Medical network - on December 28, on the third day in a row, CCTV reported using special time drug prices and health care reform - this time, the grand launch of sanming.
On the evening of December 26, CCTV broadcast "topics in focus" the "3 d linkage" to medical disease operation ", this paper introduces the 3 d linkage in fujian sanming for reform.
After two days, CCTV respectively by special news reports the high commission under high drug prices, to say no to higher medical consumable materials, the third wave of reports from the supervision of public opinion toward positive publicity, to explore the "two votes" sanming mode, as well as linkage to explore the reform of "3 d" achievements and status was this a series of contrast report again.
In this round of "fire" under continuous reports, sanming mode to the full implementation may have been just around the corner.
"Vacate basket change a bird" let hospital income structure has changed dramatically. In sanming county hospital as an example, before the reform, drug consumables accounted for about sixty percent of the total income, medical income accounts for only forty percent. By 2015, the ratio is reversed for allocation. 1 to November 2016, further medical sex income up to 71.1%. With the adjustment of the income structure, sanming to medical personnel salary system and the subversion of the reform, promote overall goal yearly salary, the profit mechanism of old was abolished." - program emphasizes.
The sanming mode have, in fact, many times in the "news broadcast" broadcast is introduced, also many times by the competent department of vocal support for sanming mode and turn it into the country.
In April 2016, the national health development planning commission will deepen the reform in 2015 work progress and deepen the reform in 2016 held a press conference of health reform project priority tasks, reform of the state council office, national health development planning commission deputy director of the full-time TiGaiSi chief priests Liang Wannian, said city public hospital reform pilot from 17, to the end of 100, among them, the reform of "3 d linkage", such as fujian sanming experience is commendable, who planning commission thought to promote in the country.
On November 8, general office of the central and the state council general office and forwarded the deepening medical and health system reform leading group of the state council on further promoting the deepening medical and health system reform experiences of the several opinions, around the core content is to promote health care reform pilot summed up in eight aspects "and article 24 experience", these experiences from sanming city, fujian province, and jiangsu, anhui, fujian, in qinghai, which was singled out "sanming city of fujian province", and on the front, sanming mode is to the important position of health care, it goes without saying.
Under such a clear signal to release for drug firms, squeeze out the water circulation was sharply will hide in the past, not in the current price has already been squeezed conditions, further shrinkage is also a certain price, the lack of core competitive product competitiveness of drug companies will become the first to be affected, niche competition will intensify, industry seating pattern will be redistributed.
The following for the CCTV network of 26 "topics in focus" content:
Nearly three years, the central comprehensively deepen reform leading group six meetings have been focused on medicine and health care system reform. For medical health concern of the people especially specially introduced five documents. At the end of 2015, it is clearly put forward to promote the implementation of the "three medical linkage", a new approach to design is the top health care, medical treatment, health care, the linkage of the medical reform as the key. Fujian sanming conducted early on 3 d linkage of grassroots reform exploration practice, linkage between 3 d? How to joint? How to solve the problems of hospital care?
In sanming city, fujian province will le county hospital, huang Lin new doctor is an orthopaedic surgery. Sanming for health-care exactly what has changed? Let's look at the three price changes over the surgery, surgery is the first use of consumables, used for intramedullary nail fixed. Doctor: "the past consumables is an average of 17000 yuan, now is about 9500 yuan to 9700 yuan."
The second number, to see if the doctor's surgery is change. Doctor: "in the past the cost of the operation is more than one thousand four hundred, is now two thousand, operation cost increased by 45%."
The third number, of course, is also the people most concerned about, that's all, patients from the pay out of pocket money is more or less? Doctor: "originally patient pays 12000 yuan, now pays 6000 yuan."
Look from these Numbers, material price goes down, the doctor's work is worth than before, the burden of the patients with ease. Although because the illness is different, different patients with different drug, data are not always the same, but the direction of such change is not possible before reform. Once upon a time, sanming also like most parts of the hide not open these three words: see a doctor expensive.
Why the doctor more expensive? Sanming thinks that one of the main contradiction is the moisture in drug prices too high, the interests of the chain is too long.
Normally go hospital sales way after drugs and consumables, passes through the national total generation - province, area generation - clinical, finally used for patients. In addition to each link layers of premium, in around the bidding, the moisture in the drug prices standing up even vendors often, to make room for the doctor kickbacks. , of course, not all drug kickbacks, more not all doctors in earn commission, however, this phenomenon has a certain universality in the country. Drug prices high, finally pay money is who? One is the medical insurance fund, and self-paid part of patients. Is responsible for the bidding and pricing need not pay, pay for the two parties are tube drug prices, while for the hospital, high drug prices do not increase the cost. Before, on the other hand, based on the reform of wage system, the more the more expensive, sell, the more likely they were to increase the income of hospitals and doctors.
In the interests of the chain drug prices and unreasonable system of mechanism combination, drug prices more expensive, also more and more heavy burden on patients and the medical insurance fund. The city as a whole, sanming 2010 worker health care was not arrived in 140 million, the second is to rise to 208 million, more than 1700 still owe the hospital. Problems reversed transmission reform, the thinking of sanming is, since medical, health care, medical problem is interaction, must be linked up and reform, and need to take the government management system operation.
Take the example of drugs, drugs ex-factory price to price bureau, before entering the hospital drug bid to health development planning commission, paid by drug involved in health care in a club of a tube, pharmaceutical production and quality management and belongs to the food and drug regulator, etc. Add up 3 d department is numerous.
Four years ago, the then vice mayor of sanming zhan product for a new position, sanming we will deepen reform of the medical and health system team leader. Sanming reform took his first step, this has just set up new department, has a and other departments related to health care are the power of the dust.
Has unified the baton, just afraid of not form resultant force. So, the reform to want where to go? The 11th meeting of the central deep change group has suggested, to adhere to the basic orientation of public hospital public welfare, break public hospital profit mechanism. Fujian sanming according to three return target power: make public hospital public welfare nature, let the doctor return to see a doctor, make medicine cure function role. On the one hand, the local government clear own do medical responsibility, take out the money into the development of public hospital construction and key subject, etc.; On the other hand is to operate on the artificially high drug prices.
The doctor is more and more expensive, here a core contradiction is the point of paying for food. By rights, pay is one of the most dynamic compression cost, but he just can't do the Lord. The prescription for you but may be because the medicine, the amount of open more expensive. How can easily the fees for the doctor to come down?
To this end, in 2013, sanming miho unity, the town worker medical insurance, the residents' health, the new farmers and three types of insurance agency orgnaization integration into a new medical center, and give it a lot of new powers, including drug centralized purchasing, the medical service price adjustment, medical behavior regulation, etc.
Have the right to purchase, medical tube center will wrap up all public medical institutions in the city, and in combination with other cities, purchasing price for national unity, with quantity demand, low bid. Drug supplies from factory to enter the hospital, only a logistics links, the whole process can only open two invoice, the original interests chain is cut off. At the same time, the implementation of a variety of two specifications, the prevent doctors under the same drug choice has varieties of kickbacks.
In new drug circulation chain, between the hospital and for prescription there will be no direct funds, they are now just need to "to order", that is what I need medicine and consumables, quote medical tube center your common name. Such reforms can squeeze out the moisture in how much prices? According to the sanming, at present, drug prices fell 30% as a whole. Sanming city, plus 15% addition of the drug after entering the hospital is also cancelled, appeared to ease patients burden.
Although prices down, but the resistance followed. Because of sanming purchasing volume is small, less than one over one thousand of the country, less bargaining power. Some drug companies reluctant to give up the sanming, appear even some high quality drugs out of sanming market situation.
To break the islanding, sanming, and part of the city has created a purchasing alliance for quantity in price, but the space that further reform will have how old, still need game.
Price goes down, the hospital and the doctor's income is lower, it will not affect the enthusiasm of the doctor? Sanming reform with that in mind, medicine and health care reform linkage.
Said, in front of the new medical tube center are endowed with a lot of new power, in addition to the purchasing power, and coming from price bureau and the power to regulate the price of medical service. Out of the water from the drug prices, realize the profit, medical tube center is rich to subsidize medical services. Such as surgery, nursing diagnosis, all of these reflect staff labor value, charge with the balance of medical insurance fund and gradually improve, they called it "vacate basket change a bird".
"Vacate basket change a bird" let hospital income structure has changed dramatically. In sanming county hospital as an example, before the reform, drug consumables accounted for about sixty percent of the total, the medical income accounts for only forty percent. By 2015, the ratio is reversed for allocation. 1 to November 2016, further medical sex income up to 71.1%. With the adjustment of the income structure, the sanming medical personnel salary system is for the subversion of reform, promote overall goal yearly salary, the profit mechanism of old was abolished.
Break profit mechanism, to cut off is dishonest gain, instead of labor value of medical staff should be respected. With reference to international practice, sanming is the salary standard of local social positions and two to three times of average wage. In youxi county hospital, for example, in 2015, its per capita salary of 116000, the equivalent of youxi county institution staff 2.5 times of average wage jobs.
The reporter understands, not all doctors can be full to get the target salary, but overall, the doctor's reform of the income on average than the sun before more than doubled. And the change of income also directly affect the doctor's diagnosis and treatment behavior.
From drug prices in the extrusion moisture, in addition to used to subsidise the medical service price, medical tube center also used to expand the scope of reimbursement, improve reimbursement ratio, etc. Only a few dollars, for example, although most of the registration fee before, now the clinic analyzes raised to 18 and 48 yuan, but it can raise to the reimbursement standard 18 yuan. Only hang average number of words, will not spend more money. Funds have the balance, also for some patients with eligible for additional benefits, further reduce the burden of patients.
Fujian sanming break original medical management and operation pattern, explore a 3 d linkage of reforms, such as reforming health insurance payment system, driven by macro-reforms, doctors would not easily excessive, to cut off the drug chain with the interests of the hospital at the same time, this will greatly reduce the burden of patients, and hospitals, doctors, medicines to the location of stepwise regression. The sanming reform has begun from the city to the village for "four push", and gradually promote in fujian province. Many departments are involved, medicine and health care reform involves the interests of the main body, also how "is refers to punch and resultant force to overcome", need further exploration. |
