Three medical linkage: enter a new stage, clear the new way

Since the State Council issued the recent key implementation plan of medical and health system reform (2009-2011) in 2009, in the past ten years, the reform measures and exploration mentioned in the plan are still in progress, and new problems have emerged However, in recent years, new solutions have also emerged and become clear in medical insurance, medical treatment and medicine The recent key implementation plan of medical and health system reform (2009-2011) mentioned: 5 Promote the pilot reform of public hospitals: (18) promote the reform of compensation mechanism of public hospitals We will promote the reform of the compensation mechanism in public hospitals, and gradually change the three channels of compensation in public hospitals from service charges, drug plus income and financial subsidies to service charges and financial subsidies Strictly control the construction scale, standard and loan behavior of public hospitals We will promote the separation of medicine and gradually eliminate drug mark ups, and will not accept drug discounts The reduced income or loss of the hospital can be solved by increasing the medical service fee, adjusting the charging standard of some technical services and increasing the government investment The medical service fee shall be included in the reimbursement scope of basic medical insurance Actively explore a variety of effective ways to separate medicine Medical insurance: the transmission of pressure; with the aging population and the outbreak of chronic diseases, the pressure of national medical insurance control is huge The National Health Insurance Bureau came into being 4 + 7 centralized belt purchase and related policies "combined fist", and issued payment standard policies to strengthen the monitoring and monitoring of the purchase and use of 4 + 7 selected drugs and non selected drugs From the perspective of profit driving, the hospital standardized the use of selected varieties and reduced the expenditure of medical insurance fund, and the balance will be transferred to the hospital, which gives the hospital and doctors the motivation to implement; from the perspective of assessment, the selected drugs will be gradually incorporated into the new DRG payment system The essence of medical treatment is service and exchange Even at the national level, the supply side of hospitals and enterprises, and the demand side of the national medical insurance bureau and patients, constitute a business behavior Medical payers need new roles to play their roles in business activities From the nature of insurance, insurance service needs to meet three preconditions: 1 Things to be insured must be probabilistic and cannot be determined; 2 The risk probability of each policyholder is irrelevant The event of claim settlement must be probabilistic, irrelevant and independent; 3 Insurance is a kind of self-sustaining business behavior To compete among insurance companies, there must be two basic methods: segmentation and aggregation Subdivide, divide people with different risks into different groups to prevent them from hitchhiking each other; add up, increase the number of insured people in the same risk group By using the law of large numbers, we can reduce the deviation caused by their risks, so as to calculate the risks more accurately, and make the premium paid by the policyholders to the minimum Because the national medical insurance does not meet the above three preconditions, it is not actually a sustainable insurance, but a subsidy system that constantly relies on new people to maintain One of the main tasks of the new medical reform is to control the government's medical expenditure, reduce the burden of individual medical care, and vigorously develop commercial health insurance Source: China Health Statistics Yearbook 2016, China Insurance Yearbook 2016, the government introduced market forces, and the prosperity of commercial health insurance will solve the payment gap to a certain extent In the future, especially the combination of chronic disease management and commercial health insurance is an important part of future medical insurance The state should encourage the commercial health insurance with medical thinking, segmentation and aggregation; instead of the personal tax premium health insurance currently implemented, there are some problems such as insufficient preferential policies, weak product attraction, complicated insurance process, etc the product design lacks the segmentation and aggregation based on medical thinking, because the benefits to commercial insurance companies and consumers are weak, since 2015 Since the implementation of the policy in, it has not been promoted > healthcare: value chain extension, medical service integration Wechat's long article "endless smoke of gunpowder: the battle of 15 years of medical reform" mentioned that the establishment of a super hospital is not encouraged by the state, and the state is more willing to grade diagnosis and treatment It said: "after more than 6 trillion government funds have been invested, there is finally a consensus between the supply side and the demand side that the medical reform can not be achieved just by spending money." Some netizens said that they are not optimistic about the transformation of Internet 2B, because their genes are C-terminal If a point can't understand "face" and "body", it can only understand "point" and "line", then put a cube in front of it, and it only sees a line The general office of the State Council issued the opinions on strengthening the performance appraisal of three-level public hospitals, in which the proportion of single drug use was replaced by the performance appraisal of medical quality, operation efficiency, sustainable development and satisfaction evaluation   Since the 3 document issued by the State Council on the promotion of Internet plus medical health and Internet hospital management (Trial), the Internet hospital has developed to a new stage, breaking through the narrow definition of only one link in 3 years ago, and gradually developing the whole process of medical service including "inquiry, hospital, hospital and out of hospital management", and coordinated medical alliance Physical, family doctors and drug channels have realized the real circulation of patient-centered medical resources Supervision The measures for the administration of Internet hospitals (for Trial Implementation) clearly states that the establishment of a provincial Internet hospital regulatory platform is a precondition for approving the license of Internet hospitals At present, most provinces and cities have not yet established a complete Internet hospital regulatory system In combination with the feedback from multiple Internet hospitals, the period of newly established Internet hospitals has been extended and the audit scale has been tightened We should speed up the construction of national unified medical and health personnel and medical institutions with reliable medical digital identity and electronic real name authentication This means that the construction of Internet hospitals must be carried out in strict accordance with the standards published by relevant departments In the process of introducing medical and health personnel, strict screening standards and evaluation system should be established to ensure the quality of medical services On the other hand, for doctors, with the promotion of multi-point practice policy, once certified, it means that they can work in multiple Internet hospitals, expand business volume and increase personal income The third party organization shall ensure that the qualification of the service personnel shall conform to the relevant regulations and shall be responsible for the services provided This means who provides the service and who is responsible Therefore, in the introduction of doctors, enterprises should establish a diversified way of cooperation, bind doctors' interests with the platform through the partner system, strengthen doctors' subject consciousness, and consciously attach importance to the safety of medical services At the same time, this means that the personal brand of doctors is highlighted, and doctors with high patient satisfaction and less medical disputes will become the focus of competition among major platforms Online prescription Electronic prescription refers to the medical documents issued by registered doctors for patients in the online diagnosis and treatment activities, reviewed, allocated and checked by pharmacists who have obtained the professional and technical post qualifications of pharmacy, and used as the drug certificate of patients Doctors need to obtain the prescription right in the registered Internet hospital before prescribing, and must input their unique digital certificate accurately before completing the prescription submission, so as to ensure that the prescription is issued by themselves Each prescription shall not exceed 5 kinds of drugs The prescription of Chinese herbal medicine, western medicine and finished medicine shall be issued separately After the prescription is issued, an electronic signature is required (the signature pattern and special seal shall be reserved in the drug administration center for future reference) And the prescription is valid on the same day If the validity period needs to be extended under special circumstances, the doctor who issued the prescription shall indicate the validity period, but the longest validity period shall not exceed 3 days Access to medicines After patients complete online consultation, they can choose online or offline two ways to complete drug purchase When online purchase is selected, the doctor's prescription shall be approved by the patient and confirmed by online operation The electronic prescription shall be transmitted to the Internet hospital through the system to sign the drug Internet e-commerce After the patient completes the payment, the drug Internet e-commerce shall complete the drug distribution according to the relevant national regulations Select offline drug purchase, patients purchase drugs according to online electronic prescriptions, offline physical pharmacies, and provide support materials for physical pharmacies to purchase drugs according to relevant national regulations Payment method Internet hospitals provide patients with a variety of online payment methods, strengthen the access of medical insurance and commercial insurance, and realize real-time reimbursement of medical expenses as soon as possible The development of Internet hospital is the result of multiple factors such as social demand, technological innovation and policy promotion The state has made detailed regulations and guidance for the application, construction, operation and medical service evaluation of Internet hospital In the future, the Internet hospital may usher in the wind, slow disease management and health management will become the development focus of the Internet hospital, and the Internet hospital will also become a new traffic entrance for medical service providers According to their own advantages and business direction, many internet medical enterprises have gradually developed different business models, but they have formed the integration of online and offline medical services, medical services, insurance, medicine, equipment and other industrial chains, with all roads open But Rome wasn't built in a day It still needs long-term improvement and optimization of business processes >Medicine: from channel concentration to channel diversity, the wechat long article "China's medicine changes the past" says: reducing drug prices requires more linkage reform, which can not be completed alone The government's 4 + 7 belt procurement and related policy "combination fist", as well as the belt procurement to be expanded during the two sessions, will bring long-term seismic impact to the pharmaceutical circle At the same time, the national health and Health Commission issued the opinions on speeding up the high-quality development of pharmaceutical care, which clearly stated that "to adhere to the public welfare of public hospital pharmacy, public hospitals shall not contract or rent the pharmacy, and shall not trust the pharmacy to profit-making enterprises" From the logic of the market, most of the pharmaceutical industry will move to the outside of the hospital DTP, Internet hospital e-prescription + retail drugstore, community hospital, county hospital and township hospital will be the source of growth   DTP and Internet hospital e-prescription + retail drugstore are not simple changes in drug sales channels; at the macro level, like the new retail concept of FMCG, pharmaceutical enterprises and chain drugstores need new business partners of joint information service providers, modern logistics distribution networks, pharmaceutical service platforms, patient management and disease management professional institutions (such as Internet hospitals), to build efficient and safe Innovative business model of integrated operation At the meso level, pharmaceutical companies still need to establish new service relationships with doctors, including helping doctors understand new drugs, helping doctors use new things such as Internet hospitals to manage patients, and guiding doctors to try applications in new medical formats After all, the volume still needs a prescription as the premise At the micro level, pharmaceutical companies need to be patient-centered - recommend appropriate medication programs and commercial health insurance programs for patients, provide "close service" such as delivery of drugs to the door for long-term patients in Internet hospitals for further consultation, and even stand in patients' families