Medical network on December 30 - shenzhen to unreasonable medical service price "the knife". On January 1, 2017, to shenzhen public hospital sees a doctor, don't have to pay the registration fee for 1 yuan money. To live in the hospital ward, also need not hand in the heating/cooling and heating. 252 large equipment inspection treatment programs, including CT, MRI and PET - CT, average prices by 20%. Meanwhile, surgery, rehabilitation, nursing fees will rise, among them, 357 level 4 operation will raise prices by 50%. Which rose after a fall, according to the calculation, the city public hospital patients a doctor cost will save 30 million yuan a year.
On December 28th, the reporter from shenzhen city planning commission, the municipal development and reform commission (NDRC) and city people club bureau joint learns at a media briefing, shenzhen medical service price reform in building for two years, and will be officially launched on January 1, 2017. In total, structure optimization, increase the medical expenditure under the premise of shenzhen will be by way of "vacate basket change a bird", three 2617 charges of public hospital price adjustment can be optimized. The first phase adjustment 833 charge first, second and third phase of reform start time is expected in the first half of next year and in the second half of the year.
Shenzhen city health department said, key points in the first phase of the medical service price adjustment is to reduce the cost of the large equipment inspection, such as surgery, rehabilitation and nursing staff represent technology labor value of medical service prices, let the medical staff on technology for dinner.
Shenzhen's plans in the second or third stage in the reform of children under 6 years old (including) added 30%, treatment and operation of the project to promote the development of pediatrics.
Why reform?
Drug prices artificially high Medical staff value has been underestimated
Recently, the media reported, hunan in Shanghai have a public hospital medical staff accepting kickbacks behavior, lead to national attention. In fact, the doctor prescribe receiving kickbacks, already is not new. The personage inside course of study points out, "drug prices artificially high" and "medicine for the medical" phenomenon of the existence of drug kickbacks problem has not been solved, the mechanism of public hospital medical service price is not reasonable and compensation mechanism is not sound are closely related.
17th floor in shenzhen city people's hospital of joint ward, a 75 - year - old granny li just finished my hip replacement surgery. Hip replacement is a level 4 surgery, the surgery the current price is 2100 yuan. "One such surgery need 3-4 doctors, two nurses, at least 2 hours to do." Shenzhen city people's hospital of division of doctor of vice director of bone wang hua told reporters. Surgery is the embodiment of the medical personnel labor and technical value, a surgery down, however, a large number of medical personnel of labor and technical value is lower than consumables. It is reported that an artificial hip joint the cheapest also want 20000 multivariate.
Obviously, the current medical service prices seriously underestimated the value of the human. Sputum suction care, for example, in patients with severe coma, or independent cough, sputum to prevent respiratory tract clogged breathing disorders, caused by suffocation or death, medical personnel must go through negative pressure device insert sputum suction tube from the mouth, nose export of nose pharynx ministry and trachea sputum suction, but at the moment for a sputum suction nursing project is 2 yuan. Medical service price is not reasonable reflect health care costs.
Shenzhen who the present planning commission deputy director of the strange introduction, the current execution of shenzhen is ten years ago (2007 years) to establish standard of medical service prices, and, in the current medical service price mainly depends on machine automation operation of large inspection to check the price on the high side, examined and reflect the value of the medical staff of technical services, operation expenses and fees on the low side, such as medical service pricing and cost into serious deviation, scientific and dynamic medical services price adjustment mechanism has not been established, as shenzhen affected and restricted the main factors of public hospital reform and development.
Patients burden will increase?
The first phase of 30 million yuan to see the doctor cost reduction
The first phase of the medical service price reform started, will cancel the registration fee and heating/cooling, reduce large equipment inspection cost, increased 357 level 4 surgery and 217 comprehensive treatment project price class medical services. For the reform, is the most concern of the consumers, adjustment of medical service prices will increase the doctor's overall spending.
ABU ki-moon said the medical service price reform is a kind of "vacate basket change a bird". Cut large equipment through the cancellation of the registration fee and inspection fee, to level 4 operation such as the medical service price increases "rose" out of the space.
According to the calculation, this round of expected price increase, the city's public hospitals will reduce the registration fee and air conditioning costs $72 million a year, large equipment inspection fees of 165 million yuan, and the operation cost and treatment cost will increase 205 million yuan. In the first stage, reduce costs more money than the cost of spending will reduce 30 million yuan, this also means that this round of price adjustment did not increase the patient's overall costs.
According to the ministry of human resources and social security bureau of shenzhen, deputy director of the health care place Li Zhongji is introduced, the increase of the cost of operation within the health care hospital reimbursement category, most will be paid by the health care, people only need to pay 10%, increase personal burden is not much. At the same time, due to reduce the large inspection fees, the outpatient treatment can reduce cost.
And the second and the third phase of reform, shenzhen will continue to "vacate basket change a bird", "" room for the space for the reform of medical service prices. ABU ki-moon said the shenzhen medical service price reform is the biggest characteristic of "3 d linkage", after the first round of the medical service price adjustment, health care costs of charge to an account also accordingly. And in the second phase, shenzhen will start the drug procurement reform, the public medical institutions in the city all drugs through market purchasing organization centralized purchasing drugs, make all drugs reduction is expected to reach more than 30% on average, drugs and consumables procurement to reduce costs, to improve the medical service price and reduce the doctor to use "rose" out of space. "In the second and third stage after the introduction of reform, overall spending is expected to patients and medical insurance fund expenditure are slightly down." Strange said.
The doctor income have change?
By supporting reform gradually increase their income
Medical service quality is the core of medical personnel, medical personnel is the value of professional judgment, but now the medical service price mechanism is putting the cart before the horse, become deformed. The doctor's professional labor value could not be paid, in order to ensure that the "performance", some doctors have to find value in excessive and examination.
Aiming at this phenomenon, this round of reform of the key is to improve the "two head" price, one is 357 4 surgery, the average price increase 50%, the second is class 217 comprehensive treatment medical services, prices by 25% on average. At the same time, reduce the cost of the large equipment inspection, let the medical staff on technology to have a meal, don't give up examination, excessive impulses.
Nanshan district people's hospital ache branch Liao Xiang recently went to the United States to study, deputy director of the local doctors do a gastroscope surgery, surgery is the price of his 6-7 times the price of doing the same operation. "Raise the medical staff income is right direction." Liao Xiangshui, domestic public hospital doctors' income and Hong Kong, Macao and Taiwan region and other countries differ widely, the doctor's technology labor value severely undervalued.
Project "surgery is the doctor degree of technology difficulty and risk of medical services, especially the four levels of surgery is the highest level of technology is difficult, complex procedure, risk is high. The current operation project serious low price, can't reflect the technical value of the medical staff." Strange said. The an increase in the price of surgery and consultation, which is beneficial to guide doctors and to develop complex as regional medical center hospital surgery, address the crisis, mysterious illness sickness, embodies the "heavy technology, labor, equipment" price reform direction, is conducive to doctors and public hospitals, to enhance the level of medical technology development direction.
According to the calculation, after the adjustment, embodied technology such as treatment, surgery, inspecting, nursing service value of revenue, will be referred to 30% from 21% now. It is worth noting that the increase in the price of this round of surgery, does not mean that the doctor income will increase. ABU ki-moon said, the doctor will be an increase in income by hospital reform of the income distribution system, salary system reform, etc. Series of coordinated reforms gradually realize.
Income will reduce hospital?
Little impact on the public hospital And financial aid
Journal of the medical profession, a think-tank, has released a data report: the public hospitals "the money" two for the medical department of clinical laboratory and radiology department, clinical laboratory in order to yield up to 89% of the cost, first on the list of medical department was ranked the second of the radiology department is as high as 80%. In respect of clinical departments, the radiation with yield up to 20% of the cost in various clinical departments first, and most of the clinical departments cost yields is negative.
"Suggests that the medical service cost is too low, the hospital must depend on inspection fee to make money." A 3 armour hospital managers was candid, adjust the income structure of hospitals and doctors, break medicine for medical, medical service price reform is imminent.
Then, after the price adjustment, the shenzhen public hospital income whether be affected? ABU strange introduction, the first phase of price adjustment project income is 233 million yuan a year, while the city's public hospitals gross income is 21.6 billion yuan a year, the percentage is about 1%. Overall, patients are spending less on 30 million yuan, this also means that the hospital income will reduce 30 million yuan, but it is not big to the influence that the public hospital. "Part of basic-level hospitals and part such as class hospital of traditional Chinese medicine hospital income will drop slightly, because the less of 4 class hospital surgery." Said ABU bizarre, but will be on financial aid policies and measures to perfect shenzhen including basic medical and health services of fiscal subsidies standards, establishing mechanisms for signing the family doctor service financial aid way give subsidies.
In the second and third stage after the introduction of reform, through drug deals, the cost of public hospital drug consumables prices will fall, hospital income will also be affected by the larger, but shenzhen will through the way of improving the cure, operation expenses, further adjustment of medical service prices. According to measure, through the "3 d linkage", after the reform, public hospital in the city of drug income proportion will fall to 24% from 33% now, the city hospital income of all types and at all levels will implement the overall balance, income structure more reasonable optimization.
The government financial investment is a solid backing to shenzhen public hospital reform. Shenzhen health development planning commission secretariat (healthcare reform office) director lee chong, from the start the reform in 2009, shenzhen public hospital financial aid accounted for the proportion of its total revenue increased from 17.2% to 30%, personal health spending accounts for the proportion of the total health expenses decreased from 23.82% in 2012 to 19.29% in 2015. In 2016, the city's public hospital outpatient and inpatient time cost were 214.9 yuan and 9592.2 yuan, to maintain in the domestic cities at the same level low. This also means that to reduce hospital income, in addition to adjust the medical service price for compensation, shenzhen will also through the government fiscal subsidies.
What are the first phase of the medical service price adjustment?
cancel Don't have to pay the registration fee and heating/cooling
Cancel 7 charge of the project, including the registration fee, single rooms, wards, heating heating, double room, ward, three or more persons ward heating, single room, double room room air conditioning cooling air conditioning cooling, three or more persons ward air conditioning cooling fee. According to the measure, the 7 after the cancellation charges, will reduce the $72 million a year.
Why do you want to cancel the registration fee? According to introducing, at present, the registration fee and the fee is almost 1 yuan to bind, easy to produce ambiguity in reality, many patients mistakenly assume that the registration fee is to cure the examined (fee). At the same time, according to the medicare policy, cure by medical insurance plan as a whole fund pays, pay the registration fee to patients, as the cloud of various medical informatization applications such as medical, mobile payment, online booking and payment separately into two programs to complete, add inconvenience to patients. At this stage to cancel the registration fee is in conformity with the relevant policy of the national health service.
Price of large equipment inspection fee prices by 20% on average
To lower the price of the 252 large equipment inspection treatment programs, such as CT, MRI and PET - CT, cut an average of 20%. Such as magnetic resonance imaging (mri) scan of tertiary hospitals (0.5 T) from 500 yuan to 400 yuan.
Large check and inspection items mainly depends on machine automation, past due to the relatively expensive equipment, these checks to test relative medical service pricing pricing has been on the high side. Cut price of large equipment inspection and test class projects, both conducive to control excessive examination and inspection, reasonable guide the hospital inspection and push the result sharing, easing the burden on patients, and can effectively alleviate queues caused by repeated examination hospital sees a doctor difficult problem, making medical service price comparison relations gradually. In a year, is expected to price increase will reduce the large equipment checks is 165 million yuan.
Price 357 level 4 surgery prices
Increased 357 class level 4 surgery medical service price, average price rises at 50%.
For example, the artificial intervertebral disc implantation increased from 2500 yuan to 2500 yuan, treated from 2000 yuan to 3000 yuan. Belong to the category of health care in hospital reimbursement as a result of the surgery, individual pay scale doesn't increase too much.
In addition, consultation and save the cost of the adjustment. The event such as hospital visits, hospital visits, remote consultation, respectively from the current 150 yuan, 10 yuan, 500 yuan, adjusted to 260 yuan, 20 yuan, 800 yuan, involving multidisciplinary cooperation small big rescue, rescue, the rescue cost also from the current 80 yuan, 40 yuan, 20 yuan to 96 yuan, 60 yuan, 40 yuan.
Skewed pricing to special specialized subject and tilt at the grass-roots level
Improve the 217 comprehensive therapy of medical service prices, increase at 25% on average.
City health development planning commission, said in the current public hospital running mode, the subject of economic efficiency is not high in hospital does not have enough attention, development lags behind. The reform plan accordingly raised prices significantly lower part of the comprehensive treatment project price. Including some prescriptions, check less, mainly depends on the medical staff special specialized technology and services, such as pathology, rehabilitation, mental, pediatric, traditional Chinese medicine, such as project, through the economic lever to the specialized subject of tilt, guide the development of public hospital, return to the public welfare.
Such as, in the first stage of the pricing, 7 pediatric exclusive projects to raise prices by 30%. In neonatal care, for example, neonatal nursing including premature babies, and evaluate the newborn environment adaptability, feeding, hip nursing, observation waste form, bath, etc., the current price is 40 yuan, after the adjustment will be to 52 yuan.
At the same time, also increased the family BingChuangFei, family visits 10 community health service projects such as cost price. Improve the basic medical and health service project price, which is beneficial to guide the sinking high-quality medical resources and improve the grass-roots medical staff's work enthusiasm, promote the formation of hierarchical diagnosis and order.
The same Individual require long-term treatment diseases is not adjusted
Reference from the experience of other provinces and cities medical service price reform, the reform in shenzhen to individual, special disease, especially for long-term or lifelong treatment and drug dependent disease, such as malignant tumor, blood and other commonly used blood and lymphatic system treatment, blood type and with the blood, medical services are not adjusted. For the long-term dependence on chronic renal failure and use of hemodialysis, hemofiltration, continuous blood purification and other medical services has been adjusted.
S voice
Zhu Hengpeng, director of the center for public policy research at the Chinese academy of medical service should be priced by the market
Why China's drug prices high "empty"? This part of the "virtual" high doctor is the price of labor, or the price of medical service is the rebate. Why the doctor labor price is not directly reflected in the price of medical service, to mix in the price? Because the government administrative pricing the medical service price is too low. The shenzhen price reform of medical treatment service, can reflect the medical staff is more technical labor value of the price, but make the government is not allowed to pricing is adjustable.
Pricing mechanism depends on the resources allocation mechanism, to make medical services price adjustment to a reasonable position, should be priced by the market, which means to promote the doctor free practice. The doctor is composed of administrative allocation, medical service price or compensation is administrative pricing. The government to hold up the medical service price, but cannot manage the doctor prescribe medicine and examination. If the doctor is the freedom of the free flow of practitioners, the doctors labor (compensation), or the price of medical service prices will be decided by the market, through the market competition, to hospitals and doctors to provide better medical service to patients, reduce the patients' medical costs.
Pediatric WeChat well-known public, "drpei" blogger PeiHongGang:
The doctor evaluation system will also change
If the medical service price reform is an important consideration in order to increase the sunlight of the medical staff income, reflect the career values of medical staff, so I think only adjust the patients' medical expense is not enough. The core question is, how to adjust the public hospital internal examination system to the doctor? This if not touch, the cure is expected to more patients. Improved operation price, how to ensure the doctor income also can increase? Is the key to the doctor's evaluation system also want to change, we need to respect the doctor's professional skills such as diagnosis, operation service, ensure the doctor can increase the proportion of income.
Nanshan district residents Liu Yue: the key to strengthen the supervision of medical practice
Large hospital check is too expensive. On a rough estimate, I according to the price of such a charge, the hospital in a few years can recover costs should be, but then why am I still so expensive? While the lower the cost of the large equipment such as CT, MRI examination, but still can't avoid the "big" examination, the doctor has prescribed sometimes doctors will be open either case is not serious, and the result is no exception. In addition to reduce costs, therefore, the key is to the regulation of the doctor's health, curb prescription, big checks. |
