Notice on promoting charging by disease

[industry trends of China Pharmaceutical network] the national development and Reform Commission recently issued the notice on promoting charging by disease, which identified 320 specific disease types for use in promoting charging by disease It is required that the pilot areas of comprehensive reform of urban public hospitals should have no less than 100 diseases charged according to diseases by the end of 2017, and the detailed rules for the implementation of charging according to diseases should be published and implemented to the public by the end of June 2017 In addition to the 320 diseases published, specific diseases can also be determined by each region according to the actual situation The document was jointly signed and issued by the development and Reform Commission, the Ministry of human resources and social security and the health and Family Planning Commission (picture source: Baidu picture) 1 After the expansion of 320 diseases, there are four principles: clear diagnosis, mature technology, less complications, and exact curative effect The implementation of charge by disease focuses on the common and frequently occurring areas with standardized clinical pathway and clear treatment effect, and daytime operation is encouraged to be included in the range of charge by disease After the specific determination, how to establish the charging standard for each disease? There are two methods: one is to refer to the technical specifications of related diseases, and this part of contents will be entrusted to relevant industry associations or associations for unified release One is to measure and calculate the actual expenses incurred in the past, based on the reasonable cost of medical services, and to reflect the value of medical technology and medical personnel services The clinical technical specifications of corresponding diseases are always regarded as a major difficulty in charging according to diseases because of the great difference between the medical technical level and the actual needs of each clinical department Now, the document specifically requires that this work be put on the agenda Compared with 2011, the specific charging scope is also clearly stipulated in the document, that is to say, all expenses incurred in the whole process of diagnosis, treatment, operation, anesthesia, inspection, care, bed, drugs, medical materials and other patients' hospitalization period, including all expenses incurred in the process of admission from patients, standardized diagnosis and treatment according to the disease treatment management process, and discharge after reaching the curative effect standard 。 In addition, it is expressly required that "no additional charge" shall be made in addition to the disease cost, and the 2011 version is expressed as "in principle, no additional charge shall be made in addition to the disease cost" In addition, it also requires that "the examination and test fees after admission shall not be converted into outpatient fees" In addition to the principle of "incentive and restriction", the "high price limit management in principle" is put forward according to the pricing standard of disease charges, and the dynamic adjustment mechanism of the charging standard should be realized It is obvious that the dynamic adjustment cannot be achieved without the health and Family Planning Commission, which manages medical services, and the human resources and social security department, which manages medical expenses Under the background that the medical insurance payment standard has not yet been issued, the Ministry of human resources and social security, which did not appear on the document six years ago, appears as the main participant this time As the buyer, it is specified in the document that the medical insurance agency shall determine the medical insurance payment standard of the corresponding diseases through negotiation with the medical institution, and adjust it in time according to the actual situation, taking into account the local implementation of the disease based charges, the bearing capacity of the medical insurance fund, the burden level of the insured personnel and other factors One of the main reasons why the pilot implementation of pay by disease in many places in China has been hindered is that the enthusiasm of medical institutions and medical personnel has not been fully mobilized, and the document clearly stipulates that pay by disease will be included in the performance evaluation system of public medical institutions 2 pharmaceutical enterprises must face that the basis of charging by disease is the clinical pathway, so for pharmaceutical enterprises, the key to be selected by the hospital is to enter the clinical pathway of products In addition, drugs and consumables will become the cost rather than the income of the hospital under the payment mode of disease charges Some analysis thinks that this will fundamentally curb the habit of using expensive drugs in the hospital, after all, the excess part of the cost is borne by the hospital And now, the performance evaluation of public hospitals will specifically assess the specific implementation of the charges according to the disease, and the pressure and motivation of hospitals will be greater Hospitals can only choose drugs with higher cost performance Some analysis points out that the competition among pharmaceutical enterprises will be further enhanced Only when drugs are included in clinical diagnosis and treatment specifications can they be more likely to be prescribed by doctors Most drugs that cannot be included in the scheme will face delisting, switching to OTC, or selling through e-commerce Product enterprises should focus on the collection of evidence of clinical value of drugs, while drug enterprises with multiple joint production should face the price war A large number of auxiliary drugs that have been basically cut off by the catalogue of auxiliary drugs and the catalogue of key drugs monitoring will be critically hit again A person in charge of a traditional Chinese medicine enterprise once said that the "disease type" in the "payment by disease type" basically uses the western medicine disease name No matter the traditional Chinese medicine basic medicine type or the medical insurance type, many of the functional indications in the manual of traditional Chinese medicine lack the title of Western medicine disease name Because it can't "enter the seat with the right number", it will inevitably lead to the situation that the traditional Chinese medicine will face the reimbursement of medical insurance However, it is clear that for generic companies with guaranteed quality and efficacy, but more advantageous price, charging by disease will be a significant benefit In addition, as the sales pressure in the hospital continues to soar, it can be predicted that more pharmaceutical companies will explore DTP business.