The Health Commission and Planning Commission interpreted the county-level medical reform

The "Opinions on Promoting the Comprehensive Reform of County-level Public Hospitals" (hereinafter referred to as the "Opinions") require that the use of medicines to supplement medicine should be eliminated and the prices of medical services should be rationalized. For example, increase the price of items such as diagnosis and treatment, surgery, nursing, beds and traditional Chinese medicine services; reduce the price of medicines and high-value medical consumables; and reduce the price of large-scale medical equipment inspection and treatment.

However, the resistance to increasing the prices of medical technology services is very large. The medical community has been appealing for many years and it has not been resolved. Where is the difficulty?

Liang Wannian said that the cancellation of medical treatment is a breakthrough in the reform of public hospitals. In June 2012, the state initiated the pilot implementation of the comprehensive reform of public hospitals in the first batch of 311 counties. Practice has proved that the overall direction of the reform pilot is correct, the policy is basically in line with reality, and basic approaches have gradually taken shape. Whether it is medical personnel, public hospitals, or government departments, the consensus has been formed to eliminate the use of medicine to supplement medicine.

After the abolition of medicines, the prices of medical technology services must be reformed.

In the early 1980s, the government invested 35% of the total hospital expenses, as well as income from drug additions. After the hospital’s expenditures are subtracted from these, the difference is supplemented by medical technology service charges. The prices established in this case were low and reasonable at the time.

Second ask how to avoid the higher bid price

The "Opinions" proposes to reform the centralized procurement of drugs. The medicines used by county-level public hospitals must rely on the provincial-level centralized procurement platform for pharmaceuticals and use provinces (autonomous regions and municipalities) as their units. In accordance with the principles of quality priority and reasonable price, they should adopt measures such as joint promotion, quantity-price linkage, and double envelope system. Conduct centralized tendering and procurement, while allowing local exploration in different ways according to actual conditions.

The bidding and procurement of drugs have been implemented for many years. Some people think that the higher the drug prices are, the more controversial they are. Will the implementation of centralized bidding and procurement of medicines be able to reduce the high and low drug prices?

Liang Wannian said that according to international experience, drug purchase is a major trend. Because centralized procurement is certainly stronger than decentralized procurement, this is the law of large numbers. There are some problems in the centralized tendering and procurement of medicines. It does not mean that the direction is wrong.

In the past, the higher the drug prices in some localities, the higher the bidding rate, mainly because the bidding price and the purchase quantity are not linked. The hospital implemented a policy of 15% increase in the price of drugs, and the higher the tender price, the higher the income. Therefore, individual hospitals hope that medicines will be as expensive as possible. Individual drug dealers also hope that drug prices are high, so that there is rebate space. These hospitals and drug dealers all hope that the drug price is high, so it is difficult to attract real prices.

"Integration of recruiting, mining, price-linking, and double-envelope system" is a good reference to the beneficial practices and experience of centralized bidding and procurement of essential medicines and overcomes the previous drawbacks. If it turns out that this practice is effective in county-level public hospitals, it is also effective in large urban hospitals.

After the implementation of centralized tendering and procurement of medicines, will hospitals and drug dealers be permitted to negotiate for bargaining? Liang Wannian said that in principle, "secondary bargaining" is not allowed. Although locally, the hospital reduced the price of drugs through “secondary bargaining”, but it was a great harm to the overall situation. If all hospitals go to “secondary bargaining” and drug dealers are under pressure, they may have to cut their prices, but the centralized bid price loses its meaning and returns to a state of decentralized bargaining. This also leads to corruption.

The "opinions" proposes to further enhance the participation of medical institutions in the procurement of pharmaceuticals. Inter-provincial joint bidding and procurement are encouraged to ensure the quality and safety of drugs and to effectively reduce the prices of drugs.

Yao Jianhong believes that there are many pharmaceutical factories in China, and the supply of pharmaceuticals exceeds demand. In 2011, the total cost of medicines in the country was 944.8 billion yuan. Among them, 73.7% were sold in medical institutions. Medical institutions will undoubtedly become the main body of drug sales. This time, we insisted on bidding and purchasing by province as the unit, and encouraged cross-provincial joint bidding and procurement in order to increase the power of group purchase and negotiation and effectively reduce the price of drugs.

How to Solve the Brain Drain in County Hospitals

Recently, many county-level public hospitals have experienced the phenomenon of "talent shortage" and the loss of key talents. How to solve the problem of talent shortage in the reform of county-level public hospitals?

Liang Wannian believes that doctors in China are institutions, and public institutions have problems in preparation and involve a series of issues such as financial investment and pensions. Therefore, the establishment of the business to a certain extent hinders the flow of doctors, especially downward. However, if doctors take the lead in eliminating the identity of public institutions, how can their social security such as pensions be solved? This is the core issue. To solve the problem, social security of social security such as retirement should be promoted.

The personnel system is not reformed, and reform of county-level public hospitals is difficult to advance. The "Opinions" proposed that the total staffing establishment of county-level public hospitals should be reasonably approved, and dynamic adjustments should be made to gradually implement the preparation and preparation system. Fully implement the employment system and post management system, adhere to the need to set up posts, compete for posts, hire by posts, contract management, implement the fixed and fixed posts, change the identity management to post management, and establish the capacity for energy efficiency and energy efficiency. Flexible employment mechanism. Combined with the actual placement of unskilled personnel.

Yao Jianhong believes that the concept of the preparation of public hospitals is being diluted due to various factors such as de-administration. If the medical staff is no longer a public institution and becomes a social person, the talent will flow freely and create conditions for more practice.

Liang Wannian said that allowing doctors to obtain dignified remuneration is the key to retaining talent. It is necessary to establish a salary system that suits the characteristics of the medical industry. At present, the salary of doctors in our country is low, which is a recognized fact. It is necessary to establish a salary system that suits the characteristics of the medical industry. This requires research and exploration. For example, in Sanming City, Fujian Province, exploring the doctor's annual salary system, whose salary is 3 to 5 times the average social wage, and the doctor's maximum annual salary of 300,000 yuan, this measure effectively mobilized the enthusiasm of the doctor.

The "Opinions" proposes to establish a talent training system adapted to the characteristics of the industry. Establish a sound standardized training system for resident doctors. By 2020, doctors who have newly entered county-level public hospitals must undergo standardized training for residents. Strengthen the training of backbone physicians at county-level public hospitals, study and implement specialized post-posted job plans, and introduce high-level talents that are in urgent need.

Yao Jianhong believes that after the establishment of a standardized resident training system, a large number of “standardized doctors” will emerge in China, which will help reduce the dual reverse flow of talents and patients.

After that, the proportion of government investment has decreased year by year. At present, the government's average investment in public hospitals only accounts for 6%-7% of the actual hospital expenses. As a result, medical technology services are not suitable for maintaining previous pricing.

In addition to this pricing method, there are three ways to price medical technology services: The first is full-cost pricing, which means that the basis for pricing is cost. The difficulty is that medical costs are not well accounted for. First of all, the doctor's labor costs cannot be accounted for because the doctor's salary is low and cannot reflect its value. Second, there is no standard for technical cost. Different doctors do the same surgery. Is the value equal? It's hard to say clearly. The second kind is based on the payment of medical insurance, that is, according to the ability to pay, the medical insurance agency negotiates with the hospital to set prices. The third kind is to implement national pricing, that is, the government sets a uniform price.

Although the adjustment of the prices of medical technology services has become a consensus, the path and method of pricing have yet to be explored.

Liang Wannian pointed out that adjusting the prices of medical technology services requires a misunderstanding that price adjustment will increase the burden on patients. But in fact, it's not. To adjust the prices of medical technology services, we must adhere to two "red lines": First, the overall burden on patients does not increase; second, the medical insurance fund can withstand.