Medical network January 12 - "a lot of pressure, our hospital medicine proportion is now about 35%, to 30% also need to adjust." The fifth wuhan hospital director zhang said in an interview with the 21st century economic report reporter, to the index, and partial fluctuation in 2016 was in a state of "nerves".
Medicine proportion, said zhang bin refers to on May 17, 2015, issued by the general office of the state council "about city public hospital comprehensive reform pilot guidance", by 2017 the city public hospital comprehensive reform pilot overall away, to effectively control unreasonable medical expenses increased, overall personal health spending accounts for the proportion of the total health expenses reduced to less than 30%. The industry said that the ratio of "medicine accounted for".
With the upcoming 2017, 21st century business herald reporters in Beijing, wuhan, xiamen, etc in the hospital for nearly a month investigation visit, found that many hospitals in order to control the medicine proportion, use all kinds of hard. A sharp cut in nearly a year to such as the fifth wuhan hospital auxiliary medicine, proprietary Chinese medicine, etc. And the other according to the medical profession, the medical m research aimed at 6305 medical practitioners, according to a research 4 into the doctor income is affected, and many hospitals by appropriate increase inspection, replace, hospital courtyard with cheap drugs to control such as external cooperation to open the pharmacy medicine proportion.
The Beijing minister, head of the medical management consulting center Shi Lichen in an interview with the 21st century economic report reporter noted that many hospitals now through various means to control the medicine proportion, most or all can meet the national medicine proportion requirements is put forward, which will greatly reduce the financial burden on health care spending, but demand for treating patients is still on the one hand, the dose may not reduce too much; On the other hand because of government subsidies, cancel the drug addition, the hospital on the prescription income or by pharmacy practice, improve the inspection fees for "little bit".
Medicine in 2017 accounted for 30% of the time
An aging population, chronic diseases increased medical costs, and especially the problems such as rapid growth of drug costs, including China, governments are taking steps to control medical costs rise rapidly, the reform and improvement of drug supply security system as a key national health development strategy.
"China's medical and health cause development report 2014, predicts that 2017 urban employee basic medical insurance fund will appear do not cover the current charge phenomenon, by 2024 there will be funds accumulated balance hole serious deficit of 735.3 billion yuan.
People club department, director of the institute of social security Jin Weigang had earlier said that since 2013, the country has 225 as a whole the area of the town worker medical insurance funds appear do not cover the revenue, accounting for 32% of the national urban workers as a whole the area, 22 of them as a whole the area calendar year cumulative balance all finished. In terms of urban health care, 2013, in 108 as a whole the area of the country do not cover the charge, health-care funds already overburdened, and now the medical insurance fund expenditure growth rate than revenue growth.
To this end, on May 17, 2015, issued by the general office of the state council "about city public hospital comprehensive reform pilot guidance", strive for to 2017 pilot cities of public hospital medicine accounted (excluding Chinese medicine yinpian) overall to around 30%. By 2017, the city public hospital comprehensive reform pilot overall away, to effectively control unreasonable medical expenses increased, overall personal health spending accounts for the proportion of the total health expenses reduced to less than 30%.
In fact, the national consciousness is in the earlier period to control the medicine proportion of problem. The ministry of health "hospital management evaluation guide (2008 edition)", "3 armour hospital 'standard of' medicine accounted for 45% or less." And, the guide also stipulates that the medicine proportion as one of public tertiary general hospital assessment rating program.
The reason that many hospitals have spare no effort to control medicine accounted for the power, because the rating is very important to hospital development. A declined to be named 3 armour hospital dean to 21st century business herald reporters that between different level hospitals in the scale of the hospital, equipment level, fee standards, scope of business, such as scientific research and teaching are of great differences, directly affects the future development of the hospital.
In meters of the survey, 76% of the parameter tuning doctors choose "the hospital has been executed medicine proportion", only 17% chose "no". And in hospital has been executed, the execution of the proportion of the third class hospitals has reached 91%, and the execution time prior to other hospitals, 6 into a hospital in 2015 before execution.
To assist operation
21st century business herald reporters in Beijing, and many other 3 armour hospital visits, found that hospitals of different departments to reduce medicine than using different methods, such as pediatric medicine for children because not many kinds, some alternative drug also is less, so a lot of doctors would choose appropriately increased inspections, and medical doctors might choose to use cheap drugs, and strictly control the use of antibiotics, etc.
In the medical m research survey, also do to a doctor's medication, such as doctors choose "reduce the drug expenditure" 31%, "23% increasing check", "using cheap medicine alternative" 24%, and 15% of the doctors suggested that patients with courtyard outsourcing medicine ".
In fact, many hospitals for control of medicine accounted for "painstakingly".
Two hundreds of wuhan city is the third batch of national pilot reform of public hospitals city one of the cities, and the fifth wuhan city hospital is one of the pilot selected 18 public hospitals in wuhan city. In January 2016, the fifth wuhan city hospital medicine proportion (excluding Chinese medicine yinpian) was 48.66%, and 2016 fell 35.61% in October.
To control drug proportion, the fifth wuhan hospital director zhang bin is one of the most important action of cutting medicine, directed against the auxiliary drug use. Clean up auxiliary drug varieties, adjust the auxiliary medicine catalogue, strengthen drug supply regulation and divided into two group of stop 35 varieties of auxiliary clinical medication management.
It is understood that the present in Beijing, anhui, liaoning, yunnan, Inner Mongolia has built more than provinces city, such as auxiliary medicine catalogue and monitoring catalogue.
Selected 35 varieties was fifth in wuhan city hospital, according to the calculation of 2015, the total amount of 16.3 million yuan, and the selection method and the principle is as long as there are two areas will be a drug as auxiliary, on February 1, one size fits all, all stop using; 24 varieties implemented a limited supply, these varieties are basically proprietary Chinese medicine and part of the enzyme.
"Cut off any medicine stressed and behind each medicine involves manufacturers, such as a medical representative, some doctors also complain. There are also many sermons, but we are rejected under pressure." Zhang bin back then decided to cut drug, be restricted to medicine, still feel "stressed out".
Adjuvant, in fact, has been in the hospital drug use proportion is large, it is also to lay their hands on one of the important reasons of frequently by the hospital, in the majority with proprietary Chinese medicine especially Chinese medicine injection preparation.
A clinical pharmacy experts who done of the drugs on a hospital use statistics, is more on adjuvant directory and monitor blood clots tong injection ranks high in the sales amount. The top 10 auxiliary medicine annual sales amount in millions of dollars to tens of millions of dollars, accounted for about floor 1/7 of the total amount of nearly 1200 kinds of drugs.
Another according to the CFDA hospital medicine institute of medicine economic south city sample database, the need of the most popular products in 2015, in addition to the best to make the capsule the rest varieties belong to TCM injections. Hospital proprietary Chinese medicine sales more than 100000 yuan in 2015 samples of 2400 varieties, although only 88 are injection, but the variety of the market share of more than 34%.
The Beijing minister, head of the medical management consulting center Shi Lichen reporter to a 21st century economy analysis, points out that now predominantly Chinese medicine injection preparations are cut off, the auxiliary medication is not used in the treatment, and controversial part of traditional Chinese medicine injection and so the future is given priority to with traditional Chinese medicine injection dosage forms of enterprise must transform.
"Part of the enterprise in the first two years in transition, specialized construction of the production line of a kind of disease, such as transformation of diabetes related pharmaceutical producing enterprises, mainly for prevention and rehabilitation, late by traditional Chinese medicine formula to prevent diabetes, auxiliary treatment is mainly to do debug intestines and stomach and regulate diabetes complications, etc." Shi Lichen said.
With sympathetic doctors "pen"
Wards of the rational use of drugs, the fifth wuhan hospital adopted a transformation of informationization means, it is to hold the doctor "prescribing".
"We will statistics the three years preceding the floor, the hospital disease is 1936, the implementation of classified according to the coding of ICT10, classified by category after all these diseases diseases with path, clinical guidelines, there is no path, according to the diagnosis and treatment of clinical guidelines to conventional implementation consistency, such as diagnosis of pneumonia, according to the clinical guidelines, system can't generate the prescription and the doctor's advice." Zhang bin to the 21st century economic report press is introduced.
In addition, the 21st century economic report reporter sees in the fifth hospital outpatient service in wuhan city has a special "lighthouse" illegal prescription, revealed multiple drug use inappropriate doctors' prescriptions. Such as pediatrics a doctor for a diagnosis of acute upper respiratory tract infection of children aged 2 to open "ibuprofen suspension liquid, medication orders of 4 ml/second, and wuhan hospital review points out that should be 3 ml / 5 times.
From 21st century business herald reporter wuhan hospital income structure monitoring index, a 5 the hospital from February with kinds of control medicine accounted for policy, after the medicine accounted for between 45% and 48% from the original down to 35%, but there was a small rebound in July.
To this, zhang bin to 21st century business herald reporter explained, through data analysis, found that this is caused by clinicians use system vulnerabilities. "Resident is found in the operation, while the system limitation, but add a diagnosis, will be able to transform the drug dosing, and at the time of discharge, the diagnostic do repair cancelled, can avoid the problem of medical department investigate diagnostic criteria."
The reason will appear this kind of the phenomenon of "cat and mouse", because for years are based on medicine medical, doctor performance directly linked to prescribe how much, is closely related with the income of hospital.
According to reporter understanding, the 21st century economy of 3 armour hospital certain defined the doctor to the patient's reach 1:1 check the costs and expenses for medicine, not up to standard will buckle bonuses; The doctor therefore can only "begged" the patient not only prescribe do not check. Industry analysis, points out that the hospital may have two lines, light and shade is to reduce the medicine proportion ", open wire to cater to the higher check, wiring is tied directly to medical personnel and department revenue, to improve hospital revenues.
And among them, the pharmacy trusteeship is a very good way to supplement revenue. Shi Lichen to 21st century business herald reporters that at present although many hospitals tooling control prescription, but after a lot of prescription issued by doctors directly through the electronic system from the designated hospital pharmacy and outflow of prescription drugs actually flows back to the hospital.
To this end, zhang bin thought to pharmacy trusteeship out this kind of practice is not very reasonable, because of the hospital pharmacy, although the profitable department from the past, into the cost of a complete unit, managed to go out can only solve the problem of supply, will not solve the problems of the clinical rational drug use, is not conducive to the development of medicine and the construction of the supporting service system of public hospital.
A 3 armour hospital dean said, because the control medicine proportion, cancel the drug addition, and government subsidies and does not reach the designated position, may be the loss of 30 million yuan in this year, and these can only be solved by the hospital.
, suzhou city health development planning commission director Tan Weiliang on a recent industry conference to reporter pointed out that the 21st century economy, clarify the price system, the need to "3 d" linkage, through price, planning department, the one club, finance departments jointly issued the file.
"We want to speed up the 3 d linkage, and promote medical, health care and medical reform, strengthen the reform of the systematic, integrated and collaborative. Scientific measurement price reform actual compensation ratio, rounds of price reform, the structure of the price adjustment, the project should be based on the data of regional diseases, focusing on the basic." Zhang said. |
