Medical network - on November 30, delayed more than a year after the country "health insurance payment standard" policy movement again. At the end of November, pending payment standard for the end of the comment, file be forthcoming. This policy will affect almost every person, health care drugs called the standard of the basic medical insurance payment standard, refers to the medical insurance fund to pay medical insurance directory standards set by the drug cost, namely, hospital drug purchase price is lower than the health care to pay part of the standard will be awarded to the hospital, higher than paid part of the standard shall be borne by the hospital in full. In addition, the drug pricing according to the common name known as main ingredients, no longer on the basis of various brand name.
The standard of the original plan, last September news recently, the standard is expected to be settled at the end of December.
"Pay standards will be introduced together with the medical insurance directory." Chinese medicine (600056, shares) enterprise management association ming-de yu reporter revealed to the 21st century economy, "the national rules, the provincial government formulate specific policies, as a whole the area for payment methods. At that time, each place according to the standards stipulated by the generic names of pharmaceuticals, probably the same drug in different local payment standards."
Health insurance payment standard is health care cost is one of the means of control, a number of the personage inside course of study to the 21st century business herald reporters, the move means medicare payments paid by the passive to active pay step by step, finally realizes the effective utilization of medical insurance fund. But there are also with other such as drug zero rate policy conflict.
influential
"After the tender policy may cause too much attention to the price, standard after everyone will pay more attention to health care medicine effective component, efficacy." Shanghai holdings (000503, shares) group director, vice President of ShangGuanYongJiang said.
Drug has gone through, according to a draft statement quality consistency evaluation or smaller differences in drug, make payment standard in principle according to the common name.
Among them, the same common name (the same dosage form, specification), according to the minimum units formulate the unified payment standard; The same generic names (different types and specifications) of drugs, step by step through selecting representative varieties comparison method to determine and calculate the price difference; Don't have the common name of standard varieties, according to different payment standards in enterprise production of drugs, in principle, no more than the same generic name has passed the payment standard of quality consistency evaluation of drugs. The basic medical insurance directory, exclusive patent medicine, then through negotiations pay standards.
This means that the various pharmaceutical goods will no longer affect the selling price.
Reporter understanding, most foreign payment in generic drugs, health care standards. The same of generic drugs, different brand may be different price, but only to pay medical insurance fund under the standard parts, drug price is higher than health care payment standard part need to pay by the hospital. Because the health insurance payment standard allows the medical establishment that decide a dot gain balance benefit, medical institutions will be more actively lower drug prices.
However, Chinese medicine consistency evaluation is still in its infancy, it will affect the pay standards.
Ming-de yu told 21st century business herald reporters: "the consistent and inconsistent problems, introducing the consistency evaluation may be two or three years later to cash, medicine the consistency of the evaluation, now a product through all have no."
How much the same generic drug companies domestic production is relatively common. According to the national food administration of drug safety statistics, we have already had the total number of drug approval number up to 189000, more than 95% for generic drugs. There are nearly 7000 drug firms, including generics companies for more than 90%. These companies often in such aspects as research and development capabilities, processes, equipment differences, lead to different with the quality and curative effect of generic drugs.
And this or will cause adverse selection.
"If all payment in common name the lowest price, high quality generic drugs have been killed, such as high-quality generic drug prices, according to the common name so bad will be in demand," medicine, chief analyst at large securities jin-yang zhang analysis thinks, "if the generics can through consistency evaluation, then pay the end will not guarantee the pay level of the original drugs."
Ming-de yu further worry: "through consistency evaluation of medicines, medicine will prior purchasing, not through the hospital did not purchase, for a period will cause leading to accelerate."
And on the ground, the concrete implementation plan of the payment standards shall be formulated by the provinces and cities. Or your form have different prices.
Very high investment researcher Tang Yuanyuan said: "the provincial main reference for the provinces a recent provincial tendering and bidding price is the lowest price, or refer to a recent purchase for the province won the bid price of the lowest price, in recent years, such as bidding purchase price of the average regional specificity is very strong."
Pilot health insurance payment standard to the current domestic provinces and cities including anhui, chongqing, zhejiang, fujian and other provinces and cities, reporter noticed that the payment standard and the method of payment is not the same, for example, anhui is according to the national minimum price adjustment of medical insurance payment standard, zhejiang is a year of a new round of basic drugs and the rest of all varieties of drugs price as the standard medicare drug payment.
"Everywhere have the right to adjust, because most of the provincial plan as a whole," ming-de yu believes that "pay in different parts of the standard difference, but the difference should not be very big. Payment standard is formulated on the basis of market prices, close to the real price of the products. Just some different products according to local custom, there may be some adjustments."
Accused one of the means
Health insurance payment standard for health care is the cause of charged fees.
Jin-yang zhang told reporters: the 21st century economic report "after the town worker, new farmers, urban residents health insurance, every part in this fund will be incremental. But now that coverage is very wide, the key drivers of future growth in medical insurance fund is make limit or fiscal subsidies limit per person per year, both are limited. In recent years, many provinces and cities spending finishing number is greater than the financing, the so-called health wear bottom."
Gao said: "the meaning of the medicare payment issued to from the point of the whole health care system, need policy coordination, such as health care integration, system design, urban and rural residents medical insurance directory adjustment, etc."
The reporter understands, medicare payment reform centered on the effective use of medical insurance fund, including medical insurance directory varieties is necessary, involving medical insurance directory adjustment; Proper reimbursement ratio, involving payment reform; Drug bidding, pricing, payment standard is required.
Among them, the supplementary medical insurance directory adjustment involving drugs variety, and health care payment standards closely linked.
This year on July 22, people club department said it would adjust medical insurance directory as one of the key work of this year. Then people club department has issued the "2016 national basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue work adjustment plan (draft)" and adjustment scheme, and will be completed by the end of 2016 medicare drug adjust the working directory, released the new medical insurance directory. Is expected in 2017, improve the measures for the management of basic health care medicine, gradually establish a standardized drug catalogue dynamic adjustment mechanism.
"In the first quarter of next year, the medical insurance directory will be formally launched, and one of the reasons for the delayed payment standard is medical insurance directory plan adjustment, supplement of more than three hundred varieties to pay standards." Jin-yang zhang said.
Medical insurance payment is, the total amount of advance payment in accordance with the project, according to such diseases. Either way, the premise condition is under total control, and gradually establish a scientific evaluation system. "Original artificialization, are the charges for coverage control documents audit, selective examination by experts, has the problem just deduction, this way has brought some problems, such as corruption." ShangGuanYongJiang summary, at present, there are malicious hedge, violate compasses, excessive medical treatment three big problems.
In 2011, 2011, "about to further promote the reform of basic medical insurance payment advice" and "the implementation of total pay of insurance of primary medical treatment to control the opinions of the" two files have issued, proposed on the basis of total amount control, combining with the exploration capitation payment outpatient service as a whole, combining with the exploration in the guarantee of hospital outpatient service a serious illness macro-reforms, establishing and perfecting the basic medical insurance agencies and medical institutions of the consultative mechanism and risk sharing mechanism.
It is reported that currently 85% of the country as a whole the area to carry out the payment total amount control, and be included in the basic medical insurance fixed-point protocol in management. More than 70% of the area where overall planning is conducted by macro-reforms, 35% of the region as a whole to carry out according to the service units, mainly by the bed, pay for 24% of the region as a whole to carry out the exploration of the capitation payment.
"Health care reform and the second level is the guarantee of a multi-level system. Health growth dropped to 4% last year to 5%. The shortage of the subsidiary medical insurance should be the introduction of commercial insurance, basic medical care to return to the public welfare, insurance basic." ShangGuanYongJiang said.
, however, also has the expert thinks, payment standard and the comprehensive advancement of drug zero rate policy conflicts, such as "the policy (paid) or to overthrow the zero rate of drug policy. Will make the hospital feeling confused about what to do." The experts said. |
