Official notice to Shanghai public medical institutions: zero profit for consumables

Yes! On December 20 (two days later), all public medical institutions in Shanghai collected medical devices at the purchase price without any profit, and the zero margin policy was implemented On December 17, Shanghai Medical Insurance Bureau and health care Commission issued a document, and the new policy on consumables sales began to be implemented According to the price law of the people's Republic of China and the notice of the general office of the State Council on printing and distributing the reform plan for the treatment of high value medical consumables and other relevant regulations: All public medical institutions in Shanghai shall regulate the price behavior of medical devices, and shall not charge patients for medical devices that cannot be charged separately according to the regulations on price management of medical services; As for the medical devices that can be charged separately, they shall be sold according to the actual purchase price of the medical institution (the price after deducting various discounts) from December 20, 2019, without any price increase After the implementation of zero difference rate, all medical institutions shall sell the medical devices according to the current purchase price and shall not raise the purchase price at will Other designated medical institutions of medical insurance in this city shall implement synchronously in accordance with relevant provisions of the agreement According to the requirements of the state health insurance bureau: before the end of the year, to achieve the "zero difference" sales of medical consumables in all public medical institutions, high-value medical consumables should be sold according to the purchase price What is it? The so-called "zero difference rate" is that medical consumables are sold according to the purchase price in the use of medical institutions, and no more price increases will generate profits In the past, consumables from the manufacturer to the sales terminal have to go through many intermediate links to increase the price After entering the sales terminal hospital, the state allows medical institutions to increase the price again and finally sell them to patients What about the lost profits of the hospital? Previously, the State Council issued the reform plan for the treatment of high-value medical consumables, which pointed out that the reasonable income of public medical institutions reduced due to the cancellation of the medical consumables bonus was mainly properly solved by adjusting the price of medical services, appropriate financial subsidies, and the connection with medical insurance payment Public medical institutions should reduce costs by means of classified and centralized procurement, strengthening cost accounting, standardizing and rational use, so as to achieve sound and stable operation How to raise the service fee and how to distribute it reasonably have always been the focus of the industry The plan of Weihai City is a typical reference Recently, Weihai Medical Insurance Bureau issued the notice on canceling the medical consumables addition and rationalizing the price of some medical services (Draft for comments) It is reported that the case was drafted in accordance with the spirit of documents such as the notice of the general office of the State Council on printing and distributing the key tasks of deepening the reform of the medical and health system in 2019 and the opinions of the general office of the provincial Party committee and the provincial government on further deepening the reform of the medical and health system According to the document, the markup of medical consumables for all kinds of public medical institutions at all levels in the city will be cancelled All medical consumables that are allowed to be charged to patients separately will be sold at a "zero margin" based on the actual purchase price For medical consumables packaged in the form of cost and included in the price of medical services, public medical institutions shall not accept the price discount or other forms of discount given by the operators in addition to the actual purchase price In price adjustment, filter price adjustment items The price adjustment mainly involves three parts: First, Mr project; Second, comprehensive and clinical diagnosis and treatment projects, involving more than 40 projects of diagnosis and treatment, nursing, surgery and traditional Chinese medicine, which are generally characterized by large labor consumption, high technical requirements and large differences from provincial standards; Third, some orthopedic surgery projects are greatly affected by the cancellation of the medical consumables addition policy At the same time, 61 medical service prices of public hospitals above the county level will be adjusted, and the adjusted price is 86.26% of the provincial standard Next, according to the unified deployment of the Provincial Bureau, we will further reduce the inspection and laboratory fees and other items to make room for optimizing the price of medical services We should strengthen the standardized management of high-value medical consumables, clarify the scope of treatment, and focus on the high-value medical consumables with relatively high unit price and resource consumption Make rules for unique identification system of medical devices Gradually unify the classification and coding of high-value medical consumables for national medical insurance, and explore the connection and application of standardized coding in the registration, purchase and use of high-value medical consumables Establish a high-value medical consumables price monitoring and centralized procurement management platform, strengthen statistical analysis, and do a good job in interconnection with the medical insurance payment audit platform Establish a mechanism for sharing and linking price information of high-value medical consumables among departments, and strengthen the monitoring of purchase and sale price information Establish the access system of basic medical insurance for high-value medical consumables, implement the directory management of high-value medical consumables, improve the dynamic adjustment mechanism of the directory, timely supplement the necessary new technology products, and withdraw the products that are no longer suitable for clinical use Gradually implement the price negotiation for medical insurance access of high-value medical consumables, and realize "price for quantity" Establish the enterprise reporting system for high-value medical consumables products Enterprises shall submit reports on relevant prices, market sales, health economics evaluation, adverse event monitoring, etc for products to be included in the medical insurance as the necessary basis for medical insurance access review Establish medical insurance evaluation management system and standard system for high value medical consumables According to the principles of purchasing with quantity, linking quantity and price, and promoting market competition, we will explore the classified and centralized purchase of high-value medical consumables All public medical institutions shall purchase high-value medical consumables through open transaction and sunshine procurement on the procurement platform For high-value medical consumables with large clinical dosage, high purchase amount, mature clinical use and produced by multiple enterprises, explore centralized procurement by category, encourage medical institutions to jointly carry out negotiation procurement with quantity, and actively explore cross provincial alliance procurement For the high value medical consumables that have passed the medical insurance admittance, defined the medical insurance payment standard and relatively stable price, the direct online purchase shall be carried out Strengthen the supervision of the actual purchase amount of high-value medical consumables in medical institutions The addition of medical consumables in public medical institutions will be cancelled By the end of 2019, the "zero margin" sales of all medical consumables in public medical institutions will be realized The sales price of high-value medical consumables will be executed according to the purchase price The reasonable income reduced by public medical institutions due to the cancellation of medical consumables bonus is mainly solved by adjusting the price of medical services, appropriate financial subsidies, and linking up with medical insurance payment Public medical institutions should reduce costs by means of classified and centralized procurement, strengthening cost accounting, standardizing and rational use, so as to achieve sound and stable operation 。 Considering factors such as payment ability of medical insurance fund, patient's bearing ability, classified and centralized procurement, actual market transaction price of high-value medical consumables, fully consider the normal operation of public medical institutions, study and formulate medical insurance payment policies, scientifically formulate medical insurance payment standards for high-value medical consumables, and establish a dynamic adjustment mechanism If the medical insurance access negotiation has been passed, the payment standard of medical insurance shall be determined according to the negotiation price For the high-value medical consumables with the same category and similar functions, the unified payment standard for medical insurance is explored Medical insurance fund and patients pay high value medical consumables according to medical insurance payment standard respectively, and guide medical institutions to reduce the purchase price actively We will improve the clinical diagnosis and treatment standards and guidelines for key departments and diseases, strictly manage clinical pathways, and improve the standardization level of clinical diagnosis and treatment Strengthen the operation management of high value medical consumables and standardize the clinical technical guidance behavior The user shall include the standardized use of high-value medical consumables into the standardized training and continuing education of medical personnel, and use them in strict accordance with the requirements of product instructions, technical operation specifications, etc To explore and promote the construction of professional system and professional team of relevant employees in medical institutions Improve the clinical application management of high-value medical consumables and incorporate it into the performance evaluation system of public medical institutions We will intensify random inspection of medical quality, carry out special governance actions in key areas, strictly investigate and deal with violations of clinical use of high-value medical consumables in various medical institutions at all levels, and establish and improve relevant credit evaluation systems Establish a mechanism for admission and selection of high-value medical consumables in hospital, and prohibit departments from purchasing by themselves Define the high-value medical consumables management department, and implement the post responsibility to each person Improve the hospital review mechanism and early warning mechanism for the use of high-value medical consumables, carry out monitoring and Analysis on the use of single brand high-value medical consumables and the use of high-value medical consumables for single operation by medical personnel, timely interview relevant medical personnel in case of abnormal use, and link the monitoring and analysis results with performance assessment The use of high-value medical consumables will be included in the medical insurance service agreement of designated medical institutions, the management of medical insurance doctors will be strengthened, and those who violate the medical insurance service agreement will be dealt with through interview, warning, criticism, rectification within a time limit, suspension or termination of the agreement, etc Improve the construction of medical insurance intelligent audit information system, strengthen big data analysis of high-value medical consumables, focus on monitoring, key audit, regular notification and public disclosure to the public for medical institutions and medical personnel with high frequency and high cost of high-value medical consumables Establish a "blacklist" system for designated medical institutions and medical personnel, and improve the credit evaluation system for designated medical institutions Strictly regulate the pre marketing registration and approval process of high-value medical consumables, and strengthen the effective connection of new product medical insurance management and registration and approval Improve the technical requirements of medical device registration, and promote the standard of high-value medical consumables to be in line with international standards Timely release relevant approval information and strengthen social supervision Establish product information traceability system and lifelong responsibility system for product quality of production enterprises Strengthen the quality management of high-value medical consumables in the whole life cycle, and improve the policies of R & D, examination and approval, and standardized application Encourage the innovation and development of high-value medical consumables, support the research and development of medical consumables, accelerate the registration and approval of high-tech high-value medical consumables, and promote fair market competition We will increase the intensity of spot check, flight check and production link check for production enterprises Establish the report system of medical consumables defect rate in medical institutions, and carry out the monitoring and re evaluation of medical devices adverse events in accordance with the management measures for monitoring and re evaluation of medical devices adverse events Improve the scale, specialization and informatization level of high-value medical consumables circulation field Public medical institutions should establish a selection mechanism for distribution of high-value medical consumables to promote reasonable market competition To standardize the management of purchase and sale contracts, medical institutions should complete the payment collection in strict accordance with the contract Encourage all localities to reduce the circulation of high-value medical consumables through "two ticket system" and other ways in combination with the actual situation, and promote the open and transparent purchase and sale behavior The credit management system shall include the credit management system of high value medical consumables related enterprises and their employees, strengthen the record, publicity and early warning of dishonesty, and strengthen the performance management We will give full play to the leading role of Party organizations in public medical institutions, strictly implement the principle of "one post, two responsibilities", and effectively strengthen the construction of a clean and Honest Party style and anti-corruption work The party organization of public medical institutions should take the prevention and punishment of corruption in the management and use of high-value medical consumables as an important part of the overall strict governance of the party, assume the main responsibility, and establish and improve the work system of strict supervision and management of high-risk departments, posts and personnel The discipline inspection and supervision institutions of public medical institutions shall perform the duty of supervision and discipline accountability, strengthen the supervision and inspection of Party members, cadres and medical personnel in strict compliance with the party discipline and national law, and seriously investigate and deal with the problems of irregularities and corruption in the field of high-value medical consumables 。 Establish a multi department joint disciplinary mechanism to crack down on business