Cancel drug additions to increase clinic fees

Yesterday, the General Office of the State Council issued the "Circular on Printing and Distributing the 2012 Major Work Arrangements for Deepening the Reform of the Medical and Health System." According to the arrangements, in 2012 China's medical reform will focus on accelerating the improvement of the universal health insurance system, consolidating and improving the basic medicine system and primary medical care. A key breakthrough was made in the three aspects of the operation of new mechanisms for health institutions and the promotion of public hospital reform.

In advancing the reform of public hospitals, the "drug-to-doctor" mechanism will be abolished. Focusing on the county-level hospitals, we will comprehensively promote comprehensive reforms such as public hospital management systems, compensation mechanisms, personnel distribution, drug supply, and pricing mechanisms, and we will select pilot counties (cities) in about 300 cities to carry out comprehensive reform pilots for county-level hospitals.

Breaking the work arrangement for the “drug supplement medicine” mechanism requires that the “drug-to-doctor” mechanism should be abolished, and the public hospital compensation should be changed from service charge, drug addition income and financial subsidy to service charge and financial subsidy.

The hospital's thus reduced reasonable income or losses will be compensated by adjusting the prices of medical technology services and increasing government investment. After canceling the drug addition policy, the price of medical technology services such as medical treatment fees, surgical fees, and nursing fees will also be increased.

In addition, the prices of large-scale equipment inspections must also be reduced, and government-invested large-scale public hospitals must set inspection prices at the cost after depreciation is deducted.

The idea of ​​deepening the reform of urban public hospitals in reforming public urban hospitals is also clear: that is, “the separation of government and affairs, separation of management and management, separation of medicines, profitability, and nonprofit separation, and the elimination of the mechanism of “remedy for medicine” as the key link to reform. Compensation mechanism and the establishment of a modern hospital management system as a starting point, deepen institutional innovation, improve service quality and operational efficiency, as soon as possible form the basic path of reform.”

Research and exploration will adopt various forms such as the establishment of specialized management agencies to determine the government-run medical institutions and perform the functions of the government's organization of public hospitals. In the areas of performance-based wage distribution, pricing, and drug procurement, the pilot regions must have certain autonomy.

In addition, all localities are required to publish as soon as possible the implementation rules that encourage social capital to organize the development of medical institutions, to refine and implement various policies that encourage social capital to provide medical services, and to support the organization and development of a group of non-public medical institutions.

Encourage public hospitals to use resource-rich areas to guide social capital to participate in restructuring and reorganization of some public hospitals, including hospitals run by state-owned enterprises.

■ Summary of why the breakthrough was aimed at the “Main Work Arrangement for Deepening the Reform of the Medical and Health System in 2012” issued by the State-Owned Office yesterday. It was clarified that this year’s public hospital reform should focus on “county-level hospitals” and select about 300 counties ( City) to carry out pilot reforms at county hospitals. This item was also reflected in the "Planning and Implementation Plan for Deepening the Medical and Health Care System during the Twelfth Five-Year Plan" that was recently released. At this point, a "bottom-up" public hospital reform path has become more and more clear-cut.

County hospital reform resistance is slightly smaller In February 2010, the reform of public hospitals started. Before reforming the county hospitals as the focus of public hospital reforms, public hospital reforms were piloted successively in 17 cities. These cities have concentrated on large public hospitals, which have high compensation, complicated personnel, and large resistance to reform. In short, although there are many models, no sample has been introduced so far.

"Top down" or "bottom up"? The path to reform of public hospitals has been discussed. Liu Guoen, a member of the Advisory Committee of the State Council's Medical Reform Experts Committee and professor of economics at Guanghua School of Management at Peking University, believes that “the focus is on county-level hospitals,” and “small resistance and easier to advance”.

According to this year's work arrangement, the reform of public hospitals at the county level has eliminated the use of medicine to supplement medicine, and it is necessary to cancel the revenue from drug additions as a subsidy channel.

Liu Guoen believes that this will require a fiscal gap. However, if it is pushed down from a large hospital, compensation "is too difficult, too much pressure."

On the other hand, strengthening primary-level hospitals is also considered helpful in mitigating the "difficulty of seeing a doctor."

Liu Guoen analyzed that county-level hospitals are located at the border between urban and rural areas and undertake medical treatment for the majority of rural residents. He said that if the grass-roots hospitals can be strengthened, farmers can cure diseases in county hospitals, which will, to a certain extent, slow the pressure on hospitals in big cities and help control the cost of medical services.

Officials from the Ministry of Health also stated that county hospital reforms must strengthen capacity building and control the rate of transfer outside the county.

However, some models that lower the price of drugs by paying the full amount of government finances have shown drawbacks. According to media reports, in some pilot regions, there is a phenomenon in which the enthusiasm of doctors is difficult to mobilize and push patients.

At the same time, Zhang Handong, deputy director of the State Council's Medical Reform Office, said in an interview with the media that "remedying medicine with medicine" is a fundamental problem for the current expensive medical treatment. However, we must consider how to supplement some "deficit".

Metropolitan medical needs to break the monopoly In Liu Guoen's view, if it is necessary to reform large public hospitals, the government must more clearly define its position.

In short, hospital competition is introduced in big cities to break monopoly.

Liu Guoen said that with the current human, material, and financial resources, the government should gradually let the social forces run the hospital. The government is more focused on reforming basic public hospitals in remote areas.

The work arrangement announced yesterday stated that it is necessary to actively introduce powerful medical institutions, overseas high-quality medical resources, and social charities to hold medical institutions.

At the same time, the government should also highlight the construction of the medical insurance system, such as giving non-public medical institutions the same medical insurance reimbursement treatment. "Public hospitals have competition to better provide services."

However, there are still many problems to be solved on the road to public hospital reform. For example, there are issues such as the management of multiple sectors such as health and education in the management of hospitals and the separation of administrative divisions in hospital management.

Key Points for Medical Reform in 2012 Main points New rural cooperative medical insurance subsidy 240 yuan New rural cooperative medical insurance personal payment 300 yuan Medical insurance, resident medical insurance, New rural cooperative payment limit ≥60,000 yuan Hospitalization cost payment ratio Urban residents medical insurance 70%, New farmers Together 75%

Standardization of residents' health electronic file more than 60%