Please answer - Health Commission's 2018

A word is far away In 2018, a new round of large-scale reform of the State Administration is undoubtedly the biggest variable affecting the future of the pharmaceutical field In this round of reform, if the National Medical Insurance Bureau (hereinafter referred to as "the medical insurance bureau") is "born out of nowhere" and splits the new era of the national medical insurance as the active payer, then the birth of the national health and Health Commission (hereinafter referred to as "the health and Health Commission") can be described as "four or two thousand catties" The "health" represented by the word "health" undoubtedly dominates all the medical and health leaders in the whole world The ultimate goal and destination of regional reform Without the health of the whole people, there will be no well-off society for all "To realize the health of the whole people" has become the will of the state, and undoubtedly the health and Health Commission, which takes the name of health after the reform, leads this important task Health is different from disease treatment, involving many factors, which is a huge project How can health be implemented as a policy measure that can be implemented now? This is undoubtedly the primary challenge faced by the health care commission after the reform of the majority system Among the lines of the "three decisions" plan, the health care Commission has clearly defined the current connotation of the ultimate goal of "achieving the health of the whole people" The new health and Health Committee has undergone profound changes in terms of its responsibilities, organization and personnel composition, all of which are aimed at changing its focus from disease treatment to people's health As the Department framework of the health committee, the change of the organization structure in the reform highlights this intention Under the background of aging in China, the health welfare of the elderly should be paid attention to Therefore, the health and Health Commission is responsible for the daily work of the National Working Committee on aging, and is in charge of the China Association for aging, which was originally managed by the Ministry of civil affairs It is responsible for the formulation of policies and measures to deal with the aging of the population and the combination of medical and health care, and the protection of the health and welfare of the elderly is included in its scope of responsibility At the same time, the occupational safety and health supervision and management responsibilities of the State Administration of work safety have also been integrated into the scope of responsibilities of the health and Safety Commission, which means that the health problems of workers have also become a topic of concern to the health and Health Commission In particular, in the new scheme, the health and Safety Commission is designated as the duty performing party of the Framework Convention on tobacco control led by the Ministry of industry and information technology, and Finally, the implementation of tobacco control work closely related to public health interests was found The health and health commission not only innovated the micro structure, but also officially released the 2018 national health city evaluation index system, which has been in preparation for a long time, within three weeks after its establishment, which means that from the perspective of urban meso level, "to achieve national health" has also found a clear quantitative definition at present The indicator system is divided into five first level indicators, 20 second level indicators and 42 third level indicators, while the health resources indicators only account for three second level indicators and eight third level indicators, and other indicators are cut into the "national health" target From this, we can also see that the focus of Health Care Commission's work has changed from health to health The scope of power is expanded and the responsibilities are correspondingly expanded Whether it's medical service, medicine or medical insurance payment, the main realization scenario is hospital and internet medical treatment As the main supervisor of the scenario, the health care Commission undoubtedly needs to coordinate multiple interests In the report on the work of the government issued in March 2018, it was clearly proposed that "in 2018, the joint reform of medical treatment, medical insurance and medicine should be carried out, the comprehensive reform of public hospitals should be pushed forward in an all-round way, the long-term drug addition policy should be cancelled, and the reform of the approval system for medical and pharmaceutical devices should make a breakthrough." In the three medical linkage work, the scene that the health care Commission manages the hospital is undoubtedly the most critical "lifeline" for the implementation of all policies After the reform of the majority system, the name of the health and Health Committee has removed the word "family planning" and added the words "health" 1 "and" glass door "of" flying cage and changing birds " At the beginning of 2018, 17 kinds of anticancer drugs were finally included in the national medical insurance catalog after three rounds of negotiations, and the price reduction rate of 17 kinds of anticancer drugs reached 56.7%, which set a precedent for the transfer of innovative drugs into the national medical insurance catalog, and the medical insurance bureau and the enterprise made coordinated concessions Subsequently, in the second half of 2018, under the premise of steady progress in the conformity evaluation of generic drugs, the national pilot program of "4 + 7" volume procurement was implemented, and the profit moisture in generic drugs is expected to be significantly squeezed in the future At the end of 2018, the national catalogue of auxiliary drugs began to be collected and prepared In the field of medicine, we are promoting the "cage for bird" policy, and medical insurance funds need to make more room for more rational use In this "great diversion" involving medicine, medical treatment and medical insurance, the health care Commission is undoubtedly the "glass door" Its tacit connection with the work of the medical insurance bureau and the drug administration directly determines the final effect of this great diversion On October 11, 2018, the medical insurance bureau held the first news conference since its establishment At the meeting, the medical insurance bureau made it clear that after 17 anti-cancer drugs were included in the national medical insurance catalog, the next step is to coordinate with relevant departments to strengthen the drug guidance for doctors, ensure the purchase and rational use of anti-cancer drugs, and ensure that patients can gradually buy anti-cancer drugs after price reduction before the end of November The key department for coordination is the health care Commission Less than one month after the ventilation meeting, the health committee, medical administration and medical administration immediately issued the notice, saying that the hospital should not influence the supply guarantee and rational drug demand of the negotiated drugs on the grounds of the total control of medical expenses, the total control of medical insurance expenses, "drug proportion" and the limit of drug varieties and quantities This means that in 17 negotiations, anticancer drugs have broken through many restrictions of the health care Commission on the use of drugs in hospitals, and the health care Commission has opened a "convenient door" for the negotiation of anticancer drugs into the medical insurance In the field of pharmaceutical bidding and procurement, the most remarkable thing in 2018 is the dust settling of the first batch of varieties purchased with "4 + 7" volume The core logic of purchasing with quantity is to exchange quantity for price and compress the price and moisture of drugs on the premise of ensuring the quality, ensuring the quantity of the winning products used by the hospital and the hospital's commitment to collect the money in time And the premise of "quantity for price" is to ensure the quantity of the winning varieties, which undoubtedly needs the active cooperation of the health care Commission At the "4 + 7" volume procurement press conference held on December 8, Ding Jinxi, Professor of China Pharmaceutical University and vice president of international medical business school, said that although centralized volume procurement is government guided procurement, both sides of the transaction are hospital and enterprise suppliers, so the final volume is guaranteed by the hospital, and the hospital and doctors should be driven to choose in policy Standard products The person in charge of the pilot office of volume procurement also made it clear that the key to the success of the pilot office of centralized procurement of drugs organized by the state is to ensure that the selected drugs enter the hospital and are used preferentially The medical security department, together with the health department, will improve the incentive and restraint mechanism of public hospitals to guarantee the achievement of the results 25 bid winning varieties of "4 + 7" volume procurement have been released According to the information of the pilot office of volume procurement, the procurement will be successively implemented in 11 cities at the end of February and the beginning of March 2019 Can the winning varieties reach the promised purchase volume? How to achieve it? This is undoubtedly the biggest focus of cooperation between the health care Commission and the medical insurance bureau in 2019 At the end of 2018, the biggest suspense left behind is the selection and release of the national catalog of auxiliary drugs, which is directly related to the space for the national health insurance to free up payment funds The fund plate of medical insurance is limited Under the premise of ensuring the normal income and expenditure, it is necessary to clean up the list of safe and invalid auxiliary drugs if more "good drugs" are to be included in the medical insurance catalog The premise of cleaning up is to closely monitor the clinical drug use and the list of auxiliary drugs provided by the health care Commission On December 8, 2018, the national health and Health Commission issued the document of the national catalog of auxiliary drugs to be issued, which clearly requires all provincial health and health administrative departments to organize medical institutions at or above the second level within their jurisdiction, to form the catalog of auxiliary drugs by using the common name of the institution and ranking the amount of annual use from more to less, and report it to the provincial health and health administrative department And the pharmaceutical industry e drug manager also learned from relevant departments that the national auxiliary drug catalog has basically completed the "local reporting link" and entered the "review link", and the catalog will be officially released soon The health and Health Committee is not only the key cooperator for the implementation of the work of "cage removal and bird replacement", but also determines the implementation effect of the tasks of the health and Health Committee In the government work report released in March 2018, an important task is to "deepen the comprehensive reform of public hospitals, coordinate and promote the reform of medical price, personnel salary, drug circulation, medical insurance payment, and improve the quality of medical and health services" One of the important prerequisites for the reform of medical service price system and the redistribution of medical personnel salary is "Teng" The work of "cage for bird" free up enough capital space At the "4 + 7" volume procurement meeting, the national health insurance bureau also responded that the core spirit of the national volume procurement is not to save money, but to invest in hospital construction and improve the quality of medical services How can the national health and Health Commission and the national health insurance bureau make a good combination of policies so that the saved medical insurance funds after the "4 + 7" procurement in 2019 can be invested in hospital reform, change the medical service price system and improve the salary and treatment of medical workers? This is no doubt to be expected in 2019 2 "30%" new game medicine reform process is always closely related to some percentages Once upon a time, this number was an important number lingering on the hospital 15% is the highest mark up rate of hospitals that have been stipulated for a long time before on the basis of the actual purchase price of drugs This policy directly nourishes the operation mode of "medical support by drugs" in public hospitals However, since 2012, the state has promoted the reform of public hospitals and gradually cancelled the drug mark up of public hospitals By 2018, the elimination of the long-term drug markup policy has been fully implemented in public hospitals A game is over and a new one is starting At present, the most concerned figure of public hospitals is 30%, which is the policy red line of "drug proportion" According to the guidance on comprehensive reform pilot of urban public hospitals issued in 2015, the proportion of public hospitals in 100 pilot cities (excluding Chinese herbal pieces) will be reduced to about 30% by 2017 But in 2018, the policy appears to have changed In 2018, 17 anti-cancer drugs were included in the national medical insurance catalog Although the average price of drugs decreased by 56.7% after three rounds of negotiation, the anti-cancer drugs themselves are still expensive If restricted by the limitations of the hospital, such as the total control of medical expenses, the total control of medical insurance expenses, "drug proportion" and the number of drug varieties, it is still difficult to land in the hospital scene On November 20, the national health and Health Commission issued a special "exemption" policy for the proportion of anticancer drugs negotiated for price reduction, stipulating that three-level general hospitals and local cancer hospitals should not influence the supply guarantee and rational drug demand of the negotiated anticancer drugs on the grounds of the total control of medical expenses, the total control of medical insurance expenses, the proportion of drugs and the quantity limit of drug varieties Before this policy was issued, there were media reports that in the short term, anticancer drugs that had been successfully negotiated in this round of medical insurance admittance may not be included in the scope of drug proportion assessment; in the long term, around the normalization adjustment mechanism of medical insurance catalogue, it is necessary to establish a long-term mechanism for rational drug use (especially drug proportion assessment) in public hospitals, rather than each medical insurance catalogue