Medical network - July 10 in early June, the national health development planning commission held in shenzhen in a kick-off meeting for DRG paying pilot reforms. As appointed by the state council in 2017 70 health reform one of the key work, DRG accept payment reform first rose to national strategic level. Our country ever pilot DRG payment reform before? How is the effect? What is the trend? What influence on pharmaceutical companies? How to deal with in advance? To solve these problems, the author will analyze one by one.
Three characteristics analysis
In fact, before the DRG payment reform into the national strategy, part of the city has carried out the pilot work:
Beijing - new farming and typical DRG payment reform
Pilot cities, Beijing is among the first to DRG as early as in 2003, Beijing began to DRG based data acquisition, pilot began in 2006, 2007 standards and dictionary library of medical record home page data specification. In 2011, the Beijing municipal health bureau to choose 108 disease to carry out pilot DRG paying. In July 2013, the Beijing municipal health bureau in pinggu district launched a new type of rural cooperative medical care payment comprehensive reform pilot work. From the current implementation, the new farmers pay reform effect is obvious.
Pinggu district of payment reform, DRG paying for 60 days under short-term hospitalization. Since August 20, 2013, 31 May 2014 in DRG grouping 8685 person-time, Beijing overall 10 area and pinggu district after the reform cost changes are shown in table 1, according to hospital short-term hospitalization cost growth under control, cases, medicine proportion were significantly reduced; Patient out-of-pocket costs reduced.
Sanming - all kinds of DRG payment reform pioneer
Since January 1, 2016, in sanming 21 at the county level and above all public hospitals to carry out the hospitalization expense by macro-reforms, conform to the conditions of private medical establishment that decide a dot, can be performed with reference to the medical establishment that decide a dot at the grass-roots level since 2017, overall hospitalization expenses and all press disease to paid work. A total of 609 diseases group and payment standards, each group sanming for worker health and residents health points given different payment standard tertiary hospitals and secondary hospital.
Sanming medical insurance fund management center statistics in the first quarter of 2017 spending on health care in the city as a whole fund, see table 2 shows all institutions after the execution of DRG, negative growth in the hospital as a whole fund cost, control effect is obvious.
Jinhua - rich regions DRG payment reform model
Downtown in July 2016, jinhua according to 42 hospitalized 18 months before the medical establishment that decide a dot of more than 210000 cases of hospitalized patients with data, will take place of all disease "packaged" into paying 595 group and disease group price is composed of disease this level and the cost of every hospital level as well as the dynamic formation health-care spending fund budget, the dynamic pricing mechanism is called "payment method" (PPS).
A fund spending growth rate is according to the local GDP development level, the city hospital population growth, price index, and zhejiang province issued medical determine the growth rate of total cost control target. Points total reaction hospital services, at the same time points adjustment mechanism is introduced, and the health care of quality, satisfaction, accounting control and the assessment results and points.
The reform pilot packaged in seven hospital department in advance, the result shows: the pilot hospitals in December 7, 2016 - the average hospitalization cost growth rate was 11%, compared with 15% in 2015, the total cost of the average growth rate, growth rate appeared a downward trend; Hospital 10711 person-times growth, the growth rate of 13.65%, but both times hospitalization cost increased from 9416 yuan to 9416 yuan only, the basic zero growth.
Trend forecasting
Combined with national perform DRG payment reform background and has the effect of the city, speculated that the reform will appear the following trends:
1. The specification of national unity Some cities have adopted various methods to promote the group payment reform, national pilot implementation of DRG will adopt to our country independent design of the national press disease diagnosis related groups receive pay ", in the country a pilot DRG before, during and after the reform of Chinese health economic association and China association for price "charge technical specification of press disease (try out)" coordinated reform.
2. The technology as the precondition "standard of the national press disease diagnosis related groups receive pay" need to have three basic tools, code, code and terminology, etc., need to have a strong information system support. Relevant national people mention to 2018, the first pilot 37 hospitals are expected to get preliminary evaluation, plan will DRG push to 50 cities in 2019, and in 2020 to 100. Is expected to pilot cities will be the informatization maturity.
3. The main scope for a hospital stay Both the United States and the domestic some pilot cities, all is for hospital disease, in 320 "press disease charging specification table" in addition to the five community treatment diseases basic diseases for surgery, so the DRG payment reform is the main scope of diseases in hospital.
4. The main targets for controlling the comprehensive effect of DRG payment reform at home and abroad, are reported to control hospitalization expenses or spending growth to reduce the medical insurance fund for effective logo, present a series of national policies and control health care costs and reduce the medicine proportion, so the implementation of DRG is to in the second negotiation, payment standard on the basis of further reduce the total hospitalization expenses and the corresponding medicine proportion.
Deal with advice
For the trend, it is recommended that the pharmaceutical enterprises attach importance to the following work:
1. Improve the academic status of related products Health economic society's disease to attachment column to display only in the corresponding drug categories, common name, no specific product clinical choice which varieties, and at present the country to promote the clinical pathway is closely related to the path choice of varieties with disease clinical diagnosis and treatment guidelines and varieties for evidence-based basis. Combing the existing key varieties, screening hospital as the main varieties of the market, the general is given priority to with injection, intervention of clinical path and guide the work ahead of time, form a favorable basis for academic status.
2. Pay attention to relevant academic promotion before pilot cities group are based on clinical diagnosis and treatment methods for specification, therefore high clinical acceptance is included in the main basis, varieties of hospital coverage and increase the products quantity is an important foundation for sustained growth in the future.
3. Improve the relevant ratio of packaging an important goal is to control the hospitalization fee, save medical insurance fund expenditure, and contrast the new pharmacopoeia, product competition, improve related variety price, become a priority in the selected combinations of the same drug product, so as to make big market.
4. Pay close attention to national pilot city reform The national pilot cities and hospital or have coverage, suggest that enterprise with its own terminal team or business team to understand DRG and dynamic development of the reform, adjust the corresponding varieties in understanding the marketing strategy.
(the writer is Shanghai pharmaceutical strategic development institute special researcher) |
