Five ministries and commissions: strictly control auxiliary drugs and continue to reduce the proportion of drugs!

Source: Medical mobile news 2015-11-08 recently, the national health and Family Planning Commission published several opinions on controlling the unreasonable growth of medical expenses in public hospitals jointly issued with the national development and Reform Commission, the Ministry of finance, the Ministry of human resources and social security, the State Administration of traditional Chinese medicine, etc., requiring to effectively reduce the burden of medical expenses of the public The opinion points out that since the implementation of the new round of medical and health system reform, with the full coverage of the basic medical security system, the overall reform of the basic medical and health institutions has been promoted, the reform of public hospitals has been gradually expanded, and the increase of the hospital average cost has been controlled to a certain extent But on the whole, the problem of unreasonable growth of medical expenses still exists, which is mainly reflected in the rapid growth of the total medical expenses of public hospitals in some cities, the relatively large proportion of drug revenue, the rapid growth of the proportion of large-scale medical equipment inspection and treatment and medical consumables, and the rapid growth of the total medical services caused by unreasonable medical treatment Therefore, the opinion requires that controlling the unreasonable growth of medical expenses in public hospitals be taken as an important goal and task of deepening medical reform, and puts forward the phased goal of cost control, i.e to 2016 In the first half of the year, all localities reasonably determined and quantified the growth rate of regional medical expenses in combination with the actual situation, regularly publicized the main monitoring indicators, initially established a monitoring system for medical expenses of public hospitals, and initially curbed the irrational growth of medical expenses By the end of 2017, the monitoring and assessment mechanism for the control of medical expenses in public hospitals has been gradually established and improved, the proportion of personal expenses in the medical expenses of insured patients has been gradually reduced, and the burden of medical treatment for residents has been further reduced It is worth noting that for the main reason that has been considered to be "expensive to see a doctor", the opinion clearly proposes that the proportion of drug revenue in medical revenue of public hospitals will decrease year by year, and strive to reduce the proportion of drug in public hospitals of pilot cities (excluding herbal pieces) to about 30% by 2017 Note: proportion of drugs (excluding Chinese herbal pieces) = hospital drug income / medical income × 100%, excluding Chinese herbal pieces, which is used to reflect the level and income structure of hospital drug expenses For the so-called "anything can be treated" auxiliary drugs, the opinion requires to establish a tracking and monitoring system for auxiliary drugs, clear the drug regulations that need to be monitored, and establish a comprehensive evaluation system for clinical drugs focusing on basic drugs In addition, the opinion also puts forward 21 main monitoring indicators for the control of medical expenses in public hospitals, including the growth of regional medical expenses, the average cost and growth rate of outpatient, the average medical expenses and growth rate of inpatients, and the average cost and growth rate of 10 typical single diseases; In terms of residents' burden, including the proportion of personal health expenditure of insured patients, the proportion of expenses outside the medical insurance catalogue and other indicators; in terms of the overall efficiency of the medical service system, including the proportion of general outpatient visits, the proportion of inpatient visits, the ratio of operation type composition and other indicators in the city's Tertiary General Hospital; The income structure of medical institutions includes the proportion of outpatient and inpatient income in medical income, the proportion of drug income, inspection and test income, and the proportion of health material income in medical income; In terms of operation and management efficiency, it includes health material cost, average length of stay, management cost rate, asset liability rate and other indicators consumed by 100 yuan of medical income, and clearly puts forward guidance requirements for indicators Among them, 11 indicators are required to be gradually reduced, and 1 item is required to be gradually increased, "the total income of registration, consultation, bed, treatment, operation and nursing accounts for the proportion of medical income" The following is the original of some opinions on controlling the unreasonable growth of medical expenses in public hospitals: some opinions on controlling the unreasonable growth of medical expenses in public hospitals Since the implementation of the new round of medical and health system reform, with the full coverage of the basic medical security system, the comprehensive reform of the basic medical and health institutions has been promoted as a whole, the reform of public hospitals has been gradually expanded, and the increase of the hospital average cost has been controlled to a certain extent But on the whole, the problem of unreasonable growth of medical expenses still exists, which is mainly reflected in the rapid growth of the total medical expenses of public hospitals in some cities, the relatively large proportion of drug revenue, the rapid growth of the proportion of large-scale medical equipment inspection and treatment and medical consumables, and the rapid growth of the total medical services caused by unreasonable medical treatment In order to effectively control the unreasonable growth of medical expenses of public hospitals, effectively reduce the burden of medical expenses of the masses, and further enhance the comprehensive effect of the reform, the following suggestions are put forward 1、 General requirements We will take controlling the unreasonable growth of medical expenses in public hospitals as an important goal and task of deepening medical reform, plan as a whole, implement comprehensive policies, strengthen the policy linkage of standardizing medical treatment, improving medical insurance and reforming medicine, promote the coordination of the growth of medical expenses with the economic and social development, the operation of medical insurance funds and the people's bearing capacity, safeguard the people's health rights and interests, and promote medicine and health The healthy development of life Adhere to total amount control and structural adjustment, control the growth rate of total medical expenses, reasonably adjust the price of medical services, reduce the proportion of drug and consumable expenses, optimize the revenue and expenditure structure of public hospitals, and achieve sound operation Adhere to internal and external governance, strengthen supervision, strengthen internal management and external supervision of public hospitals, establish and improve the monitoring and disclosure mechanism of medical expenses, reform the payment method of medical insurance, standardize and guide medical service behavior Adhere to the combination of systematic governance and prevention, optimize the allocation of medical resources, gradually establish and improve the hierarchical diagnosis and treatment system, strengthen disease prevention and control and health management, and improve the overall operation efficiency of the medical service system Adhere to the actual, hierarchical classification, from the two levels of regional and medical institutions to strengthen the cost control, according to the level and growth of medical expenses in different regions and the functional positioning of the hospital, determine the cost control requirements and make dynamic adjustment By June 2016 At the end of the month, all localities reasonably determined and quantified the growth rate of regional medical expenses in combination with the actual situation, regularly publicized the main monitoring indicators, initially established a monitoring system for medical expenses of public hospitals, initially curbed the irrational growth of medical expenses, and reduced the growth rate of total medical expenses of public hospitals in cities, the average medical expenses of outpatients and per capita medical expenses of inpatients 。 By the end of 2017, the monitoring and assessment mechanism for the control of medical expenses in public hospitals has been gradually established and improved, the proportion of personal expenses in the medical expenses of insured patients has been gradually reduced, and the burden of medical treatment for residents has been further reduced 2、 To take comprehensive measures to control medical expenses (1) to standardize medical staff's diagnosis and treatment behavior To carry out the clinical pathway management, to take the negative list management of prescriptions, to implement the prescription review, antibiotic use, auxiliary drugs, consumables use management and other systems Strengthen the supervision of the rational application of Chinese herbal pieces, establish a special comment system for the prescription of Chinese herbal pieces, and promote the rational use of drugs Establish a tracking and monitoring system for auxiliary drugs, drugs used abnormally in hospitals and high-value medical consumables, make clear the drug specifications that need to be monitored, and establish a comprehensive evaluation system for clinical drugs focusing on basic drugs Strictly implement the system of clearly marked price of medical institutions and clear list of medical expenses Establish a personnel compensation system in line with the characteristics of the medical and health industry It is strictly prohibited to set income generating indicators for medical personnel, and personal salary of medical personnel shall not be linked to the business income of the hospital such as drugs, consumables, large medical equipment inspection and treatment （2） Strengthen the internal control system of medical institutions To strengthen budget constraints, the health and family planning administration department, the traditional Chinese medicine administration department or the government run medical institutions should review the hospital budget according to the industry development plan and the medical cost control objectives Strengthen the cost accounting of public hospitals and explore the establishment of cost information base of medical institutions Strengthen the use of information technology, improve the fine management level of medical records, clinical pathway, drugs, consumables, cost audit, finance and budget in public hospitals, and control unnecessary expenses Strive to reduce the consumption of health materials in the 100 yuan medical income (excluding drug income) of public hospitals in pilot cities to less than 20 yuan by 2017 （3） Strictly control the scale of public hospitals In accordance with the requirements of the notice of the general office of the State Council on printing and distributing the planning outline of the national medical and health service system (2015-2020) (GBF [2015] No 14), the provincial health resource allocation standard and the medical institution setting plan, reasonably control the bed size of public hospitals, and prohibit the unauthorized addition of beds We will strictly implement the allocation plan for large-scale medical equipment and strengthen the use evaluation, supervision and management It is strictly prohibited for public hospitals to borrow money and strictly control the construction standards （4） Reduce the inflated price of medical consumables Implement the guidance of the general office of the State Council on improving the centralized drug procurement in public hospitals (GBF [2015] No 7), and implement classified drug procurement For the basic drugs and non patent drugs with large clinical dosage, high purchase amount and produced by many enterprises, the provincial centralized bulk purchase advantages shall be brought into play, and the provincial drug purchase institutions shall adopt the two envelope open bidding procurement We will establish an open, transparent and multi-party price negotiation mechanism for some patented and exclusively produced drugs We will strengthen supervision and inspection of the implementation of drug prices Implement the sunshine purchase of high-value medical consumables, and encourage the purchase of domestic high-value medical consumables on the premise of ensuring the quality We will strictly investigate and punish commercial bribery in the purchase and sale of pharmaceutical consumables （5） We will push forward the reform of payment methods for medical insurance We will gradually reform the way of payment for all designated medical institutions and all diseases in the overall planning area We will strengthen the budget for the revenue and expenditure of medical insurance funds, establish a composite payment method that focuses on payment by disease, such as payment by head and by service unit, and gradually reduce payment by project Encourage the implementation of DRGs We will improve and implement the negotiation mechanism between medical insurance agencies and medical institutions, dynamically adjust payment standards, and strengthen quality supervision We should give full play to the role of various medical insurance in regulating, guiding, supervising and restricting medical service behaviors and costs On the basis of standardizing daytime operation and non drug diagnosis and treatment technology of traditional Chinese medicine, the scope of non drug diagnosis and treatment technology of daytime operation and traditional Chinese medicine preparation, acupuncture, therapeutic massage and other traditional Chinese medicine in medical institutions, which are included in medical insurance payment, will be gradually expanded Strict economic evaluation and examination shall be carried out for the high-value drugs and consumables entering the medical insurance catalog Considering the quality and safety of medical services, basic medical needs and other factors to develop clinical pathway, accelerate the promotion of clinical pathway management By the end of 2015, the reform of medical insurance payment mode in the pilot area of comprehensive reform of urban public hospitals should cover all public hospitals in the region The number of cases under clinical pathway management should reach 30% of the number of discharged cases in public hospitals, and the number of diseases paid by disease should not be less than 100 （6） Change the compensation mechanism of public hospitals We will eliminate the mechanism of supplementing medical services with drugs, rationalize the prices of medical services, reduce the prices of large-scale medical equipment for examination and treatment, and reasonably adjust and improve the prices of medical services that reflect the value of technical services provided by medical personnel Establish a dynamic price adjustment mechanism based on the changes of cost and income structure Adhere to the principle of "total amount control, structural adjustment, rise and fall, and gradually in place", and set aside space for adjusting the price of medical services by reducing the cost of drug consumables and strengthening cost control Effectively implement the government's role in public health care