The Ministry of Commerce restarts the separation of medicines: Is it popular or bad?

Source: from September 9, 2014, the Ministry of Commerce, the national development and Reform Commission and other six departments jointly issued the notice on implementing the key tasks of medical reform in 2014 to improve the service level and efficiency of drug circulation (hereinafter referred to as the "notice") The notice made it clear that we should clear and abolish the unreasonable policies of intervening in the pharmaceutical market, adopt various ways to promote the separation of medicine, and explore the role of retail pharmacies in hospital pharmaceutical services in the pilot city of public hospital reform On September 4, according to media reports, people familiar with the matter said that the Ministry of Commerce will lead the separation of medicine, and has sent the documents related to "separation of medicine" to the State Council, waiting for the issuance of the premier The document advocates to seek the separation of various forms of medicine, improve the supply and guarantee ability of retail drugstores, and gradually transfer the outpatient drugstores of hospitals to retail drugstores In the past five days alone, the news has been made public In response to the rumor that "in the future, the Ministry of Commerce will be responsible for the separation of medicine", the insiders close to the Ministry of Commerce told the health sector, "it can not be said that the Ministry of commerce is responsible for the separation of medicine, only the Ministry of commerce can push." "On the morning of September 10, the Ministry of Commerce will organize relevant insiders to discuss the first draft," he told the health community It is worth noting that according to the 2014 key tasks of deepening the reform of the medical and health system issued by the general office of the State Council on May 28, of the 31 key tasks, only the task of "improving the service level and efficiency of drug circulation" is led by the Ministry of Commerce At the same time, the State Council also proposed in the document that "the Ministry of Commerce may take various forms to promote the separation of medicine." However, there is no specific implementation path It is not difficult to find out that the main theme of the Ministry of Commerce to promote the separation of medicine is to "peel off the outpatient pharmacy of the hospital and let the retail pharmacy undertake the hospital pharmaceutical service" However, under the current medical system, public opinion has different opinions on the exploration mode Among them, drug distribution enterprises actively support, and medical institutions negatively treat or even oppose There are also industry concerns that, in the current environment where the management and management have not been separated and the reform of public hospitals has stagnated, it is impossible to achieve the desired results by administrative means to force "separation of pharmaceutical industry" As early as 2007, the debate on separation of medicine was clearly put forward in the report of the 17th National Congress of the Communist Party of China The direction of medical reform should be divided into four parts, namely, "separation of politics and affairs, separation of management and management, separation of medicine, separation of profit-making and non-profit" Among them, the separation of medicine is regarded as an important cut-off point to maintain medicine On March 17, 2009, the State Council issued the opinions of the CPC Central Committee and the State Council on deepening the reform of the medical and health system, which made it clear that "medical separation" was one of the four basic principles for the implementation of the public hospital reform in the new medical reform Later, the "recent key implementation plan of medical reform" clearly proposed "actively explore a variety of effective ways to separate medicine" The plan and implementation plan for deepening the reform of the medical and health system during the 12th Five Year Plan period, issued on March 23, 2012, determined that "separation of medicine" is a key link in the reform of public hospitals, aiming to eliminate the mechanism of supplementing medicine with medicine Since then, the 12th Five Year Plan of medical reform and the subsequent reform of county-level public hospitals, the leading idea of medical separation reform is to cancel drug addition, in order to cut off the interest relationship between drugs, hospitals and doctors However, there have been different views on how to define "medical separation" There have always been different practices in the separation of medicine, including two lines of revenue and expenditure, pharmacy trusteeship, cancellation of drug markup, etc At present, the separation of medicine is mainly carried out from the interest mechanism without changing the institutional settings This is also the main point of view of the national health and Family Planning Commission on the separation of medicine, that is, "separation of medicine" means that the income and expenditure of medicine and medicine are calculated separately in the hospital, and the revenue and expenditure are managed in two lines; it is to cancel the addition policy of medicine sales in the hospital, and the zero difference rate of medicine sales, etc But corresponding to this, there are also claims that the essence of medicine separation should be "medicine separation", that is, medical institutions do not set up outpatient dispensaries, patients can buy drugs from retail pharmacies with doctors' prescriptions The Ministry of Commerce, which is in charge of the drug distribution industry, has been inclined to the latter approach An expert who once participated in the investigation organized by the Ministry of Commerce said that the Ministry of Commerce proposed that the division of medicine industry should "let doctors and medical representatives not know where patients are going to buy drugs with prescriptions, so as to cut off the economic connection between doctors and drugs" In fact, this reform is not the first time for the Ministry of Commerce to propose to divest the outpatient pharmacy of the hospital, and the retail pharmacy is responsible for the pharmaceutical service of the hospital In June 2010, a notice on defining the division of responsibilities for drug distribution management was issued by the office of the CPC Central Committee, which completely transferred the drug distribution industry from the drug regulatory department to the Ministry of Commerce After obtaining the subjective right, the Ministry of commerce immediately proposed to cut down the community pharmacy as a new member of the medical reform team, and the patients went to the pharmacy to buy medicine According to the analysis, the reason why the Ministry of Commerce put forward the above idea is that in China, the big terminal of drug sales is still in the hospital, and the power of the Ministry of commerce is not worthy of the name However, if the drugstores are put into the drugstore industry from the most basic community hospitals, the supervision power of the Ministry of Commerce will be actually expanded with the help of the pilot of pharmaceutical industry division 2011 5 In June, the Ministry of Commerce issued the 12th Five Year Plan for national drug distribution industry, which clearly stated that we should actively explore the specific ways to realize the separation of medicine In the basic medical institutions that have implemented the basic drug system and cancelled the medical supplement with medicine, especially in the urban community medical service institutions with relatively complete supporting facilities for drug retail, we can take the lead in exploring that doctors are responsible for outpatient diagnosis, and patients can take the lead in finding out that doctors are responsible for outpatient diagnosis The mode of prescription to retail drugstore In February 2012, researchers organized by the Ministry of Commerce conducted an investigation in community hospitals in Beijing, Shanghai and other places In March, the Ministry of Commerce submitted a research report to the State Council, pointing to the chronic disease of the medical system of "supporting doctors with drugs", asking to participate in the reform, and elaborating the plan and implementation path of its participation in the reform According to the report, it is a common practice in the world to hand over outpatient dispensaries to pharmaceutical commercial chain companies, and it is also a necessary way to truly separate medicines According to the report, 80% of drugs in developed countries are sold in drugstores The main channel of medicine circulation is the affordable drugstore For example, 85% of drugs in France are sold through pharmacies, only 15% of which are directly sold by manufacturers to hospitals; 84% of drugs in Germany are sold through pharmacies; 89% of drugs in Japan are sold through drug wholesale enterprises; 74.9% of drugs in the United States are sold in drug retail stores In China, 80% of drug sales are concentrated in hospitals, and only 20% in the retail market This proportion shows that the main body of drug circulation in China at this stage is hospitals The report suggests that Beijing, Shanghai and other places should be taken as pilot areas to close the pharmacy of community health service center and allow patients to purchase drugs by themselves in social chain drugstores with prescriptions According to the report, this can reduce management costs, improve management efficiency, effectively reduce drug prices and costs, and cut off the interest chain between medical institutions and drug sales enterprises through "medical separation", so as to eliminate the motivation and behavior of doctors prescribing high priced drugs, and achieve the purpose of standardizing medical behavior and rational drug use At that time, the Ministry of commerce mainly focused on grass-roots and community medical and health institutions In the notice just released, promoting the separation of medicine is a pilot city for the reform of public hospitals At present, there are 34 pilot cities for the reform of public hospitals in China According to the notice, in the pilot cities of public hospital reform, retail pharmacies with large scale, strict quality control, complete licensed pharmacists' pharmacy service system and good credit record can be explored to undertake various forms of reform of outpatient pharmacy service and other professional services of medical institutions, and effectively strengthen the pharmacy management of medical institutions to promote clinical rational use of drugs It is clear in the document that the future development direction is to "gradually form a new mode in which doctors are responsible for outpatient diagnosis and patients can purchase drugs independently from medical institutions or retail pharmacies by prescription." Is the path feasible? However, the reform plan that the Ministry of Commerce intended to promote in 2012 was shelved by the State Council due to the opposition of the former Ministry of health But from now on, the opinion of the Ministry of Commerce on promoting the separation of pharmaceutical industry is in the upper hand Some people think that the Ministry of Commerce has the upper hand because the medical reform has entered the current stage and a new way is needed A person in the industry said in an interview with the media, "the measures such as the zero difference rate of drugs and two lines of income and expenditure pushed by the national health and Family Planning Commission reflect the typical planned economy thinking, which is difficult to achieve Because on the one hand, it's not difficult to control the industry, but on the other hand, it can't be fully funded " The above people pointed out that the marketization route advocated by the Ministry of commerce is more consistent with the marketization of medical resources advocated at this stage: now we advocate "no ban on access", support the development of private hospitals, open doctors and medical resources, including trusteeship pharmacies, etc., all show a high-level attitude to break the resource monopoly of public hospitals, strengthen competition through marketization, and straighten out the system In the context of the cancellation of drug markup, the reform advocated by the Ministry of Commerce has increased the possibility of implementing the separation of pharmaceutical industries Pei Jianhua, deputy director of the market order Department of the Ministry of Commerce, once said, "county level hospitals and other large hospitals will gradually realize zero margin sales of drugs, which will have a great impact on retail pharmacies in the short term, and more patients will choose to see doctors in hospitals But in the long run, the enthusiasm of the hospital to retain the unprofitable outpatient pharmacy will gradually weaken, increasing the possibility of pharmaceutical industry division " In addition, the reform of medical insurance payment methods, such as total prepayment, has also increased the motivation of saving drugs in hospitals However, if the so-called separation of pharmaceutical industry is implemented, there are still many practical problems For these problems, the Ministry of Commerce conducted a survey in February 2012, which has been discussed in detail In March 2012, the website of the Ministry of Commerce published the investigation report on the pilot project of medical separation in Hunan Province, which pointed out that there are still some unsatisfactory aspects in the aspects of supervision, management system and the characteristics of social pharmacies, which have a negative impact on the implementation of medical separation First, hospitals are reluctant to give up the revenue from drug sales According to the current practice, the income from drug sales is still an important source for medical institutions that have not cancelled the drug mark up According to the medical institutions, the hospital's drug revenue accounts for 46% - 75% After the implementation of zero margin sales of drugs, although there are government subsidies, there is still a funding gap in some medical institutions In addition, the impact of medical separation on the interests of medical staff and the safety of the diagnosis and treatment process are all factors that can not be ignored Secondly, from the perspective of the configuration of licensed pharmacists and the quality of practitioners, although there are licensed pharmacists in social retail pharmacies, most of them are lack of clinical medication experience, so it is difficult to guide patients in clinical medication, so it is difficult to judge the quality and effect of drugs On the contrary, licensed pharmacists in pharmacies of medical institutions will dispense medicines reasonably according to doctors' orders Therefore, after the separation of pharmacies, how to guide and supervise pharmacies in business, ensure the timely supply of drugs, ensure the quality of drugs, so that people's medication is not affected is a prominent problem Third, there are obstacles in the application of medical insurance fixed-point qualification of social pharmacy agency