On the adjustment of the price of medical services These 14 recommendations must be seen

According to the guidance issued by the State Council in 2015 on the pilot medical reform, the proportion of drugs in public hospitals in 100 pilot cities must fall below 30%, of which the proportion of drugs is clearly defined as the proportion of personal health expenditure to total health expensesThe aim is to reduce the current inflated drug prices, change the status quo of medicine-based medicine, reduce the cost of medical care for ordinary peopleAccording to public statistics, the proportion of medicines in public hospitals fell from 43.5% in 2015 to 28.36% in 2018According to the Opinions on Strengthening the Performance Assessment of Three Levels Public Hospitals issued by the General Office of the State Council in January 2019, the proportion of drugs will no longer be used for assessment, but medical control fees still need to continue2017, the comprehensive reform policy for public hospitals was fully rolled out, and by the end of September, all public hospitals in the country had abolished drug-addedLooking at the year-on-year health statistics yearbook, drug revenue accounts for more than 40% of the total revenue of public hospitalsUnder the reform, the reduction in revenue will be offset by adjustments in the price of health services and increased government subsidiesMost cities use "901", "811" and "721" to compensate, i.e90% or 80%, 70% through the price adjustment of medical services, 10% or 20% of the government subsidies, 10% by the hospitalSome places support the promotion of drug supplies band procurement, medical insurance payment method reform, hope to complete the overall compensationdata released by the National Health Insurance Administration on September 19, 2019 showed that compared with the end of the 12th Five-Year Plan, the prices of medical services in various provinces increased by 20% to 100%, the prices of surgical medical services increased by 40% to 150%, the prices of nursing medical services increased by 50% to 200%, and the prices of Chinese medicine services increased by 20%-60%The State Health Insurance Administration will further guide all localities in establishing a reasonable determination and dynamic adjustment mechanism for the price of medical services in public hospitals conducive to optimizing the price structure and rationalizing the price relationship, and support increasing the proportion of medical service revenue in the total hospital incomeThis paper makes some suggestions from the three medical linkage, the rights and interests of doctors and patients(i) Adjust the price of medical services for nursing projectsNursing items are priced at a deformedlow price, cost and charges are upside down, because of the small dispute, suitable for priority adjustmentThe financial subsidy is given the tilt ratio of care, so that the price payer gradually adapts to the increase in feesNursing service is in the intersection of medical and health care, rehabilitation, strong nursing value is to encourage greater health, cultivate the community to pay for health care awareness Long-term non-adjustment is not conducive to the healthy and sustainable development of nursing cause, is not conducive to the long-term nursing insurance supply side to form a price-to-price relationship (2) on the price adjustment of clinical treatment items After figuring out the necessity of price adjustment, try to start at the same time, the phased promotion can be different, but it is not appropriate to exist "tone and do not adjust, the adjustment does not adjust" situation There are references between different clinical treatment projects, but also the need of their own existing costs, the same adjustment, in order to find a reasonable path and level in the collision Let key projects, key personnel first "rich" up, recognize the value of knowledge-based economy to cash in, with the limited role of a good market economy (3) on the rationality of the return of inspection items Repeated inspection times, excessive inspection items, high price pricing is a prominent contradiction related to the interests of the people, blocking evil roads, the positive road will also significantly increase the sense of mass access Exploring the inspection and inspection project in the country or a certain overall area of the unified pricing of fees, is the administrative idea Adjusting the reasonable charging level according to the use of the equipment during the period of the period, so that the windfall is impossible, is the market approach The general analysis of the examination prescription, the demonstration of the necessity of examination, and the promotion of medical and treatment norms (4) the maximum linkage effect on financial assistance Financial assistance for the health service, the imbalance and inadequacy of the problem is also a lot Some of the most profitable hospitals have a higher proportion of their spending; Financial subsidies in the new medical reform linkage logic, not only the combination of awards, the survival of the fittest, but also to take care of the need, tilt the weak It is not appropriate to flood with large water sand, to engage in egalitarianism Financial specific practices can be tested first in the pilot areas of price adjustment (v) about the rights and interests and roles of the price payer The adjustment of the price of medical services is the distribution of money and is a matter of concern to medical service providers Medical insurance and medical care as the enjoyment of medical services, but also care about people's care, value good order of medical services The hospital in The University of Junior Has fully established the appointment system to control the limited number of services available and to further safeguard the quality of service Objectively, add a fire to the graded diagnosis In the performance appraisal of all hospital doctors, the impact weight of improving patient satisfaction is weighted (vi) a reasonable boundary on medical value services At present, the hospital in The Third A is full of people, and some other hospitals are full, which is unreasonable for financial subsidies, for hospital operations, and for social interests The ideal state of transformation is: doctors and beds in large hospitals do difficult medical treatment, do teaching and research and standard training, and other qualified hospital doctors and beds play a major role in quantity and quality The direction is to try to reduce patients and increase services Internet medical care one more, increase accessibility, convenience (vii) about the price gap between hospitals of different grades Just like the volume procurement, the surface is the control fee, is actually to adjust the structure The development of graded diagnosis and treatment, the surface is to regulate patient diversion, the actual classification of division of labor The same medical service project, the tertiary hospital is more expensive than the second-level hospital, for the present or the future, not reasonable To advocate the price difference between different levels of hospitals must reflect the objective basis, in the background of this principle, gradually reverse the subjective judgment of patients choosing different levels of hospital, classification imbalance may be easier to alleviate (viii) on the role of the internal performance reform of hospitals Linkage, integration to do pharmaceutical performance and medical performance, so that drug consumption and price reduction, medical price increase, and then on the right track Respect the realistic conditions, emphasizing that scientific research should have applied value, reform output The background of system and reform is people, and the development of talents is an inexhaustible driving force Taking the influence of Dr Zhang Wenhong on the new corona epidemic as an example, the hospital explores the forms of knowledge and ability realization for all staff and encourages doctors to play a social role in the fields of treatment, health care and scientific research (9) Project management on the price adjustment of medical services In the Opinion on Doing a good job in the dynamic adjustment of the current medical service price, it is mentioned that the basic path of "setting the starting conditions, evaluating the trigger implementation, raising and lowering the price adjustment, connecting medical insurance payment, tracking and monitoring assessment" is mentioned, and from the point of view of project management, it is recommended to pay attention to these five elements: the calculation and adjustment of adjustable interval; (10) a consultative environment on price adjustmentfor medical services Cost investigation has both historical limitations and participation in the main body The government and finance, hospitals and doctors, medical insurance and patients, from their respective efficiency, efficiency, all put forward the game of reform ideas, through linkage can force sustainable reform Confidently in the right direction, do not have to rush to success, the Ministry of Reform (11) on the central and local reforms complement each other Hospital management is more difficult than the implementation of medical service price, and the price adjustment of medical service is more complicated than the reform of medical insurance payment The reform of medical service price will greatly affect the hospital management, it will certainly not be like DRG national chess, need to borrow the co-ordination area like pay by disease group value to play practical and creative The central government gives three-point guidance, the local seven-point implementation, encourage situ at the local level in accordance with the principle direction to play dynamic, performance assessment from forever changed to their own to change (12) on excellent methodology to promote according to local conditions Shanghai medical service price adjustment experience, expensive in the phased, hierarchical sense, systematic, in the process of touching the stone across the river to take the lead in the relocation of the difficult place, which in many other places must be a very controversial matter Patching secondary issues that arise after the initial adjustment in the later stages provides an efficient methodology for many other places Some conditional places, from advanced cases to take its essence, dare not change can also be changed, not good change is also thorough (13) on the negative resistance to private health care With public hospitals as the main focus, the non-profit needs of the medical sector need to continue to be maintained New medical reform measures, including the price adjustment of medical services, should be reformed to promote the rational operation and full development of hospitals, and to maintain the balance between overall medical care and local supply and demand The new medical reform gives public hospital staff a bright career prospect, to prevent the excessive distribution of private medical care and excessive management, the expansion of disorderly, unorganized discipline, the public hospital to be reformed medical resources siphon decomposition (14) Terminals on the effect of price adjustment for medical services The most compelling is the individual side of the patient, more fresh and specific than the total medicare budget data In particular, the case of patients out-of-pocket expenses, can focus on the embodiment of the proportion of drugs, reasonable medical treatment, effective treatment of color Through the fight against fraud and insurance, payment method reform, graded diagnosis and treatment competition so that the statistical results of hospital doctors have the so-called, will force the clinical path to improve the quality Perfect government pricing and negotiation ability, it is possible in the universal free health care in the angel situation can be controlled and adjustable.