Eight departments issued documents!

Medical Network September 2 News August 31, National Medical Insurance Administration, National Health Commission, National Development and Reform Commission, Ministry of Finance, Ministry of Human Resources and Social Security, General Administration of Market Supervision, State Administration of Traditional Chinese Medicine, State Food and Drug Administration 8 departments The "Pilot Plan for Deepening the Reform of Medical Service Prices" was jointly issued.
It is understood that this was officially announced in full text after it was deliberated and approved at the 19th meeting of the Central Comprehensive Deepening Reform Committee on the afternoon of May 21
.
The "Plan" divides medical services into general medical services and complex medical services
.
The government-guided price of general medical services floats around a unified benchmark
.
Diagnosis, nursing, beds, and some traditional Chinese medicine services that are widely developed by medical institutions and have a high degree of service homogeneity are included in the general medical service catalog
.
The government-guided price of complex medical services is formed by the introduction of public medical institutions
.
For complex medical services that are not included in the general medical service catalogue, a price formation mechanism led by the government and hospital participation shall be established, and the professional opinions and suggestions of hospitals and doctors shall be respected
.
Public medical institutions make price recommendations in accordance with the rules on the basis of cost accounting
.
Supporting medical services that are technically difficult, highly risky, and really necessary to carry out, appropriately reflect price differences
.
Guide public medical institutions to strengthen cost management and actuarial balance, coordinate the number and range of price adjustment projects, and guide public medical institutions to adopt methods such as lowering high prices to increase the total price adjustment
.
"The reform of the price of medical services has reached a time when it will not change
.
" said Xu Yucai, the columnist of "Seeing the Medical Circle" and deputy director of the Health Bureau of Shanyang County, Shaanxi Province
.
Xu Yucai believes that first, the reform of medical service prices has become a shortcoming of the three-medicine linkage
.
In recent years, the " medicine " reform in the three-medicine linkage reform has been advancing rapidly and has achieved remarkable results.
The "medical insurance" payment system reform will be implemented in a large-scale pilot program (30 DRGs and 71 DIP cities) this year.
Price) reform is obviously lagging behind
.
In March 2018, the Medical Insurance Bureau was established and was appointed to coordinate and promote the important task of "three-medicine linkage", and there should be some action
.
It is understood that the plan mentioned in this plan to do a good job in the coordination of medical service prices and payment policies, total price management control, total medical insurance budget management, and regional point method coordination
.
Explore the formulation of medical insurance payment standards
.
Establish and improve the management system of medical insurance and medical consumables catalog
.
Deepen the reform of multiple and compound medical insurance payment methods based on the type of disease and grouping related to disease diagnosis
.
Explore the implementation of the total medical insurance payment for the close medical complex, strengthen supervision, reserve the balance on the basis of assessment, and share the reasonable over-expenditure
.
Promote all online procurement of medical consumables, and expand the scope of centralized procurement of high-value medical consumables
.
At the same time, general difficulties have emerged in the operation of medical institutions
.
Xu Yucai said that with the rapid advancement of the "medicine" reform (purchasing in quantities, negotiating purchases to reduce the price of medicines and consumables), hospitals that previously relied on gray income for survival and development can no longer continue; The days for medical insurance to "eat" no longer exist; coupled with the huge impact of the new crown pneumonia epidemic, the operation of medical institutions across the country has generally encountered unprecedented and obvious difficulties.
Under the situation of huge downward pressure on the economy, they attempted to pass substantial financial Support to alleviate the difficulties in the operation of public hospitals is not realistic.
Therefore, it is urgent to pour a bucket of "water" on public hospitals that are already thirsty through the reform of medical service prices, so that they can rejuvenate their vitality as soon as possible and strengthen economic management, on the other hand.
Improve the quality of operations and lay the foundation for high-quality development
.
According to the "medical community", the National Medical Insurance Administration, in conjunction with relevant departments, initially selected five cities based on scientific evaluation, focusing on pilot projects such as total volume control, price classification formation and dynamic adjustment, monitoring and evaluation, and strengthening direct contact.
Guidance
.
Provinces (autonomous regions and municipalities directly under the Central Government) where conditions permit may organize cities divided into districts to participate in the pilot
.
Pilot cities should formulate pilot implementation plans based on local conditions, advance steadily and orderly, and form a reproducible and extendable reform experience
.

　　Attachment: Deepening the pilot program of
medical service price reform Deepening the reform of medical service price is an important measure to promote the high-quality and coordinated development of medical security and medical services
.
In accordance with the mission of the Party Central Committee and the State Council on deepening the reform of the medical security system, in order to accelerate the establishment of a scientifically determined and dynamically adjusted medical service price formation mechanism, and continue to optimize the medical service price structure, this plan is hereby formulated
.

　　1.
General requirements
(1) Guiding ideology
.
Xi Jinping, the new era of socialist ideology with Chinese characteristics as guidance, thoroughly implement in the 19th Japan-ninth two of the party, in the third, fourth, the spirit of the Fifth Plenary Session, adhere to the people's health as the center clinical value-oriented, The law of medical development is to follow, establish and improve a medical service price formation mechanism that adapts to economic and social development, better exerts the role of the government, medical institutions fully participate, and reflects the value of technical labor services, adheres to the public welfare attributes of public medical institutions, establishes a reasonable compensation mechanism, and mobilizes medical services The enthusiasm of personnel, promote the innovative development of medical services, improve the quality and level of medical and health services for the people, control the burden of medical expenses of the people, and ensure that the people receive high-quality, efficient, and affordable medical and health services
.
(2) The overall idea
.
Standardize the management of medical service price items, and establish a pricing unit system that conforms to the price law
.
Make overall plans and take into account the needs of medical development and the affordability of all parties, and regulate the overall level of medical service prices
.
Explore a price formation mechanism that combines government guidance and participation of public medical institutions, give full play to the professional advantages of public medical institutions, and reasonably determine the price of medical services
.
Establish a sensitive price dynamic adjustment mechanism, clarify the starting and restrictive conditions of price adjustment, give full play to the function of reasonable price compensation, stabilize price adjustment expectations, straighten out the price relationship, and ensure the overall stability of the masses’ burden, the affordable medical insurance fund, and the healthy development of public medical institutions Sustainable
.
Strengthen the supporting role of big data and informatization, strengthen the price monitoring and evaluation of public medical institutions, and ensure the stable operation of the price mechanism
.
Adhere to the system concept, coordinate the promotion of public hospitals' compensation mechanism, graded diagnosis and treatment, medical control fees, medical insurance payment and other related reforms, improve the incentive and restraint mechanism, and enhance the systematic, integrated, and synergistic reform of the reform to form a comprehensive effect
.
(3) Reform goals
.
Through 3 to 5 years of pilot projects, explore the formation of reproducible and extendable medical service price reform experience
.
By 2025, the pilot experience of deepening medical service price reform will be extended to the whole country.
The medical service price mechanism of classified management, hospital participation, scientific determination, and dynamic adjustment will be mature and finalized, and the function of price leverage will be fully utilized
.

　　2.
Establish a target-oriented price project management mechanism
(4) Develop a price project preparation standard
.
In accordance with the principle of service output-oriented, medical human resource consumption as the basis, and separation of technical labor and material consumption, the establishment of national price project standards shall be formulated
.
Clarify the project establishment conditions and management rules for the transformation of medical technology or medical activities into price items, and clarify the policy boundaries between price items and clinical diagnosis and treatment technical specifications, medical institution cost elements, and additional charging standards for different application scenarios
.
Construct a price item system that has clear connotation boundaries, is suitable for clinical diagnosis and treatment, and is convenient for evaluation and supervision
.
(5) Improve the national price item specifications
.
On the basis of fully listening to the opinions of clinical experts, the current price items are classified and integrated, the national medical service price item specifications are improved, the price item codes are unified, and regional differences are gradually eliminated
.
Realize the decoupling of price items from technical details such as operating procedures, diagnosis and treatment sites, enhance the compatibility of current price items with medical technology and medical activities, and reduce the number of items reasonably
.
Medical consumables are gradually separated from price items, the market mechanism is brought into play, and centralized procurement and "zero markup" sales are implemented
.
(6) Optimize the management of newly added price items
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Simplify the application process of newly added price items, accelerate the progress of acceptance and review, and promote the development and clinical application of medical technology innovation
.
To carry out innovative and economic evaluations for newly-added price projects that consume large resources and have high price expectations
.
For major innovative projects that optimize diagnosis and treatment plans for major diseases or fill gaps in diagnosis and treatment, open up green channels to ensure that patients receive timely medical services with more clinical value and cost-effectiveness
.

　　3.
Establish a more sustainable price management total control mechanism
(7) Strengthen the macro management of medical service prices
.
According to the level of economic development, medical technology progress and the affordability of all parties, macro-management of the total price adjustment of medical services of public medical institutions shall be implemented to control the excessive growth of medical expenses and improve the social benefits of price management
.
Focus on the key points within the total price adjustment range, adjust the price of medical services with rising and falling, and give full play to the leverage of price tools
.
(8) Reasonably determine the total amount of price adjustments
.
Establish and improve the determination rules and indicator system of the total price adjustment
.
Based on the total medical service expenses of public medical institutions in the region, comprehensively consider the regional economic development level, the scale and structure of total medical expenses, the financing operation of medical insurance funds, the operating costs and management performance of public medical institutions, the flow of patients across regions, the development of new formats, etc.
Factors to determine the total amount of price adjustments for medical services in public medical institutions within a certain period of time
.
(9) Overall planning and balance of total distribution
.
The total growth rate of inter-regional price adjustments should be combined with speed to promote effective supply of medical resources and increase the level of equalization
.
Regions with excessively rapid growth of medical expenses must strictly control the growth
.
The total price adjustment between public medical institutions is under pressure, reflecting reasonable returns and advanced incentives, reflecting the functional positioning and service characteristics of public medical institutions at all levels and various types, supporting the development of weak subjects, primary medical institutions and traditional Chinese medicine medical services, and promoting hierarchical diagnosis and treatment
.

　　4.
Establish a standardized and orderly price classification mechanism
(10) The government-guided price of general medical services floats around a unified benchmark
.
Diagnosis, nursing, beds, and some traditional Chinese medicine services that are widely developed by medical institutions and have a high degree of service homogeneity are included in the general medical service catalog
.
Based on the analysis of service element cost big data, combined with macro index and service level and other factors, formulate a unified benchmark for the government-guided price of general medical services.
Public medical institutions of different regions and different levels can implement floating in a certain range to promote general medical care.
Standardization of services and equalization of cost recovery rates
.
(11) Government-guided prices for complex medical services are introduced into the formation of public medical institutions
.
For complex medical services that are not included in the general medical service catalogue, a price formation mechanism led by the government and hospital participation shall be established, and the professional opinions and suggestions of hospitals and doctors shall be respected
.
Public medical institutions make price recommendations in accordance with the rules on the basis of cost accounting
.
All localities will receive centralized acceptance, establish prices within the total amount of price adjustments and rules, strictly control excessive prices that deviate from the reasonable price range, and uniformly announce government-guided prices
.
Establish a mechanism for investigation and monitoring of weak subjects and policy guidance, allow the prices of weak subjects with historically low prices and insufficient medical supplies to be adjusted first, and promote the rationalization of price comparisons
.
Fully consider the characteristics of TCM medical services and support the inheritance and innovation of TCM
.
Supporting medical services that are technically difficult, highly risky, and really necessary to carry out, appropriately reflect price differences
.
Guide public medical institutions to strengthen cost management and actuarial balance, coordinate the number and range of price adjustment projects, and guide public medical institutions to adopt methods such as lowering high prices to increase the total price adjustment
.
(12) Market-adjusted prices will be implemented for special services and new projects during the trial period
.
Public medical institutions determine the prices of special services and new items during the trial period (trial period 1 to 2 years), and report them to the competent department of medical service prices for the record
.
Pricing should comply with the price rules set by the government, and match the hospital's grade, professional status, and functional positioning.
The increased medical service costs of the pricing occupy the total price adjustment
.
Strictly control the charging items and the proportion of fees for the market-adjusted prices of public medical institutions, and do not exceed 10% of all medical services
.
After the trial period of new projects expires, they will be managed as general-purpose or complex projects
.

　　5.
Establish a sensitive and effective price dynamic adjustment mechanism
(13) The prices of general medical service items are adjusted dynamically with reference to income and price indices
.
The benchmark prices of general medical service items are regularly evaluated and dynamically adjusted with reference to the average salary of urban employees and changes in the consumer price index
.
If the cumulative increase in the average wage of employed persons in urban units reaches the trigger standard and the consumer price index is below a certain level, the benchmark price shall be adjusted in accordance with the rules
.
(14) The prices of complex medical service items are regularly adjusted after the assessment reaches the standard
.
Establish and complete a comprehensive evaluation index system for price adjustments, and calculate the increase in medical and health expenses, the income structure of medical services, the changes in factor costs, the proportion of medicines and medical consumables, the proportion of large-scale equipment income, the average salary level of medical staff, the balance of medical insurance funds, and patients Indicators such as self-payment level and consumer price index are included in the assessment scope, and the triggering and limiting standards for dynamic adjustments are clarified
.
Regular price adjustment evaluations are carried out, and when the standards are met, the price suggestions made by public medical institutions will be initiated and accepted
.
(15) Establish a special adjustment system for medical service prices
.
In order to implement major reform tasks such as centralized procurement of medicines and medical consumables, respond to major public health incidents, resolve prominent contradictions in medical service prices, and alleviate imbalances in the supply of key specialist medical services, special adjustments to medical service prices will be initiated according to actual needs, with flexibility Select the price adjustment window period, scientifically calculate and reasonably determine the total amount of price adjustment and the scope of the project based on factors such as the income and cost of public medical institutions, and adjust the price as it rises or falls
.

　　6.
Establish a strict and efficient price monitoring and assessment mechanism
(16) Strengthen the price and cost monitoring of public medical institutions
.
Monitor the price changes of important items in public medical institutions
.
Implement a medical service price publicity and disclosure system, compile and regularly publish medical service price indices
.
If monitoring finds that the price of medical services is abnormal and the price of new items is too high, if necessary, organize cost investigation or supervision, evaluation of cost recovery rate, health technology evaluation, or price hearing to prevent abnormally high and low project prices
.
(17) Do a good job in evaluating the reform of medical service prices
.
Closely track the progress of the reform of the medical service price project management mechanism, and regularly evaluate the implementation effects of new projects
.
Complete control of the price of medical services and dynamically adjust the amount of regulation implementation on a regular basis to assess the impact of price adjustment public sector operation, the patient and the health insurance fund burden
.
Closely track the implementation of the price classification formation mechanism, and regularly evaluate the price comparison relationship between regions and disciplines
.
The scientific application of the evaluation results is linked to the formulation and adjustment of medical service prices to support the stable and efficient operation of the new medical service price mechanism
.
(18) Implement the price responsibility assessment system of public medical institutions
.
Formulate assessment methods for the main responsibility of the price of medical services of public medical institutions
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Check the authenticity and compliance of internal price management and pricing of public medical institutions, check the implementation of medical service prices in public medical institutions, and evaluate public medical institutions for implementing reform tasks, complying with price policies, strengthening operation and management, optimizing revenue structure, and standardizing service behaviors Wait for the situation
.
The results of inspections, inspections and assessments are linked to the prices of public medical institutions
.

　　7.
Improve the support system for price management
(19) Optimize the allocation of medical service price management authority
.
Medical service price items are managed at the national and provincial levels
.
The price level of medical services is based on the localized management of cities divided into districts.
The national and provincial medical security departments can provide policy guidance on the price of some medical services based on functional positioning, cost structure, and medical technology complexity
.
(20) Improve the procedures for formulating and adjusting the price of medical services
.
Carefully design the rules for setting and adjusting the prices of various medical services, reduce and standardize the discretion of the administrative departments, and ensure that the procedures for the formation of medical services prices are standardized, scientific and reasonable
.
Establish a price adjustment publicity system
.
Strengthen prior price adjustment impact analysis and social risk assessment, focus on groups with special difficulties, and proactively prevent and control risks
.
Reform and optimize the procedures for setting and adjusting prices for medical services in accordance with laws and regulations, and take various forms to listen to opinions
.
(21) Strengthen the construction of medical service price management capabilities
.
Improve the linkage response and emergency response mechanism, and strengthen the connection between upper and lower levels, regional linkage, and information sharing
.
Smooth information reporting channels to provide good information support for price adjustments
.
Improve the information level of medical service price management, and strengthen the construction of medical service price management team
.

　　8.
Coordinate and promote supporting reforms
(22) Deepen the comprehensive reform of public hospitals
.
Improve the configuration and management of medical equipment in regional public hospitals, guide reasonable configuration, and strictly control excessive and excessive equipment
.
Strengthen the internal professional and refined management of public medical institutions
.
Standardize the diagnosis and treatment behavior of public medical institutions and medical staff
.
Reasonably determine the salary level of public hospitals, reform and improve the assessment and evaluation mechanism, and realize the transparent and transparent salary of medical staff.
It is strictly forbidden to issue income-generating targets, and it is not allowed to directly link the salary of medical staff with departmental and personal business income
.
(23) Improve the comprehensive supervision of the medical industry
.
Strengthen the supervision and inspection of medical service prices in medical institutions, as well as information sharing between departments and cooperation in law enforcement
.
Research and formulate guidelines for price behavior of medical services
.
Strictly investigate and punish various price violations, such as non-implementation of government-guided prices, non-standard pricing in accordance with regulations, and the use of medical insurance funds in violation of regulations
.
(24) Improve the government investment mechanism of public medical institutions
.
Implement government investment in the capital construction and equipment purchase of public medical institutions that conform to the regional health plan, and the development of key disciplines
.
Implement preferential policies for investment in traditional Chinese medicine (ethnic medicine) hospitals and specialized medical institutions such as infectious disease, mental illness, occupational disease prevention and treatment, obstetrics and gynecology, and children
.
(25) Regulate the prices of non-public medical institutions
.
The medical services provided by non-public medical institutions shall implement the market-adjusted price policy, be reasonably priced in accordance with the principles of fairness, legality, honesty and credibility, and consistent quality and price, and be included in the management of the medical insurance fund paid in accordance with the medical insurance agreement
.
Strengthen the supervision of prices in non-public medical institutions during and after the event, do a good job in price monitoring and information disclosure, and take measures such as price surveys, letter inquiries, interviews, and public exposure when necessary to maintain a good price order
.
(26) Link up with the reform of the medical security system
.
Do a good job in the coordination of medical service prices and payment policies, total price management control, total medical insurance budget management, and regional point method coordination
.
Explore the formulation of medical insurance payment standards
.
Establish and improve the management system of medical insurance and medical consumables catalog
.
Deepen the reform of multiple and compound medical insurance payment methods based on the type of disease and grouping related to disease diagnosis
.
Explore the implementation of the total medical insurance payment for the close medical complex, strengthen supervision, reserve the balance on the basis of assessment, and share the reasonable over-expenditure
.
Promote all online procurement of medical consumables, and expand the scope of centralized procurement of high-value medical consumables
.
Strengthen the management of designated agreements in public medical institutions
.

　　9.
Organize and carry out pilot projects
(27) Strengthen organizational leadership
.
The regions that carry out the pilot program must fully understand the importance, complexity and arduousness of deepening the reform of medical service prices, regard the pilot reform as an important task of deepening the reform of the medical security system, implement the party’s leadership throughout the pilot process, and establish pilot work leaders.
Institutions, improve working mechanisms, strengthen organizational leadership, and carry out pilot work in strict accordance with unified deployment
.
(28) Pilot projects in a stable and orderly manner
.
The National Medical Insurance Administration, in conjunction with relevant departments, initially selected five cities on the basis of scientific evaluation, focusing on pilot projects such as total volume control, price classification formation and dynamic adjustment, monitoring and evaluation, and strengthening direct contact and guidance
.
Provinces (autonomous regions and municipalities directly under the Central Government) where conditions permit may organize cities divided into districts to participate in the pilot
.
Pilot cities should formulate pilot implementation plans based on local conditions, proceed in a steady and orderly manner, and form a reproducible and extendable reform experience
.
(Twenty-nine) careful organization and implementation
.
The pilot implementation plan should focus on prominent issues and key links, in-depth exploration of system and mechanism innovation, and strive to make breakthroughs and achieve practical results
.
The pilot implementation plan will be organized and implemented by the provincial people's government after review and report to the National Medical Insurance Bureau for the record
.
When major situations are encountered during the pilot, report to the National Medical Insurance Bureau and the provincial people's government in a timely manner
.
Non-pilot areas should follow the requirements of the "Opinions on Doing a Good Job in the Dynamic Adjustment of Current Medical Service Prices" (Yibaofa [2019] No.
79) issued by the National Medical Insurance Bureau and other four departments, and continue to straighten out the relationship between medical service prices.

.
(30) Do a good job of propaganda and guidance
.
All regions and relevant departments must take the initiative to interpret policies for deepening the reform of medical service prices, respond to the concerns of the masses in a timely manner, and rationally guide social expectations
.
Fully mobilize the enthusiasm and initiative of all parties to support and cooperate with the reform, listen to opinions extensively, gather social consensus, conduct risk assessments in advance, and strive to create a good reform atmosphere
.