Beijing medicine separate comprehensive reform implementation program

Beijing Comprehensive Reform Implementation Program for Separation of Medicine

A few days ago, Beijing released the comprehensive reform implementation program for separation of medicine in public medical institutions. From April 8th, all public medical institutions in Beijing will implement the new policy. The following is the full text of the program, just for reference!

In order to fully implement the Party Central Committee and the State Council on the reform of separation of medicine decision-making and deployment, and actively explore a variety of effective ways to gradually eliminate the use of medicines to compensate for the medical, the establishment of a scientific and reasonable compensation mechanism, based on the "Central **** the State Council on the deepening of the reform of the medical and health system," the "State Council on the issuance of the? The State Council's Opinions on Deepening the Reform of the Medical and Health Care System Thirteenth Five-Year Plan Notice on deepening the reform of the medical and health system planning" (Guo Fa [2016] No. 78) and "the General Office of the State Council on the comprehensive reform of urban public hospitals pilot guiding opinions" (Guo Baifa [2015] No. 38), the development of this program.

First, the scope of reform

In accordance with the requirements of the CPC Central Committee and the State Council, this program applies to public medical institutions organized by the government, public institutions and state-owned enterprises within the administrative area of the city, and to the medical institutions of the People's Liberation Army and the armed police forces in Beijing.

The government purchased the services of social-run medical institutions, urban and rural basic medical insurance designated social-run medical institutions, can voluntarily apply for participation in this comprehensive reform of the separation of medicine, and the implementation of the reform policy.

Second, the reform objectives

Comprehensive reform of the separation of medicine adhere to the leadership of the party committee, the government co-ordination, comprehensive promotion, adhere to the medical, pharmaceutical, medical insurance linkage, enhance the reform of the systematic, holistic and synergistic. Through the abolition of drug markups, the establishment of medical service fees, the transformation of the operating mechanism of public medical institutions, standardize medical behavior; through the sunshine procurement of pharmaceutical products, medical insurance control measures to reduce the inflated prices and costs of drugs, equipment, supplies, etc.; standardize the price of medical services, and the gradual establishment of a dynamic adjustment mechanism for the price of medical services based on changes in the cost and revenue structure; strengthen the supervision and management of health care institutions and improve the cost and cost control mechanism of medical institutions. Medical institutions cost and expense control mechanism, the establishment of financial classification compensation mechanism, promote the reform of health insurance payment method, enhance the public welfare of public medical institutions, so that the masses have more sense of gain.

By the end of 2017, in order to administrative districts as a unit, the proportion of drugs in public hospitals (excluding traditional Chinese medicine tablets) strive to reduce to about 30%, 100 yuan of medical income (excluding drug income) in the consumption of health materials fell to less than 20 yuan; by 2020, the above indicators have been further optimized, and the growth of medical costs in public hospitals stabilized at a reasonable level.

Three key reform tasks

(a) the abolition of drug markups, registration fees, diagnostic fees, the establishment of medical service fees. Participate in the reform of all medical institutions to abolish the drug markup (excluding traditional Chinese medicine tablets) and registration fees, consultation fees, all drugs to implement zero-differential sales, the establishment of medical service fee (medical service fee standard see annex), to achieve the compensation mechanism conversion. The medical service fee is mainly used to compensate for the operating costs of medical institutions, reflecting the value of the technical labor of medical personnel.

(ii) the implementation of drug sunshine procurement. The company's website has been updated with the latest information about the company's products and services, and the company's website. The two-pillar system? (production enterprises to the circulation of enterprises to open an invoice, the circulation of enterprises to the medical institutions to open an invoice). Encourage and standardize group purchasing, medical consortium purchasing and regional joint purchasing, further increase the participation of medical institutions in centralized drug purchasing, and reduce the prices of medicines and consumables. Drug purchases are all conducted on the online centralized drug procurement platform set up by the government, and drug procurement prices are dynamically linked to the lowest prices of centralized drug procurement at the provincial level nationwide. Publicize the varieties, prices, quantities and changes in drug adjustments in public medical institutions to ensure that all aspects of drug procurement operate under the sun.

(C) standardize the price of medical services. In accordance with ? The total amount of control, structural adjustment, rise and fall, gradually in place? The principle of advancing the reform of medical service prices, the establishment and improvement of dynamic adjustment, multi-party participation in the formation of medical service price mechanism. Prices of large-scale medical equipment inspection items have been reduced, and prices of medical service items reflecting the value of medical personnel's technical labor, high technical difficulty and high risk of practice, such as traditional Chinese medicine, nursing care and surgery, have been raised, so as to gradually rationalize the relationship between the prices of medical services. The first batch of 435 items selected for price standardization.

(D) Improvement of medical services. The implementation of the action plan to improve medical services, strengthen the service consciousness of medical personnel, and improve the quality and level of medical services. Establish and improve the long-term mechanism of medical quality management, comprehensive consideration of medical quality and safety, basic medical needs and other factors, to strengthen the management of clinical paths, to promote the refinement of the treatment program, standardization; strengthen the drug prescription audit and prescription review, to promote the rational use of drugs. Vigorously implement non-emergency appointment and treatment services, promote the service model of well-known expert teams, standardize the service process, and improve patients' experience of medical treatment. Enriching the content of contracted services for family doctors, so that residents can enjoy more convenient medical consultation and referral services. Promote mutual recognition of examination results among medical institutions in Beijing, Tianjin and Hebei.

(V) Strengthen cost and expense control. Improve the monitoring system of medical costs and key performance indicators of public medical institutions, and promote the control of costs and expenses of public medical institutions. The use of information technology means to increase the abnormal, high medical costs 'warning and analysis, control the unreasonable use of high-value medical supplies. Strict access and management of new technologies, new programs and special-needs services. Strengthening the feasibility demonstration for the acquisition of large-scale equipment, and improving the efficiency of medical equipment utilization. Strengthen the internal performance evaluation of public medical institutions, and maintain a reasonable increase in the number of staff and salaries of medical institutions.

(VI) Improve the system of hierarchical diagnosis and treatment. Improve the policy system of hierarchical diagnosis and treatment, improve the mechanism of division of labor and cooperation among medical institutions, and gradually realize the first diagnosis at the grass-roots level, two-way referral, emergency and slow treatment, and up and down linkage. Promoting the construction of close-knit medical associations and specialized medical associations to provide continuous medical services. Guiding doctors and returning specialists from large hospitals to work at the grassroots level, and improving the capacity and level of grassroots medical service provision. Improve the contracted services of family doctors, unify the procurement and reimbursement catalogs of large hospitals and primary healthcare institutions for commonly used medicines in the stabilization period of four types of chronic diseases, such as hypertension, diabetes mellitus, coronary heart disease, and cerebrovascular disease, so that qualified patients can enjoy the convenience of two-month long prescriptions in primary healthcare institutions, and divert outpatient volume of tertiary hospitals in an orderly manner.

(VII) Establishment of a financial categorization compensation mechanism. According to the public medical institutions affiliated with the implementation of financial investment policies, actively participate in the comprehensive reform of the separation of medicine and good results of the medical institutions to give appropriate subsidies to protect the public medical institutions capital construction and equipment purchases, retired personnel costs, the development of key specialties, the construction of human resources, the government's directive tasks and undertake public **** health services and other aspects of expenditure. Continuously improve the financial classification of input policies, Chinese medicine (including integrated Chinese and Western medicine, ethnomedicine), infectious diseases, mental illness, occupational diseases, maternity, children, rehabilitation, oncology, geriatrics and other medical institutions and primary health care institutions to be tilted to promote the coordinated development of all levels and types of medical institutions.

(H) Increase the reform of health insurance protection and payment methods. By improving the health insurance payment system, medical insurance system, medical assistance system, etc., to reduce the burden of insured patients. Under the framework of the total budget management of the medical insurance fund, explore the composite payment method which is mainly based on the payment for each type of disease, supplemented by the payment for each person, the payment for each service unit and the payment for each group of related groups of disease diagnosis, and gradually reduce the payment for each item. For inpatient treatment of severe mental illness, rehabilitation during recovery from illness, community rehabilitation for non-communicable diseases, and geriatric care, the reform of payment per bed day is being explored. Give full play to the role of various types of medical insurance in regulating and guiding medical service behaviors and costs, as well as in monitoring and controlling them. Comprehensively implementing major disease insurance for urban and rural residents, and promoting the accelerated development of commercial health insurance. It will also improve the medical assistance system for low-income and other difficult groups, strengthen the synergy between medical assistance and medical insurance, and prevent poverty due to illness.

Four, safeguard measures

(a) improve the working mechanism. In accordance with the requirements of the CPC Central Committee and the State Council, set up by the Beijing Municipality and the relevant departments of the Central Government, as well as the People's Liberation Army, the Armed Police Force and other **** with the composition of the reform of the pharmaceutical separation of the Coordination Group, coordinating and coordinating the pharmaceutical separation of the work of comprehensive reform. Give full play to the role of the Beijing Municipal Healthcare Reform Leading Group and the Working Group on Separation of Medicine Reform, study and solve major problems encountered in the reform in a timely manner, and ensure that the various reform measures are synergistic and smoothly promoted. Each district government should establish a corresponding working mechanism, carefully organized, carefully deployed, and take strong initiatives to ensure that the reform measures are implemented.

(ii) refine the division of responsibility. Separation of medicine reform working group office (located in the Municipal Health and Family Planning Commission) to scientifically analyze the risks of reform implementation, improve preventive measures and emergency response plan, and strengthen the implementation of the reform supervision and inspection. The Municipal Health and Family Planning Commission shall do a good job in the organization of sunshine procurement of medicines, supervision and management of medical institutions, improvement of medical services, and promotion of the construction of hierarchical diagnosis and treatment system and other related work. The Municipal Finance Bureau shall improve the financial input policy and study and formulate a categorized compensation method according to the affiliation. The Municipal Development and Reform Commission shall guide and supervise medical institutions to update their price catalogs and publicize them, strengthen price management, and severely investigate and deal with price violations. The Municipal Bureau of Human Resources and Social Security shall implement the health insurance policies in this reform and improve the composite health insurance payment system. The Municipal Civil Affairs Bureau shall improve the medical assistance measures for social assistance recipients. The city's editorial office should do a good job of managing the preparation of public medical institutions.

(C) do a good job of publicity and guidance. Adhere to the correct orientation of public opinion, make full use of all kinds of news media, strengthen the policy publicity and interpretation, reasonable guidance of social expectations, timely response to the concerns of the masses, a wide range of cohesion **** knowledge in the whole society to form a good atmosphere of concern for the reform, support for the reform, participation in the reform.

This program from April 8, 2017 onwards.

The core of this reform is to abolish the 15% drug markup in public health care institutions, the implementation of zero-differential rate sales; abolish the registration fee and diagnosis and treatment fee, the establishment of the medical service fee. After the reform, the public hospital compensation mechanism will be from the past financial subsidies, service charges and drug markup income three channels into financial subsidies and service charges two channels.

According to the policy, in the future, all drug purchases will be made on the government's online centralized drug purchasing platform, and price information will be traceable throughout.

The establishment of the medical service fee is, on the one hand, an important initiative for hospitals to balance their income and expenditure after the abolition of the drug markup, and on the other hand, it also allows the value of doctors to be better reflected. Taking the new fee for tertiary hospitals as an example, from April 8, the fees for general outpatient clinics, deputy chief physicians, chief physicians, and outpatient clinics for renowned specialists have been set at 50, 60, 80, and 100 yuan, respectively, although the reimbursement of medical insurance is also higher.

The policy also standardized the adjustment of 435 medical services prices, reduce the price of large medical equipment inspection projects, improve Chinese medicine, nursing, surgery and other medical services reflecting the value of the technical labor of health care personnel prices.

Mainly on the contradiction is more prominent, the various aspects of the higher call for reform, the basic formation of **** knowledge of the 5 categories of 435 medical service prices were standardized and adjusted.

Specifically including:

Comprehensive medical services, such as beds, nursing fees, such as 125 items, accounting for 28.7%;

Diagnostic imaging, such as CT, MRI, etc., 185 items, accounting for 42.5%;

Traditional Chinese medicine medical services, such as acupuncture, massage, etc., 96 items, accounting for 22.1%;

Chinese medicine medical services, such as acupuncture, tuina, etc., accounting for 22.1%;

Clinical surgical treatment category, such as appendectomy and other 26 items and clinical physical therapy, such as radiotherapy and other 3 items, accounting for 6.7%.

So many medical services, what exactly is the price of which items went up, which downward adjustment? The short answer is ? Two down and one up? The so-called? Two down? First, it is reflected in the reduction of the price of large medical equipment inspection project, such as reducing the price of CT, MRI and other large equipment inspection project, head CT from 180 yuan to 135 yuan, MRI from 850 yuan to 400?600 yuan, PET / CT from 10,000 yuan to 7,000 yuan.

The second is reflected in the abolition of the drug markup and the sunshine procurement of medicines, reducing the price of medicines, this reduction is greater than 20%.

In addition to the ? two reductions? There are also? A rise? The standardization of medical service price adjustment, increased the price of Chinese medicine, nursing, surgery and other services that reflect the value of the technical labor of medical personnel. For example, the adjusted general bed fee, from the current 28 yuan to 50 yuan; secondary care costs from 7 yuan to 26 yuan; appendectomy from 234 yuan to 560 yuan; acupuncture from 4 yuan to 26 yuan, etc..

Although, the price of medical services have risen and fallen, but patients do not have to worry too much about the impact of price fluctuations, because the health insurance policy for the design of the linkage, after reimbursement by the health insurance, the residents of the personal burden of the overall remained stable.

The program also proposes to improve medical services, strengthen cost and expense control, improve the system of hierarchical diagnosis and treatment, establish a financial classification compensation mechanism, and increase the reform of health insurance coverage and payment methods. Through the reform, by the end of 2017, the city's public hospital drug ratio (excluding traditional Chinese medicine tablets) strive to reduce to about 30%, 100 yuan of medical income (excluding drug income) in the consumption of health materials fell to below 20 yuan; to 2020, the above indicators have been further optimized, the growth of public hospital health care costs stabilized at a reasonable level.

The scope of this reform includes all the government in Beijing, public institutions and state-owned enterprises organized by the public medical institutions and the People's Liberation Army, the armed police forces in Beijing medical institutions. Government-purchased services of social-run medical institutions, urban and rural basic medical insurance designated social-run medical institutions, can voluntarily apply to participate in this comprehensive reform of the separation of medicine, and the implementation of the reform policies.