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The reform of medical insurance payment methods from charging by service items to paying for budget management is in full swing across the country
.
The basic principle of the reform is to partially shift the financial risk from the payer level to the provider by setting a package price upfront
.
Therefore, hospitals have a lot of incentive in the DRG/DIP reform to reduce economic losses
.
.
The basic principle of the reform is to partially shift the financial risk from the payer level to the provider by setting a package price upfront
.
Therefore, hospitals have a lot of incentive in the DRG/DIP reform to reduce economic losses
.
The original intention of the "drug ratio" is to scientifically regulate hospital charges and reduce patients' medical expenses
.
Because it has become a tool for medical insurance assessment hospitals, the proportion of drugs has changed to the reason why
some hospitals prescribe laboratory tests without indication.
.
Because it has become a tool for medical insurance assessment hospitals, the proportion of drugs has changed to the reason why
some hospitals prescribe laboratory tests without indication.
At a time when hospitals are about to weaken the impact of medical insurance payment method reform on hospital revenue by accelerating turnover and cost transfer, it is particularly important to
deeply explore the reform ideas of further drug proportion.
deeply explore the reform ideas of further drug proportion.
01.
Hospital assessment urgently needs to be refined
Hospital assessment urgently needs to be refined
The extensive drug proportion assessment index not only does not reduce the burden of personal drug costs, but also declines the other, and the cost of medical consumables and diagnosis and treatment rises
.
Because the cost of medical insurance negotiation drugs is relatively high, the proportion of drugs will increase, so although "life-saving drugs" finally enter medical insurance, if they cannot be purchased in hospitals, they can only open up the "last mile"
through the special special office that does not temporarily include anti-cancer drugs in the assessment of drug proportion.
What's more, some doctors play "edge ball", do not take the medical insurance channel to prescribe drugs, and let patients go to pharmacies to buy drugs at full self-expense, which not only increases the burden on patients, but also transfers medical costs to patients and affects the doctor-patient relationship
.
.
Because the cost of medical insurance negotiation drugs is relatively high, the proportion of drugs will increase, so although "life-saving drugs" finally enter medical insurance, if they cannot be purchased in hospitals, they can only open up the "last mile"
through the special special office that does not temporarily include anti-cancer drugs in the assessment of drug proportion.
What's more, some doctors play "edge ball", do not take the medical insurance channel to prescribe drugs, and let patients go to pharmacies to buy drugs at full self-expense, which not only increases the burden on patients, but also transfers medical costs to patients and affects the doctor-patient relationship
.
As an indicator, the proportion of drugs is neutral in itself and is an objective reflection
of things.
When an indicator is overemphasized or paid attention to, it will "deform" the hospital's medical behavior and affect the basic interests of
patients.
of things.
When an indicator is overemphasized or paid attention to, it will "deform" the hospital's medical behavior and affect the basic interests of
patients.
Even if the proportion of drugs itself does not obviously exceed the standard, fraudulent insurance methods such as "hanging the bed", over-scope operation, minor diseases, excessive inspection and medication, high charges, decomposition charges, and collusive exchange fees may still emerge one after another
.
.
Extensive management policies failed to distinguish the differences in medication in patients with different severity of disease, nor did they distinguish the differences between patients diagnosed and treated in different departments and the different effects of
different drug efficacy.
different drug efficacy.
With the advancement of information technology and the further improvement of the unified medical insurance platform, the medical insurance department can grasp the information of all medical insurance drug consumables payment, as well as the prescribing records
of each prescriber.
Analysis of this data quickly identifies individuals
whose prescription patterns differ significantly from the industry average of their peers in the same class.
Further manual review can identify whether these "discrete values" are irrational drug use
.
of each prescriber.
Analysis of this data quickly identifies individuals
whose prescription patterns differ significantly from the industry average of their peers in the same class.
Further manual review can identify whether these "discrete values" are irrational drug use
.
02.
Clinical comprehensive evaluation is a heavy task
Clinical comprehensive evaluation is a heavy task
Hospital administrations need to exercise stricter management
over unreasonable prescribing behavior by individual doctors.
If the hospital and the doctor have a binding of interests and cannot carry out effective supervision, the payer outside the hospital needs to intervene
.
In this regard, the comprehensive clinical evaluation system of drugs is pinned on high expectations
.
over unreasonable prescribing behavior by individual doctors.
If the hospital and the doctor have a binding of interests and cannot carry out effective supervision, the payer outside the hospital needs to intervene
.
In this regard, the comprehensive clinical evaluation system of drugs is pinned on high expectations
.
In the past two years, the comprehensive clinical evaluation of drugs has been valued by all parties, the state has organized the formulation of management guidelines, relevant technical institutions or industry associations have been entrusted to formulate technical specifications such as evaluation methods and standards, established a comprehensive clinical evaluation expert committee, and organized and carried out comprehensive evaluation
around the selection of the national essential drugs list, the list of encouraged generic drugs, and the list of children's drugs encouraged to develop and declare for development.
around the selection of the national essential drugs list, the list of encouraged generic drugs, and the list of children's drugs encouraged to develop and declare for development.
In the next step, we need to make full use of big data resources
such as drug use monitoring data.
If we can comprehensively use materials such as drug market access, large-scale multi-center clinical trial results, "real-world" data on drug clinical practice, and domestic and foreign literature, we can integrate and analyze qualitative and quantitative data around the dimensions of drug safety, effectiveness, economy, innovation, suitability, and accessibility, and formulate priority and test-tested standards
for the selection and use of drugs in medical institutions.
such as drug use monitoring data.
If we can comprehensively use materials such as drug market access, large-scale multi-center clinical trial results, "real-world" data on drug clinical practice, and domestic and foreign literature, we can integrate and analyze qualitative and quantitative data around the dimensions of drug safety, effectiveness, economy, innovation, suitability, and accessibility, and formulate priority and test-tested standards
for the selection and use of drugs in medical institutions.
For example, the value of drugs can be evaluated in detail, and the use value of drugs in different indications can be quantitatively and qualitatively analyzed, and a set of multi-dimensional index systems
suitable for the local medical system environment can be developed.
It can also be classified and managed according to "strong recommendation", "weak recommendation" and "non-recommendation" drugs to make room for drugs with higher clinical comprehensive value, and ultimately play a role in
improving the proportion of drugs.
suitable for the local medical system environment can be developed.
It can also be classified and managed according to "strong recommendation", "weak recommendation" and "non-recommendation" drugs to make room for drugs with higher clinical comprehensive value, and ultimately play a role in
improving the proportion of drugs.
