Eight departments issued the "Deepening Medical Service Price Reform Pilot Program"!

Medical Network, September 1 News On August 31, the National Medical Insurance Bureau and other eight departments issued the "Notice on Printing and Distributing the Pilot Program for Deepening Medical Service Price Reform" (hereinafter referred to as the "Pilot Program"), and the National Medical Insurance Bureau responded to the " Ten questions related to the Pilot Program were answered
.
1.
Please introduce the background and significance of the "Deepening Medical Service Price Reform Pilot Program"? Answer: The price of medical services is the most direct and practical interest issue that the people are most concerned about, and it is also related to the high-quality development of public medical institutions and medical undertakings
.
In recent years, various localities have cooperated with the cancellation of drug and medical consumables bonuses, and the implementation of centralized procurement of large quantities, which has steadily and orderly adjusted multiple rounds of medical service prices, which has promoted the optimization of medical service prices to a certain extent
.
As the medical reform continues to deepen and the situation changes and develops, the price management of medical services cannot just continue the existing practice, focusing on the number of projects and price levels
.
The first is to adapt to the new requirements of high-quality development of public hospitals
.
In the past ten years, China's public hospitals have developed rapidly.
The medical income of public hospitals and the medical insurance funds and financial subsidies flowing to public hospitals have maintained an average annual double-digit rapid growth
.
The enormous abundance of medical resources has made a positive contribution to alleviating the burden of medical care for the people
.
In the future, the development mode of public hospitals will shift from scale expansion to improvement of quality and efficiency, and higher requirements are put forward for increasing public hospitals' fine management, optimizing the structure of medical income, improving efficiency and saving costs
.
The second is to actively respond to new challenges facing the sustainability of medical security levels
.
Population aging has become China’s basic national conditions for a period of time in the future.
The elderly population has increased rapidly, the total fertility rate has fallen, and the number of births has fallen.
Coupled with the impact of changes in the disease spectrum and rising levels of consumption, medical insurance financing and expenditures are facing multiple challenges.
It is necessary to make better use of the price lever function, improve the efficiency of the use of medical resources, and ensure that the masses receive high-quality, efficient, and affordable medical services
.
Third, we must adhere to the problem orientation and make up for the shortcomings of the system
.
For example, medical service price management emphasizes micro-price setting and adjustment, and macro-adjustment is insufficient, and leverage needs to be strengthened; hospitals and doctors and other professional groups participate in price setting and adjustment to a low degree, and prices do not fully reflect the value of technical services; medical service price items are too detailed, There are large differences between regions, and there are deviations from clinical practice and patient experience; the price mechanism of medical services lacks effective connection with mechanisms such as medical staff compensation and financial investment compensation, and the comprehensive effect is insufficient
.
The price of medical services needs to be closely related to the implementation of the new development concept and the construction of a new development pattern, so as to make efforts to ease the deep-seated mechanism contradictions
.
  　　2.
What are the specific contents of the "Pilot Plan"?   　　Answer: The "Pilot Plan" requires that people's health is the center, clinical value is the direction, and the law of medical development is the law, to establish and improve to adapt to economic and social development, to better play the role of the government, to fully participate in medical institutions, and to reflect the value of technical labor services.
The price formation mechanism of medical services
.
The main content can be summarized as "5+3+4"
.
"5" refers to the establishment of five mechanisms: one is to establish a more sustainable total control mechanism, strengthen the macro management of the price of medical services, balance the needs of medical development and the affordability of all parties, and highlight key points within the total range.
There will be ups and downs to avoid flooding
.
The second is to establish a standardized and orderly price classification formation mechanism.
For common projects that are commonly developed, the government must manage the price benchmarks; for complex projects that are technically difficult, the government must "set rules and act as judges", and respect hospitals and hospitals.
The professional opinions and suggestions of doctors can better reflect the value of technical labor
.
The third is to establish a sensitive price dynamic adjustment mechanism, clarify the starting conditions and constraints of price adjustment, implement adjustments on the basis of pre-assessment, scientifically grasp the price adjustment window, and stabilize price adjustment expectations
.
The fourth is to establish a goal-oriented price project management mechanism, build a price project system with clear connotation boundaries, adapt to clinical diagnosis and treatment, and facilitate evaluation and supervision, gradually eliminate regional differences, and promote the development of medical technology innovation and clinical application
.
Fifth, establish a rigorous and efficient price monitoring and evaluation mechanism, strengthen the evaluation of the operation of medical service price reforms, and establish an incentive and restraint relationship and transmission mechanism between the monitoring, evaluation and medical service prices to ensure the stable operation of the price mechanism
.
"3" refers to strengthening three supports: one is to optimize the allocation of management authority, so that the medical service price management system can better meet the needs of macro management, and better match the management capabilities of various levels of the country, provinces, and cities.
A good reflection of the localized characteristics of medical resources
.
The second is to improve the price setting and adjustment procedures, to replace discretion with rules as much as possible, to better meet the management requirements of regulation, order, and sensitivity, and to better balance efficiency and fairness
.
The third is to strengthen management capacity building, including strengthening upper and lower linkages, regional linkages, and information sharing, improving the informatization level of medical service price management, and strengthening the construction of medical service price management teams
.
"4" refers to the coordinated promotion of 4 supporting reforms, including deepening the comprehensive reform of public hospitals, improving the comprehensive supervision of the medical industry, improving the government investment mechanism of public medical institutions, and linking up the reform of the medical security system
.
3.
In recent years, the Party Central Committee and the State Council have deployed and promoted a series of reforms such as centralized procurement of pharmaceutical consumables.
The prices of pharmaceutical consumables have continued to decline.
At the same time, medical staff expect the space left by price cuts to be used to adjust the price of medical services and reflect the value of technical labor
.
In this regard, how is the reform considered? Answer: Reforms such as centralized procurement of pharmaceuticals and consumables have lowered prices and reduced the burden on the people, which also created conditions for adjusting the prices of medical services
.
However, some media interpreted the deepening of the reform of medical service prices as "patching" the reform of centralized procurement of pharmaceuticals and consumables, and the unreasonable income squeezed out by the latter was recovered through price increases in medical services.
This interpretation is inaccurate
.
First of all, the Party Central Committee decided to deepen the reform of medical service prices with lofty intentions
.
General Secretary Xi Jinping presided over the 19th meeting of the Central Deep Reform Commission and emphasized that we must strengthen the public welfare attributes of basic medical and health services, deepen the reform of medical service prices, establish a reasonable compensation mechanism, stabilize price adjustment expectations, and ensure that the general burden of the masses is stable and the medical insurance fund can bear it.
, The healthy development of public medical institutions is sustainable, and the quality and level of medical and health services for the people will be improved
.
Deepening the price reform of medical services, through the promotion of innovation management, system integration and quality and efficiency, further enhance the price of medical services in the deepening of medicine leading role in the supply side reform service in promoting fairness, enhancing well-being, encourage innovation and support the development, Preventing risks and other aspects play a role.
It is not a two-round price increase and price reduction, nor is it a gourd and a left hand to a right hand
.
Secondly, centralized procurement with volume has created a favorable opportunity for the reform of medical service prices, but in terms of specific advancement, it is still necessary to "return to the bridge and return to the road"
.
Specifically, the centralized procurement of pharmaceuticals and consumables is aimed at "sales with gold", the purpose is to purify the market environment, squeeze out the price moisture, and reduce the unreasonable burden of the people; the reform of medical service prices is aimed at its own shortcomings, and the purpose is Build a more scientific and reasonable price mechanism to better exert leverage
.
Centralized procurement, price reduction and fee reduction have alleviated the burden on the people and won a window for reforms in the price of medical services.
However, the two reforms have their own internal logic.
It is not a simple matter of shifting, converting, and shifting medical expenses by reducing prices and increasing prices.
"Seesaw" relationship
.
Third, the specific tasks borne by the price of medical services have changed, and some past practices cannot be mechanically applied
.
From 2015 to 2019, various localities coordinated to cancel the bonuses for medicines and medical consumables, and simultaneously adjusted the prices of medical services
.
The cancellation of the drug and consumables bonus reduces the legal income required for public hospitals to maintain normal operations under the old mechanism.
The corresponding space is directly used to adjust the price of medical services, which is to cooperate with the completion of the transition of the public hospital compensation mechanism
.
After entering a new stage, public hospitals have fully implemented the "zero markup" sales of pharmaceuticals and consumables, and centralized procurement and price reductions can save public hospitals procurement costs.
The space for medical expenses thus freed up must first release the reform dividend to the people and strengthen the people.
The sense of gain and happiness
.
In addition, from the survey results, all regions have focused on increasing the prices of services such as diagnosis, surgery, nursing, and traditional Chinese medicine, which are mainly technical labor services in the past two years
.
Some professional survey reports released recently also show that the average annual cash salary of public hospitals is already higher than the average salary of urban employees
.
Regarding how the medical staff are concerned about how to better reflect the value of technical labor services, it is necessary to strengthen coordination between the reform of medical service prices and the reform of the salary system of public hospitals, reasonably determine the salary level and distribution mechanism of public hospitals, and transmit the reform dividend to the medical staff.
It is also necessary to avoid directly linking medical staff salaries with project prices and income-generating capabilities
.
4.
Does deepening the reform of medical service prices mean that medical service prices will continue to rise? Will the medical burden of the people increase as a result? Answer: Deepening the reform of medical service prices is not simply a matter of pricing adjustments, and it is not about replacing reforms with unilateral price increases
.
First of all, the most important thing in the reform of medical service prices is to establish a sound system and system
.
The price management of medical services must be standardized and standardized.
Whether adding or subtracting prices, there must be rules to follow; price trends must be related to the performance indicators of medical cost control and cost reduction.
If there is a fall, do not engage in flood irrigation; the rhythm of price changes must be controlled by the starting conditions and constraints, and you cannot rise as you want, and rise again and again; if the price can withstand the inspection of monitoring, assessment and evaluation, the price should be reduced.
Prices must be lowered in time, and social benefits must be seen when prices rise
.
Secondly, the top priority of medical service price management is to straighten out the relationship between price comparisons and give full play to the leverage function. .
For example, pediatrics, nursing, and other weak disciplines with low historical prices and insufficient medical supplies need policy incentives; difficult and high-risk medical services such as complex operations need to appropriately reflect price differences; traditional Chinese medicine with outstanding distinctive advantages and obvious functional effects Service requires inheritance, innovation and development; inspection and treatment items with a high proportion of equipment depreciation need to squeeze out water and benefit the people
.
These price comparison relationships have been straightened out.
Hospitals rely on service quality to attract people, rely on technological value to obtain returns, and their dependence on drug consumables income is reduced, which can also play a role in reducing unreasonable growth in total medical expenses
.
Third, it is necessary to improve supporting measures to ensure the overall stability of the masses' burden
.
Specifically, it is necessary to evaluate the feasibility of price adjustments beforehand, and not deviate from the basic premise of controlling the excessive growth of medical expenses and improving social benefits; in the event, the impact of price adjustments must be analyzed, focusing on groups with special difficulties, and proactively preventing and controlling risks.
Put the reform concept through the price management from beginning to end
.
After the event, that is, when it is implemented, it is necessary to coordinate the price of medical services and payment policies, and include the price adjustment part into the scope of medical insurance payment according to regulations
.
5.
What role will deepening the reform of medical service prices play in the high-quality development of public hospitals? Answer: The high-quality development of public hospitals is an eternal proposition.
The main line of the proposition is "high quality".
In other words, it is shifting from "quantity accumulation" to "quality improvement"
.
The price of medical services can play the following functions in promoting the high-quality development of public hospitals: One is the "measurement" of the value of technical labor services
.
In the past, some hospitals mostly relied on medicines and consumables to increase their income.
The “income-generating” ability of disciplines dominated by technical and labor services was weak, the status of the hospitals declined, and the development momentum was insufficient
.
At present, the state has reduced the proportion of revenue from pharmaceuticals and consumables by abolishing the addition of pharmaceuticals and consumables and concentrated purchases in quantities, and gradually optimizes the price of medical services.
The medical and medical technology disciplines based on technical and labor services are difficult to develop under the traditional model.
Reform It is expected to usher in a period of opportunity later
.
The second is the "signal light" for optimizing the allocation of medical resources
.
For example, in accordance with the system design, the introduction of public hospitals into price formation for complex projects, the price adjustment will be more flexible and targeted; for general-purpose projects, the government will strengthen the control of price benchmarks and price adjustment rhythms. .
The price classification mechanism can guide high-level hospitals to focus on difficult and risky projects, avoid the siphon effect, and promote hierarchical diagnosis and treatment
.
The third is a "booster" for public hospitals to practice their internal skills
.
The reform of medical service prices links the incentive and restraint mechanism with the high-quality development of public hospitals.
Public hospitals have carried out "knife inward" reforms in standardizing diagnosis and treatment behavior, controlling costs and expenses, etc.
, which has become a window to help open medical service price adjustments.
The key to expanding the total amount of price adjustments has added a mechanism guarantee for public hospitals to demand dividends from reforms and benefit from management
.
Of course, the development of medical and health services is ultimately to serve the health and well-being of the people.
It requires not only a higher level of service capabilities and a higher level of medical technology, but also the burden of controlling the burden within the range that the whole society can bear.
The relationship between "good disease" and "people can afford to get sick" should guide public hospitals to "practice their internal skills" and avoid "arms race", blind expansion, and excessive advancement
.
We cannot simply use the price of medical services as a compensation tool for public hospitals, and blindly build and expand the scale by raising prices and increasing revenue
.
6.
The "Pilot Plan" proposes to combine the characteristics of medical services and manage the prices of medical services by classification.
What are the specific considerations for implementation? Answer: Medical treatment is a very professional field.
There are various diseases and complicated treatment plans.
All of them adopt the same set of price formation mechanism, rules and methods, and it is difficult to reflect the characteristics of the service itself
.
The "Pilot Plan" proposes to establish a standardized and orderly price classification mechanism, and divide medical services into two types: First, general-purpose services such as diagnosis and nursing.
The path is simple and the content is clear.
It is widely controlled by the majority of medical institutions and medical staff.
Application, the degree of service homogeneity is relatively high, and a standardized, stable, and universal nationwide and regional price system can be constructed
.
Although the number of general-purpose projects is small, they occur frequently and on a large scale
.
They play a decisive role in the entire medical service price system and public hospital service income .
We must adhere to the public welfare attributes of public medical institutions, and manage the price benchmarks of general-purpose projects well, and play the role of ballast and stabilizer. .
The second is complex projects, such as difficult and high-risk surgical projects, which require relatively high requirements for the personal capabilities of medical staff and the technical support system of medical institutions, and the degree of homogenization of services is limited
.
In the past, price management relied entirely on government administrative decision-making, and the hospital doctors only implemented it passively
.
The reform emphasizes that the government "sets rules and acts as a referee", manages the "cage" and "ruler" of price adjustment, introduces public hospitals to participate, and forms prices within the given "cage" and "ruler", which not only gives play to the professional advantages of public hospitals, Also guide public hospitals to strengthen internal fine management
.
In addition, for special medical services whose prices are set by public medical institutions independently, we must adhere to the public welfare attributes of public hospitals, strictly control the scale, and avoid impacting the dominant position of basic medical services
.
7.
The "Pilot Plan" proposes to establish a sensitive and effective price dynamic adjustment mechanism, and clarify the starting conditions and constraints of price adjustments.
What are the specific considerations? Answer: The price of medical services involves a profound adjustment of various interests
.
The establishment of sensitive indicator conditions and trigger mechanisms can better solve the problems of expected management and price adjustment windows, and avoid long-term immobility and sudden changes
.
In 2016, the state has already put forward the requirements of a "dynamic adjustment mechanism for medical service prices"
.
After the establishment of the National Medical Insurance Administration, on the basis of a wide range of opinions, together with the Health Commission, the Ministry of Finance, and the State Administration of Market Supervision, issued the "Opinions on Doing a Good Job in the Dynamic Adjustment of Current Medical Service Prices" (Medicine Baofa [2019] No.
79) , Requiring all provinces to design a dynamic adjustment mechanism in accordance with the basic path of “setting start conditions, evaluation trigger implementation, price adjustments with price increases and price reductions, medical insurance payment connection, tracking monitoring and assessment”, and corresponding regulations on starting conditions and price adjustment paths
.
The "Pilot Plan" combines the overall design of deepening the reform of medical service prices and proposes an upgraded version of the dynamic adjustment mechanism, which is not only a continuation of historical tasks, but also innovation and optimization from a new starting point. .
The first is to further clarify the activation conditions, constraints and trigger mechanisms of dynamic adjustments, and achieve institutional closed loops through the "indicator system + regular evaluation", so that macro management can better guide micro price adjustments, and micro price adjustments can better serve macro management
.
Second, a differentiated dynamic adjustment mechanism has been established for the price adjustment of general-purpose projects and complex projects, making the triggering mechanism of general-purpose projects more concise, price trends more stable, and making the triggering mechanism of complex projects more sensitive and within a controllable range , Highlight the key points, walk quickly in small steps, and adjust the rotation
.
The third is to allow flexible selection of price adjustment windows for special price adjustments that are coordinated with major reform tasks, major public health incidents, and eased prominent price contradictions
.
8.
Medical service price items are an important part of price management.
Some medical institutions have reported that the existing medical service price items cannot fully meet clinical needs, and the slow pace and long procedures for applying for new items affect technological innovation
.
In this regard, what are the considerations and measures for the reform pilot? Answer: The price item is the basic unit of medical service charges.
It is the basis for the pricing, execution, and evaluation of medical services.
It is also the focus and difficulty of deepening the reform
.
There are indeed some problems with the existing price items, which are mainly manifested in: First, it is out of touch with the feelings of the masses
.
At present, setting up price items is relatively close to the operation steps and job division, which facilitates the financial management of the hospital, but correspondingly, the complete medical service will be split into too many and too detailed charging items.
There are many complaints from the masses and they think that the medical care is to be bought.
The output of the service is priced and paid item by item according to the input of medical services, which is difficult to understand
.
The second is out of touch with clinical improvement and innovation
.
At present, the “technical specifications” of price items are heavy, and the operating steps, technical standards, and allowable equipment consumables are included in the content of the item.
If you slightly change the operating parts, steps, and methods in clinical practice, you may not find the corresponding price.
Projects, and applying for new price projects may face the issue of whether innovation and economy are sufficient.
The long demonstration period affects clinical improvement and innovation
.
The third is out of touch with the need for price management
.
New medical technologies are relatively free to enter clinical applications, and there is no technical access link similar to drug review and approval. .
For the same service items, the names, connotations, and boundaries of different regions are not unified, and after they are converted into pricing units, this difference continues.
As a result, it is difficult to accurately evaluate prices between regions, which affects the scientific and effective price management
.
Moreover, in the past, it was emphasized that medical consumables should be combined in the price item.
The original intention was to indirectly restrict the cost of medical consumables.
However, many problems have been exposed in practice.
In fact, innovation and economy are not high.
If the price department allows additional items to be charged, it will increase the patient's unnecessary burden, and if the original item is required to charge, it will be criticized for hindering progress
.
The "Pilot Plan" proposes to establish a goal-oriented price project management mechanism, which is to clarify the top-level design and bottom-level logic of the medical service price project from the perspective of patient benefit and follow the direction of "output-oriented, technology-consumption separation" A price item system that has clear connotation boundaries, is suitable for clinical diagnosis and treatment, and is easy to evaluate and supervise, so that medical service price items return to the proper appearance of the service pricing unit, and strive to solve the "unfriendly", ungrounded price items, and the rhythm of new items from the source Problems such as slowness and imbalance in the proportion of Chinese and Western medicine items
.
At the same time, the National Medical Insurance Bureau will classify and integrate existing price items, optimize the management of new price items, introduce innovative and economic evaluations, and ensure that patients receive timely medical services with more clinical value and cost-effectiveness
.
9.
The "Pilot Plan" proposes to establish a strict and efficient price monitoring and assessment mechanism.
What are the specific considerations? Answer: The price of medical services is an important price for people’s livelihood.
It involves 1.
4 billion people, 7.
87 million medical staff, and a huge body of more than 50,000 medical institutions.
It involves trillions of dollars in benefits every year.
Reliable data and information are required for reform and management.
Basic, sensitive monitoring and evaluation mechanism guarantees, supported by analysis and evaluation before and after the event
.
Before the price adjustment, comprehensive and accurate data cannot be obtained.
Based on the experience operation, the scientificity and pertinence of the price adjustment cannot be guaranteed; after the price adjustment, the impact of the new price on medical behavior and medical resources cannot be tracked and evaluated, and the price policy cannot be improved in time
.
The "Pilot Plan" proposes to establish a strict and efficient price monitoring and assessment mechanism
.
The first is to upgrade price monitoring from a general work requirement to a special price mechanism, closely cooperate with price mechanisms such as total volume control, classification formation, and dynamic adjustment, to form a complete management system and policy closed loop, so that price management and hospital operation can be integrated.
Form a positive interactive relationship between
.
The second is to enrich the specific content of the price monitoring mechanism.
On the basis of consolidating the data foundation of price management and grasping the effect of price implementation of medical institutions, it is proposed to compile and release the price index of medical services to provide support for strengthening macro management and avoid blindness, Arbitrary; again, it emphasizes the use of price monitoring results, including the requirement that the monitoring results be linked to the price of medical services, etc.
, monitoring finds that the price is abnormally high and low, and intervention measures should be taken to implement the hospital's price responsibility assessment
.
Extend price monitoring and evaluation from a simple observation and discovery function to a certain supervision and management function to provide institutional guarantees for the effectiveness and long-term vitality of the reform
.
10.
The positioning of this deepening of the reform of medical service prices is a pilot.
What are the specific considerations and arrangements? Answer: The price of medical services involves many stakeholders and the situation is complicated.
There are profound chemical reactions with many mechanisms such as the development of medical services, the operation of public hospitals, and the construction of the medical security system, which need to be promoted steadily
.
Therefore, the price reform of medical services will be a gradual, step-by-step, and time-honored process
.
We will start from the pilot program.
It is estimated that within 3-5 years, we will explore the formation of reproducible and extendable reform experience and typical samples, and then gradually promote them
.
In the next step, the National Medical Insurance Bureau will identify five pilot cities in accordance with the requirements of the "Pilot Plan", and directly contact and guide them to actively, steadily and orderly advance
.
At present, the National Medical Insurance Bureau has formulated a detailed work plan, and the application and selection of pilot cities are progressing smoothly
.
Provinces that have not participated in the national pilot program, and where conditions permit, may organize cities with districts to carry out pilot projects in accordance with the requirements of the "Pilot Program" and to jointly transform the reform vision described in the "Pilot Program" into tangible results for the people
.
  　　Deepening the pilot program of medical service price reform   　　Deepening the reform of medical service prices 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
.
Guided by Xi Jinping’s Thought on Socialism with Chinese Characteristics for the New Era, thoroughly implement the spirit of the 19th National Congress of the Communist Party 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 the price items, the market mechanism is brought into play, and centralized procurement and "zero markup" sales are implemented
.
(6) Optimize the management of new price items
.
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 shall determine the prices of special services and new items in the trial period (trial period 1 to 2 years), and report them to the competent department of medical service prices for the record
.
Pricing must 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 occupies 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 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
.
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
.