Release date: 2010-01-06
In 2009, the new medical reform, which carried the hopes of 1.3 billion people, started hard. As the most difficult and arduous task in the reform, the national essential medicine system and public hospital reform seek breakthroughs in exploration.
The basic drug system is steadily advancing
In 2009, as an important part of the new medical reform, the national essential medicine system began an ice-breaking journey. In August, China announced 307 national essential medicines suitable for primary health care institutions, requiring all government-run medical and health institutions to use these drugs, unified procurement and distribution, and no increase in sales. This means that the construction of the national essential medicine system has officially started.
In October 2009, the National Development and Reform Commission announced the retail price limit for essential drugs. Compared with the current price, 45% of the drugs are reduced, 49% of the prices are not adjusted, and 6% of the shortages are increased. According to preliminary estimates, the overall price of medicine can be reduced by 25%.
The reporter learned from the Ministry of Health that at present, the construction of the national essential medicine system is progressing steadily. The National Essential Medicines Working Committee has been established, and the 2009 edition of the National Essential Drugs List (Basic Section) and other normative documents have been formulated, and all essential drugs have been included in the basic medical insurance drug reimbursement catalogue. All provinces (autonomous regions and municipalities directly under the Central Government) began to implement the national essential medicine system in 30% of government-sponsored urban community health service institutions and county medical and health institutions, and cooperated with relevant departments to strengthen drug quality supervision. All localities have improved the government-led centralized drug procurement platform and implemented the basic drug bidding procurement task. In Beijing, Ningxia and other places, grassroots medical and health institutions have all achieved zero-difference sales of drugs, and the burden of drug use has been alleviated.
â—Ningxia: One dollar can get medical treatment and buy medicine
"Now go to see a doctor, just spend a dollar!" said Wang Liping, a villager in Zhangyi, Yuanzhou District, Guyuan City, Ningxia Hui Autonomous Region. He went to the village clinic to see a cold, and the village doctor prescribed the prescription of cephalosporin tablets and ribavirin particles according to the condition. After seeing the disease, Wang Liping only paid 1 yuan. The rural doctor who was admitted to the clinic said: "The peasants have a headache and brain fever. Look at the village clinic. The medicine fee is below 3 yuan, and the penny is not charged. The drug fee is more than 3 yuan and the fee is 1 yuan."
Ningxia implemented the unified bidding and procurement reform of medicines, innovated the “three unification†model of unified bidding, unified distribution and unified price of medicines, and on this basis, realized that farmers can spend nearly one yuan to get close to the doctor.
The “three unifications†of medicines started from three years ago. Ningxia uniformly implemented the zero-profit sales price of medicines in the urban community health service institutions and rural medical and health institutions in the whole autonomous region, and added 5% of the losses on the basis of the winning bid price, and the government added Great financial input, the township medical institutions will be included in the management of the full-scale public welfare institutions, and the village clinics will be given certain subsidies; the second-level and above medical institutions will uniformly implement the highest retail price limit of 15% of the winning bid price, and regulate the public hospital drugs. Price; at the same time promote the medical institution drug price publicity system, accept the supervision of patients and the society, put an end to medical institutions to increase drug prices or increase drug prices.
Through the reform of the pharmaceutical system, Ningxia has lowered the prices of medicines and medical consumables. Through three rounds of unified bidding for municipal community health service agencies, rural first-level medical institutions, city and county secondary medical institutions and tertiary medical institutions, the price of medicines dropped by an average of 40.71%. Standardize the supply channels for drug supply. More than 90% of the medicines in the medical institutions of the autonomous region have been included in the unified distribution management system, and the coverage rate of the winning drugs has reached 100%. It broke the previous drug supply model, reduced the supply and circulation of drugs, stabilized the market drug price, standardized the order of drug circulation, effectively prevented counterfeit and inferior drugs from entering medical institutions, ensured the quality of drugs, and promoted the standardized management of drug purchases.
On the basis of the “three unifications†of medicines, starting from 2009, the Ningxia Hui Autonomous Region launched the pilot project “Experimental Project for Basic Medical and Public Health Services for Allâ€. As the first pilot areas, urban and rural residents in Yinchuan City and Guyuan City enjoy free access to 49 basic public health services including immunization planning, maternal and child health care, and chronic disease management. When farmers go to the nearest village clinic to see a doctor, they only need to pay 1 yuan for pharmacy, and they can get 30 kinds of common diseases and 74 kinds of essential medicines for outpatient treatment services free of charge, which greatly reduces the burden of medical expenses for the masses.
â—Tianjin: Community basic drug sales at a fair price
In 2009, the centralized drug procurement and community health service institutions implemented zero-difference rate sales of drugs, which were listed in the 20 key projects of the Tianjin Municipal Government and the Tianjin Municipal Health Reform. According to the actual situation, Tianjin has formulated its own “Catalogue of Basic Drugs for Community Health Service Organizationsâ€. There are 537 kinds of drugs in the “Catalogue†according to the common name, including 237 kinds of proprietary Chinese medicines and 300 kinds of western medicines. Some common names have prescribed dosage forms. . The Catalogue covers the basic medication needs of common diseases, frequently-occurring diseases and well-diagnosed chronic diseases in the community.
In Tianjin, the Catalogue of Basic Drugs for Community Health Service Organizations is not only a catalogue of community medications, but also a catalogue of basic medications for medical institutions in Tianjin. All public medical institutions at all levels in the city are used. Some community health service agencies in the six districts and 18 districts of Tianjin have implemented catalogues and sold at zero rate. Other districts and counties are also implemented according to the catalog before the implementation of the zero rate of drugs. The second-level medical institutions in the city use the varieties in the catalogue, and do not implement the zero-difference rate of drugs. The medical institutions at all levels in the city have implemented new procurement methods since April 1, 2009, and the current response is good. The Catalogue basically meets the needs of the community.
According to statistics, after the implementation of the Catalogue, the burden of medication for residents was effectively reduced. The cost of the drug-added portion originally paid by the patient will be subsidized by the medical insurance payment and government compensation to the community health service institutions to achieve the same price of the basic drug sales in the community and the same city, so that the basic drug price of the community will be reduced by at least 15%. Moreover, through the city's unified online procurement, standardize the procurement channels for basic drug use in the community, and further ensure the safety of drug use by the community.
Public hospital reform test
The reform of public hospitals began in 2009. As the most difficult problem in the new medical reform, the Ministry of Health began to study the reform ideas of public hospitals, formulate guiding documents for pilot work, and start pilot reforms. Tianjin, Shanghai and other places optimize the structure of public hospitals according to the trend of urban development and population changes. Cities such as Wuhu in Anhui and Mohe in Heilongjiang actively explored effective ways to achieve separation of medicines. Guangdong and Yunnan carried out pilot work on doctors' multi-point practice and explored management methods. Heilongjiang carried out professional training for hospital deans and improved the management capacity of the dean.
In order to ensure the people's enjoyment of high-quality medical and health services, in 2009, the Ministry of Health focused on strengthening the quality management system and standardization system, establishing a clinical application management system for medical technology, further strengthening the management of medical institutions and the construction of specialists, and promoting the rational use of drugs. . In order to strengthen medical quality and blood safety management, the Ministry of Health launched the “Medical Quality Miles†work, conducted quality and safety supervision and inspection on nearly 300 hospitals and more than 110 blood stations, strengthened hospital infection prevention and control, and voluntary voluntary blood donation accounted for clinical blood donation. The ratio reached 99%.
The construction of the nursing team has received further attention. In 2009, the number of nurses was further increased, and the structure and quality of personnel were improved. All localities began to establish and improve the graded care system to improve the quality of care and technology. At the same time, the Ministry of Health conducts inspections of large hospitals, actively explores the establishment of hospital evaluation systems and evaluation systems, and prepares for evaluation and evaluation.
In the second half of 2009, a “outpatient revolution†kicked off. In October, the Ministry of Health required all tertiary hospitals to make appointments for medical services, and hospitals in various places responded. This initiative aims to gradually alleviate the problem of people going to large hospitals to see a doctor. In December, the Ministry of Health issued a notice to determine the clinical path management of 112 diseases in 50 hospitals across the country, laying a foundation for further standardizing medical service behavior and reducing the medical burden of patients.
â—Shaanxi: Zichang created "parity hospital"
On June 1, 2009, Zichang County of Shaanxi Province launched a reform of public hospitals with the creation of “parity hospitals†as the main content. Starting from the drug purchase and sale system, all public medical institutions in the county implemented centralized drug procurement and unified distribution to reduce circulation. Linking off the abnormal interest chain between pharmaceutical manufacturers, medical representatives and medical personnel. After gradually realizing the low price of medicines, Zichang County canceled the 15% drug addition allowed by the policy, and implemented zero-rate sales. All the drugs in the county and townships were required to be of the same price and the disease was imposed on 23 diseases. Kind of charge. The County Price Bureau lowered the cost of large-scale inspections according to cost accounting, and the hospital's reduction was partially subsidized by the county. The reform of the public hospital in Zichang County highlights the public welfare nature of the hospital. While breaking the medical care system, it has increased the government's support for the public, changing the county public hospital from the difference unit to the full budget unit, and the medical staff allowance. All the expenses such as subsidies and personnel training are included in the budget, and the government allocates funds for the hospital to purchase advanced equipment and equipment. According to the statistics of Zichang County Health Bureau, compared with before the reform, the drug prices of public hospitals in the whole county dropped by about 40%, the average monthly cost of inpatients decreased by 44.8%, and the average monthly cost of outpatients decreased by 45%. The cost of gallstone surgery is less than 3,000 yuan, which is nearly 2,000 yuan lower than before the reform. The number of outpatients and inpatients in the county people's hospital increased by 25% and 17.3%, respectively, and the number of discharged patients increased by 130. (turn down to the third edition) (on the first edition)
â— Anhui: Wuhu pilot medicine separation
At the end of 2007, Wuhu City, Anhui Province established the Drug Administration Center of the Municipal Medical Institution. In 2008, the city implemented pilot reforms in medicine separation and drug unified management in eight municipal hospitals. At present, the reform has passed the running-in period and entered the normal operation period.
The Wuhu Municipal Health Bureau has established a drug management center to establish a unified drug procurement and supply system, and through the implementation of drug online bidding procurement, effectively reduce the cost of drug procurement, and cut off the interests of pharmaceuticals, pharmaceutical personnel and medical institutions. The bidding and procurement of drugs shall be divided into three parts: decision-making, implementation, and supervision, and strengthen the supervision of the whole process of purchase and sale of medicines. In the two years since the introduction of medicines, the city’s drug add-on has been reduced from 15% to 10%. In 2008, the sales of medicines reached 244 million yuan, directly making profits of 12 million yuan. In 2009, through the centralized bidding for drugs, the cost of medicines was reduced by more than 60 million yuan.
Wuhu City has also increased government investment in health and promoted the reform of the compensation mechanism for public hospitals. First, starting in 2008, within five years, the government will invest no less than 50 million yuan each year to integrate medical resources and support medical institutions to accelerate infrastructure construction. The second is to transfer more than 2,000 retired employees of medical institutions to social security management. In the past, the annual funding for nearly 40 million yuan paid to hospitals has not been reduced. The third is to change the medical insurance patient fee and pay the system as a prepayment system, and prepay the hospital 80% according to the medical insurance fee level in the same period of last year.
â—Jiangsu: trial clinical path management
In the reform practice, Jiangsu Province proposed to focus on improving medical services, strengthening the supervision of medical service quality, and allowing the people to truly feel the new changes brought about by medical reform. The outpatient appointment registration service was fully pushed. Up to now, 98% of the tertiary hospitals (including Chinese medicine hospitals) and 143 secondary hospitals in the province have carried out different forms of appointment registration services, and the awareness rate of outpatient visits is nearly 60%. The proportion of patients who visited the hospitals in the second-level hospitals in the province was close to 10%, and that in tertiary hospitals reached 13.5%. The informationization of appointment medical management was progressing steadily.
The efficiency of medical services has further improved. The average hospitalization day for tertiary hospitals in the province was shortened from 16.63 days in 2005 to 12.3 days in 2009. Since 2007, the average cost of outpatients in the province and the average cost of discharged patients have been much lower than the increase in disposable income of urban and rural residents, and medical expenses have been further controlled.
In addition, Jiangsu Province has also strengthened clinical pathway management. Starting from September 1, 2006, with the single disease type limit price management as the entry point, select 7 professional 45 single disease types, and promote clinical path management in the province. By the end of last year, 13 provinces in the province had carried out the management of single path clinical pathways except Suqian. According to incomplete statistics, the number of single diseases that have been clinically managed by provincial-administered cities has reached 200, and more than 50 secondary and tertiary hospitals have been tried for clinical pathway management.
â— Shenzhen: Establishing a corporate governance structure
The reform of the management system of public hospitals is the highlight of the new medical reform. According to the "Opinions on Promoting the Reform of the Medical and Health System" promulgated by the Shenzhen Municipal Party Committee and the Municipal Government in 2009, the health administrative department no longer directly organizes public hospitals, but gradually transfers public hospitals to hospital management organizations for independent management through entrusted management. . The health administrative department, as a representative of the funder, strengthens the supervision of state-owned assets and public service functions of public hospitals. At the same time, we will promote the reform of corporate governance structure in public hospitals, and adjust the power structure and operational mechanism of decision-making, enforcement, and supervision powers that are mutually constrained and coordinated, and adjust the owners, operators, medical personnel, and the public. The “responsibility, power, and profit†of stakeholders will achieve the goal of maximizing the operational efficiency of public hospitals on the premise of ensuring public welfare. Among them, Nanshan District People's Hospital set up a council, the chairman of the board of directors is the deputy head of the district, under the office and financial, auditing, performance evaluation and other professional committees, the office director is also the director of the district health bureau. Longgang District has set up a hospital management center, which is the full-funded financial institution directly under the deputy department of the District Health Bureau. It fulfills the duties of the public hospital funders, undertakes the functions of holding 11 street hospitals, and accepts the business guidance and industry supervision and management of the district health bureau.
It is understood that the city's public hospital management structure reform is divided into three parts: the hospital management committee is the decision-making department, composed of representatives of government departments, people from all walks of life, hospital representatives, operating according to the charter, responsible for the government; the hospital leadership team is The executive department shall manage the hospital affairs according to law, implement the decision-making and deployment of the hospital management committee, operate according to the requirements and functions and systems of the hospital management committee, and be responsible to the hospital management committee; the supervision department shall be composed of representatives of the workers (representatives), the public and industry supervision departments. Effective supervision of the operation and management of public hospitals and functional manifestations.
â—Hainan: Exploring the management system of “separation of government and affairsâ€
How to solve the problem of “paving and steering†in the health administrative department, Hainan Province takes hospital evaluation and quality management as a breakthrough, and draws on the international experience of third-party evaluation to explore the management system of “separation of government and governmentâ€.
In April 2008, Hainan Province took the lead in setting up the Hainan Hospital Evaluation and Medical Quality Supervision Center, authorizing the center to implement eight functions including evaluation, evaluation and medical quality supervision at various levels of medical institutions at the provincial level. "Separation of political affairs." The appraisal center has a triangular relationship with the health administrative department and medical institutions. At the same time, the evaluation center and the medical institution are interactive partnerships, and the health administrative department mainly evaluates and supervises the hospital by means of entrustment and authorization. In May 2009, Hainan Provincial Health Department further merged the Hainan Provincial Infection Surveillance Center, Clinical Testing Center and Nursing Center into the evaluation center. The tasks undertaken by the three centers were planned and implemented by the evaluation center. In June 2009, the Hainan Provincial Health Department commissioned the evaluation center to formulate the “Basic Standards for Medical Institutions in Hainan Provinceâ€. After more than a year of exploration and practice, the health administrative department changed the evaluation and quality supervision of the hospital from a single administrative supervision to a third-party professional management under administrative control, and initially rationalized the health administrative system and formed an independent The third-party supervision mechanism and the replacement of the “administrative†operation mechanism by “professionalization†have improved administrative efficiency and reduced management costs. (health report)
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