DRG to ferocious drug ratio give way?

Four years after the implementation of the "drug ratio" policy, the proportion of drugs reached the target, but the cost of medicine increased, "China Health Statistics Yearbook 2019" (hereinafter referred to as "Yearbook 2019") published and published, and similar to previous years, which counted dozens of (Note: before 30, 2019 statistics for 2018 data for 29) medical expenses, through analysis found that the implementation of the strict drug control policy in recent years, there are indeed some diseases significantly reduced the proportion of "drugs", but the overall cost of medicine29 diseases, the proportion of drugs and drug costs to achieve a general decline in the proportion of drugsthe largest decline was the proportion of pulmonary malignant tumors, from 43.05 percent in 2014 to 23.67 percent in 2018, a cumulative decline of 19.38 percent over four yearsIn addition, there is a four-year cumulative decline in viral hepatitis also a large number of 16.60%, the rest of the majority of disease drugs accounted for a cumulative four-year decline of more than 10%The proportion of drugs in the four-year cumulative decline of less than 5% of the only old-age cataracts, and cataracts itself has been a low proportion of drugs, but also from 7.65 percent in 2014 to 4.68 percent in 2018Note: According to the Statistical Yearbook data summary analysis of the Commission/Health And Wells Commission, for referenceIf only 29 of the diseases counted are likely to be relatively weak, we can also look at the national per capita outpatient and inpatient average drug cost ratio change trend: outpatient severity ratio from 2014 The annual decline of 48.3% to 40.9% in 2018, a cumulative decrease of nearly 8%, and the proportion of inpatients' average cost of medicines decreased from 38.3% in 2014 to 28.2%, a cumulative decrease of more than 10%It can be seen that the proportion of controlled drugs in general achieved a decrease in the proportion of drug costsof these 29 diseases, in addition to the average annual cost of caesarean section in 2014-2018 slightly increased, the vast majority of the drug costs have also decreased to varying degreesAmong them, lumbar disc protrusion and myocardial infarction coronary artery bypass drug costs decreased by more than 30%, the rest of most of them are also more than 20%Note: According to the Statistical Yearbook data summary analysis of the Commission/Health And Wells Commission, for referencelooks like the data is "pretty beautiful."the proportion of medicine in the general decline, the overall cost of medicinethrough the absolute amount of medical costs, in the proportion of medicine looks "very beautiful" behind the 29 diseases of the pharmaceutical costs are generally risingamong the, the drug accounted for the largest decline in the proportion of lung malignant tumors, the largest annual increase in the annual increase, to 13.2% Undeniably, this degree and the two years of the country on the treatment of lung cancer new drugs continue to be on the market to a certain extent to push up the cost of drugs, drug costs other than the rapid growth rate, in the case of a sharp decline in the proportion of drugs brought about a substantial increase in the cost of medicine In addition, there is acute appendicitis, uterine smooth fibroids and caesarean section four diseases of the annual increase in medical costs of more than 7% Note: According to the Statistical Yearbook data summary analysis of the Commission/Health And Wells Commission, for reference strictly control the proportion of drugs, why can't we reduce the cost of drugs? the proportion of drugs is only a proportion, to achieve the goal of reducing the proportion of drugs, nothing but a reduction of molecules (drug costs) and plus mother (medical costs) two ways However, from the current actual situation, by increasing the cost of drugs in addition to the means of adding more mother, so reduce the proportion of drugs but can not reduce the cost of medicine through public information found that since the implementation of drug ratio assessment, more and more public hospitals through various methods to avoid the drug ratio of the cost of control objectives, including raising the cost of inspection, increase registration costs, such as the main denominator, will be part of the prescription flow outside the hospital and other methods in terms of the trend of changes in medical expenses, or in the "Yearbook 2019" statistics of the national per capita outpatient, inpatient average medical fee change trend, the average medical expenses of outpatients increased from 220 yuan in 2014 to 274.1 yuan in 2018, a cumulative increase of 24.6%; It can be seen that the main reason behind the decline in the proportion of drugs is the larger denominator, other than drugs, other costs of the rise Half of the decline in medicines was absorbed by an increase in the proportion of health materials, while the other half was absorbed by the slight increase in the examination of most diseases, hospitalization services and subsidies most of the increase in the proportion of examination fees, the change in the proportion of treatment costs, the change in the proportion of surgical expenses and the proportion of health materials in 2014-2018 29 diseases, the proportion of examination fees increased in 22, the proportion of treatment costs increased by 27, the proportion of surgical expenses all increased, and the proportion of health materials costs also increased in 19 Note: According to the Statistical Yearbook data summary analysis of the Commission/Health And Wells Commission, for reference , it can be seen that the proportion of drugs is not the fundamental method of governance rise, in early 2019 the General Office of the State Council issued "on strengthening the performance appraisal of three-level public hospitals" (hereinafter referred to as "Opinion"), according to the contents of the Opinions, the three-level public hospital performance appraisal index system by the quality of health care, operational efficiency, sustainable development, satisfaction evaluation and other 4 aspects of the composition of 55 indicators, no longer use the drug ratio for assessment As a result, the anecdotal drug ratio policy will become weaker and weaker the disease diagnosis group is in a strong trend, reasonable control fee or cure method
Recently, the State Medical Security Administration issued the "Notice on the issuance of the "DrG-related disease-related group (DRG) paid national pilot technical specifications and grouping programs", and officially announced the "National Medical Security DRG Group and Pay Technical Specifications" (hereinafter referred to as the "Technical Specifications") and the National Medical Security DRG (CHS-DRG) Group Program (hereinafter referred to as the "Group" ) (hereinafter) It can be seen that the comprehensive cost control means of disease diagnosis sub-group measures are about to enter the implementation stage it is worth noting that the disease diagnosis group and pay by disease, the disease diagnosis group is more comprehensive and fine, the need for patient age, sex, hospital days, clinical diagnosis, illness, surgery, complications and complications, the clinical process is similar, the cost of similar cases into the same DRG (disease group), resulting in hundreds of obvious differences in the disease group Clinical resource consumption is an important factor of DRGs, the same DRG group does not necessarily have only one disease, as long as it is a systemic disease, clinical pathways, medical resourceconsumption similar, may be divided into a group the implementation of disease diagnosis groups has a profound impact on hospitals, doctors and pharmaceutical companies (1) on the impact of the hospital: forced the hospital to pay attention to cost control, hospital evaluation index more refined the implementation of disease diagnosis sub-group, DRGs appeared in order to control the unreasonable increase in medical costs, the cost growth of hospitals have a certain deterrent effect, to promote the hospital to do cost control The way of paying for medical insurance has moved from the original method of payment of quantity to the method of quality payment, which helps to encourage hospitals to strengthen the quality management of medical care, and forces the hospital to take the initiative to reduce the cost in order to obtain profits The reform stimulates the endogenous power of "cost control and quality control" in medical institutions (2) Impact on Doctors: Motivate Sanative and Normative, Reduce Large Prescriptions, and Improve Efficiency Under the premise of ensuring the quality of medical care, hospital will establish an internal performance appraisal and internal distribution system to strengthen the hospital management in order to reduce costs and stimulate the enthusiasm of employees reduce the behavior of large prescriptions and large examinations Because the hospital to control costs, regulate the treatment behavior, we must avoid large prescriptions, unnecessary examination and other behavior, while paying more attention to the case front page to fill in, conducive to patients follow-up treatment and medical payments (3) impact on pharmaceutical companies: further crisis of complementary drug use, the exact efficacy of drugs to benefit, drugs that can provide combination treatment programs to benefit, Internet drug service model space further crisis of assisted drug use, the exact efficacy of drugs to benefit, can provide a combination of treatment programs of drugs to benefit pharmaceutical companies, Internet drug service model space is large forced pharmaceutical companies to focus on data in areas of cost and efficacy Low-priced, good efficacy of drugs, the higher the price-performance of the drug will be more popular DRG has shifted drug sales from a single product sale to a group of product sales This means that drug companies need not just sales figures for individual drugs, but the likelihood of a portfolio of sales in a particular area for a disease group pharmaceutical companies can explore new models of cooperation with hospitals to meet the needs of patients in an Internet-based pharmaceutical service Such as some patients who need long-term medication after discharge, or often prescribe drugs for chronic diseases, can first register under the online, the use of special mobile phone APP registration, even if discharged or inconvenient to the hospital, can also be at any time in the mobile phone APP or public number registration, there are doctors to prescribe, pharmacists audit, pharmaceutical company logistics costs sent to complete, directly realize the "prescription outflow", not only conducive to promoting drug sales, is conducive to reducing the cost of hospitals.