has decreased from 42 yuan to 26 yuan, in which the average cost of traditional Chinese medicine in Jianggan District has decreased from yuan to yuan, with a decrease rate of 40.5%; in addition, the average cost of traditional Chinese medicine in the four districts including Xiacheng District has decreased by more than 10%; the average cost of traditional Chinese medicine in other counties (cities and districts) under the jurisdiction of Hangzhou city has been controlled within yuan throughout the year Other 10 cities in Zhejiang Province have basically met the requirements of cost control of Chinese Herbal Pieces: in the first quarter of 2013, the average cost of Chinese herbal pieces was within yuan in Shaoxing, Jinhua, Quzhou and Huzhou, and the lowest city in Wenzhou was only yuan It is necessary to strengthen the management of the use of Chinese herbal pieces According to the reporter, Zhejiang Province issued the "double limit" regulation on the control of the cost of Chinese herbal pieces, which was affirmed by medical institutions at all levels and the vast number of patients: first, to promote the return of Chinese herbal medicine services to the public welfare Qian Jing, President of Haining Hospital of traditional Chinese medicine, said that at present, hospitals at county (city) level and below in Zhejiang Province implement the system of basic medicine and zero difference rate of drug sales, but do not implement zero difference rate sales of Chinese Herbal Pieces for the time being Therefore, some doctors prescribe traditional Chinese medicine randomly, which leads to the inability to afford traditional Chinese medicine The "double limit" policy of traditional Chinese medicine prescription will effectively control the cost of traditional Chinese medicine, and help hospitals adhere to the public welfare better The second is to reflect the feasibility of the prescription of Chinese herbal pieces Zhang Zulin, Secretary of the Party committee and director of Fuyang people's Hospital of traditional Chinese medicine, thinks that under normal circumstances, it is feasible and reasonable to control a prescription of traditional Chinese medicine within 20 tastes, and the average cost of the post should not exceed yuan For individual patients, it may be necessary to use more than 20 traditional Chinese medicines and expensive medicines, but individual cases cannot be regarded as universal Third, the cost control policy is practical at the grassroots level Cheng Zhiwen, Secretary of the Party committee and director of the Yongjia Hospital of traditional Chinese medicine under the jurisdiction of Wenzhou City, told reporters that their hospital mainly treated farmers The annual reimbursement for Chinese and Western medicine by the local price guarantors is limited to yuan Therefore, each prescription of traditional Chinese medicine has more than ten kinds of medicine, and each prescription costs 20 to 30 yuan The large prescription can not be opened Fourth, the "double limit" of traditional Chinese medicine prescription is conducive to improving diagnosis and treatment technology Zhao Jinlong, President of Pinghu City Hospital of traditional Chinese medicine, said that after the prescription of traditional Chinese medicine is limited and the price is limited, the prescription can no longer "play the sand gun", which requires doctors to use less medicine, good medicine and more cheap medicine under the premise of ensuring the curative effect, so as to better study business and learn skills Fifth, it is conducive to correct the unhealthy trend in medical services, and effectively correct the problems such as damage to patients' rights and interests and waste of traditional Chinese medicine resources caused by large prescriptions But there's another story A provincial hospital official told reporters that the "double limit" control of the cost of traditional Chinese medicine prescriptions should first emphasize the premise of ensuring the curative effect and benefiting the development of traditional Chinese medicine, and should not control the cost for the purpose of controlling the cost The president of a county hospital of traditional Chinese medicine in Western Zhejiang told reporters that not only the price of medicinal materials has increased, but also the labor cost of traditional Chinese medicine service has been rising The average cost of placards is not more than yuan, which is too low Therefore, the county medical insurance department has made a supplementary adjustment: the average cost of placards for ordinary prescriptions of traditional Chinese medicine is controlled within 450 yuan, up by 120 yuan over the provincial regulations The main problems are worthy of attention First of all, the average cost of Chinese herbal medicine prescription in private hospitals is high In the first three quarters of 2012, there were 42 medical institutions in Hangzhou, 39 of which were private, 2 were community health institutions, and 1 was public hospital; 8 of which were private medical institutions, all of which were private medical institutions, with a TCM outpatient department as high as RMB In the first quarter of 2013, 25 of the 26 medical institutions in the main urban area of Hangzhou city with average cost of traditional Chinese medicine placards exceeding yuan were private medical institutions, of which 4 exceeded yuan and the highest was yuan Although the average cost of most private hospitals has also decreased, it is still far higher than that of public hospitals The average cost of some private hospitals is not even reduced but increased Secondly, the average cost of prescribed diseases, especially tumor patients, is often higher than the document Some patients with tumor and other diseases have multiple complications They need a large amount of medicine and rare and expensive traditional Chinese medicine These patients have a great response to "double limit" cost control They think that the cost control of traditional Chinese medicine should be based on the actual conditions of patients, and need to further improve the relevant drug system Thirdly, the price of traditional Chinese medicine fluctuates obviously The outbreak of avian influenza and the non renewable resources of some traditional Chinese medicine have led to the rising price of traditional Chinese medicine in the first half of this year in Zhejiang Province, with the price of some traditional Chinese medicine rising even more than 70%, and the task of controlling the cost is arduous In addition, publicity and supervision should be strengthened It is understood that the cost of non drug treatment of traditional Chinese medicine is relatively low, and "expensive to see a doctor" of traditional Chinese medicine mainly lies in "traditional Chinese medicine" The basic reason of "expensive to eat traditional Chinese medicine" is the rising price of traditional Chinese medicine; the second reason is the decline of the quality of traditional Chinese medicine, which results in the increase of the prescription dosage of decoction pieces Reporters through the interview feel that the following two points seem to be worth thinking: first of all, hospital management, Chinese herbal medicine prescription income should be completely decoupled from the doctor's bonus Doctors' bonuses should be distributed according to their work, not according to their income At the same time, in terms of financial investment, we should constantly improve the compensation mechanism for traditional Chinese medicine services Zhang Qibo, President of Beilun District Hospital of traditional Chinese medicine of Ningbo City, introduced to reporters that since last year, the district's finance has increased subsidies for each patient of traditional Chinese medicine outpatient service and each bed of hospitalization of traditional Chinese medicine, plus the hospital staff's "capitation fee" and government subsidies for purchasing traditional Chinese medicine to participate in public health services In 2012, the hospital received a total of 47.44 million yuan of normal financial subsidies, double the previous year, accounting for 2012 34.9% of the total annual revenue of 165 million yuan Therefore, the hospital does not need to "find rice to cook", and doctors will not use the brain of "more money, more money" If the "double limit" is violated, bonus will be deducted In order to further strengthen the management of the use of Chinese herbal pieces, the relevant departments of Zhejiang Province have made arrangements: to carry out joint inspection, to carry out special inspection on the use of Chinese Herbal Pieces in the designated medical institutions of Hangzhou Medical Insurance, including the average cost of Chinese herbal pieces, the average number of flavors, the cost at their own expense, the evaluation of Chinese herbal prescriptions in medical institutions, etc.; to implement the rectification measures, the average cost for two consecutive quarters is over The subject medical institution urges the rectification, or suspends the service agreement, and if the circumstances are serious, it shall request the human resources and social security department to cancel its medical insurance designated qualification; it shall give a warning to the doctors whose average expenses exceed the standard and have no justifiable reason, and it shall cancel their medical insurance physicians' qualification if the average expenses exceed the standard for two consecutive seasons; it shall regulate the diagnosis and treatment behaviors, and medical institutions at all levels shall comment on the prescription of Chinese herbal pieces once a month; timely adjust According to the whole policy, there are problems such as high price and big fluctuation in traditional Chinese medicine commonly used by patients with cancer and other diseases, and the cost of disease species should be adjusted timely.