2006-4-18 10:28:51
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Special Feature: Shunde Small and Medium-sized Enterprises Government Procurement Promotion Association
Source:: China Medical Frontier Magazine
In February of this year, the Beijing Municipal Development and Reform Commission (NDRC), in conjunction with the Municipal Health Bureau (MHB), issued a letter of solicitation to the major hospitals in Beijing, to the effect that, on a citywide basis, the price of inspection and treatment of large-scale medical equipment such as CTs and MRIs would be significantly lowered, with the proposed rate of decrease to 30%.
The initiative caused shock in the industry. However, it was rumored that the initiative would be included in the "Notice on Further Standardization and Cancellation of Charges for Some Medical Services" (the "Notice"), which has been released by Beijing, and was not seen at the end of the day.
"The government to reduce the CT and other large medical equipment inspection fees is undoubtedly good intention. The key to the problem is to reduce how much? How a drop method? This all need cost measurement." This reporter in the survey of a number of hospitals in Beijing, heard more of such voices.
30% price reduction is reasonable?
At present, the hospital level is more focused on the view that "the original CT, MRI examination fee reduction is too high, should be controlled at 10% is appropriate."
Of course, whether or not this "civil opinion" is adopted by the government depends on the conclusions of the Beijing Municipal Government's calculation of the cost of large-scale medical equipment inspections. The price reduction program is still a mystery to be solved.
NDRC-led price reduction
Beijing's initiative to reduce the cost of CT, MRI examination began on December 28 last year, the day the National Development and Reform Commission and the Ministry of Health *** with the introduction of the "on the development and adjustment of large-scale medical equipment, inspection and treatment of the price of the guiding opinions" (referred to as "Guiding Opinions"). The "Guiding Opinions" indicates: "Strengthen the management of large-scale medical equipment inspection and treatment programs, price authorities around the world in conjunction with the health administrative departments to develop and adjust the price of large-scale medical equipment inspection and treatment, must be clear about the content of the project, such as specific service content, shall not distinguish between the origin and model of the equipment, should be based on the different grades of hospitals, a reasonable spread of the difference between the prices, to guide the patients to diversion. "
The intention of this move is very clear, the National Development and Reform Commission, pointed out that the current large medical equipment inspection fees are high, some medical institutions in the interest of driving, blindly purchasing large medical equipment, chaotic inspection, charging and other phenomena are more serious, not only increased the burden of medical costs of the patient, but also waste of medical resources. The "guidance" is an attempt to change this situation as soon as possible, a more reasonable configuration of large medical equipment, reduce the price of inspection and treatment, control the cost of inspection and treatment, reduce the burden of medical costs.
The "guiding opinions" clearly requires that large medical equipment inspection and treatment prices in accordance with the "make up for the reasonable cost, not profit" principle of development and adjustment. By the National Development and Reform Commission and the Ministry of Health on the relevant large medical equipment inspection and treatment project cost measurement, and commissioned industry associations or intermediary organizations to publish the average cost of the community, for the localities in a timely manner to reduce the high price of inspection and treatment to provide a reference basis.
Although the final results of the calculation have not yet been released, some pilot provinces have already begun to move.
On February 27, Shandong Provincial Hospital announced that the PET/CT examination price from the whole body examination of 9980 yuan / person / time, partial examination of 6080 yuan / person / time, adjusted to the whole body examination of 6986 yuan / person / time, partial examination of 4256 yuan / person / time, which opened the prelude to the province's large-scale medical equipment inspection fee reduction.
Shandong Province is not quite a pioneer. Some media reports said that earlier, Henan, Jiangsu, Shanxi, Guangdong, Hubei and other places have long ignited the CT, MR examination of the price reduction of the fire - July 1, 2005, Shanxi Province, in the new implementation of the "price of medical services," clearly, the ordinary CT from each part of the 180 yuan down to 120 yuan, spiral CT from each part of the 270 yuan. CT by each part of 270 yuan down to 180 yuan, nuclear magnetic **** vibration from each part of 800 yuan down to 550 yuan; October 1, the same year, Jiangsu Province, also announced a new large-scale medical equipment inspection charges, a single head CT inspection charges by the original 290 yuan sharp reduction to 150 yuan, a reduction of nearly 50%; two weeks later, Henan Province, also put forward, "from October 15, 2005 onwards, the province's large medical equipment diagnosis and treatment charges will be a comprehensive downward adjustment of 28.7%," and Liaoning Province is in the original 30% reduction in the above, an average of another 20%!
In just a few months, from the south to the north, from top to bottom, "large medical equipment to check the price reduction" has become the local development and reform commission and the health sector's most inciting words. "It coalesces too many themes: public and private interests, the strong and the weak, fairness and favoritism." An industry insider commented, "More than a dozen provinces and cities in China are seeking their own solutions, and thousands of large and medium-sized hospitals as well as untold wealth have been swept up in this torrent."
Yet the reforms have failed to quell internal and external controversies. Nearly two months after the National Development and Reform Commission and the Ministry of Health's "Guiding Opinions" were issued, more localities are still entangled in the discussion of "down or not down, down more or less", and it is difficult to make a decision.
In accordance with established practice, involving public **** interests of price changes should be discussed through the hearing. But Beijing has not yet held a hearing of the movement. As for large-scale medical equipment to check the specific price reduction program, Beijing has drawn up a 30% reduction standard, around this standard and then put forward two sets of options, by the hospitals combined with their own costing situation to come up with specific proposals. The logic of Beijing's move is actually very simple: large-scale medical equipment inspection revenue involved in the adjustment of the interests of all parties and the game, the first to draw up a reference standard, put forward a few options, can facilitate the parties to "targeted discussion".
However, the actual operation is far more complicated. Due to the government's decision-making and hospital management's opinion is difficult to reach a unity, should have been introduced in the near future of the Beijing large medical equipment inspection price reduction policy had to enter the "pending" program.
The program of the discernment
According to Beijing's original proposed CT, MR examination price reduction program, the main content is:
The first program is only on the equipment scanning fee and laser photography fee reduction: CT "head scanning + laser photography + enhancement" price from 230 yuan to 160 yuan; The price of CT "whole body scanning + laser photography + enhancement" was reduced from $360 to $250. MR examination was reduced from $850 to $595 (all MRI).
The second option is to reduce the equipment scanning fee, laser photography, film and drug costs and other items as a whole package (Note: the amount of film and drug costs by the Beijing Municipal Bureau of Health based on past experience): CT "head scanning" total cost from 305 yuan to 235 yuan; The total cost of CT "head scan" is reduced from RMB305 to RMB235; the total cost of "head enhancement" is reduced from RMB570 to RMB500; the total cost of "whole body scan" is reduced from RMB615 to RMB505; the total cost of "whole body enhancement" is reduced from RMB1015 to RMB905; and the total cost of MR is reduced from RMB1015 to RMB905. The total cost of the MR "Flat Sweep" was reduced from $970 to $715; the total cost of the "Enhancement" was reduced from $1,220 to $965.
"If it's a choice between the two, we prefer the first option, which is a single cost for film and medication." Zhang Jingbo, vice president of Tiantan Hospital, believes that "the second option is to package all the costs as a whole, so that although it is easy to operate, but does not have the significance of promotion." He explained that hospitals in the large medical equipment inspection, often combined with the actual patient to carry out the corresponding diagnostic investigation, "such as head CT, scanning is 2 films, do enhancement requires 3 films, if the scanning plus CTA examination more need 6 films. Different amounts of film, the cost is definitely different. In addition, if an enhanced examination is done, it is also necessary to add medicines, and there is a great difference between the prices of imported and domestic medicines. Therefore, it is not reasonable to authorize the total cost in a lump sum manner."
In fact, more views that the two price reduction program in fact, "can only solve the urgent need, difficult to make a permanent solution.
Mao Yu, president of Beijing Ditan Hospital, holds this view. He commented, by reducing prices to ease the cost of medical care, the government is the easiest thing to do, but also to do a good job, but this means of reducing prices has great limitations.
First, the large-scale equipment inspection price reduction to benefit the surface is limited, difficult to alleviate the "difficult to see the doctor, see the doctor expensive" to produce substantial help. Currently, only 4% of patients seeking treatment at large general hospitals do CT and MR tests. This means that even if the price is lowered, only a small number of people benefit, and the benefit is limited, most people still do not enjoy the reality of the benefits of price reduction.
Second, only in the hospital this single link to cut profits, is bound to affect the sustainable development of hospitals, resulting in "good to do not long". Mao Yu believes that large medical equipment and spare parts are not "zero profit" to provide to the hospital, in order to make the policy of price reduction of long-term implementation, it is necessary to equipment production, circulation and use of the entire chain of holistic consideration. For example, as a core component of the CT balloon, exposure 150,000 times usually have to be replaced, and the price of a balloon is often as high as four or five hundred thousand. Therefore, the chain of upstream prices down, large equipment inspection fee natural "water down boat low"; on the contrary, only in a single link on the heavy hand, most likely to lead to a vicious circle - hospitals can not afford to take other ways to make up.
Mao Yu for this account, "I am in the Tongren Hospital, outpatient clinics every day to reach more than 4,000 people, of which only 140 people to do a CT examination, to do a magnetic examination of the people but more than 30 people." According to the 140 cases of CT examination per day, the price reduction of 70 yuan for each case of examination, Tongren Hospital will have less income of more than 3 million yuan a year. In the case of government financial compensation can not be synchronized in place, "no one can guarantee that the hospital does not go to expand the amount of examination or the use of imported high-grade reagents to make up for the cost of price reductions brought about by the cost of the shortfall. In the end, the government still has to passively go around putting out fires and pressing scoops in the water tank."
Mao Yu's opinion is that the solution to the "difficult to see a doctor, see a doctor", can not just rely on price regulation, the main thing is to strengthen the medical management, so that hospitals "use these machines, so that the examination of people do not spend money; should not be examined not to spend a penny. "
Although the reasoning is so, but the order to reduce the price has been issued from the top, as for "how to reduce, how much" is a matter of detail to be debated. In this regard, the two ministries in the issuance of the "guidance" in the early clear: the National Development and Reform Commission and the Ministry of Health to calculate and publish the average cost, around the "reduce the high price of inspection and treatment" to be used as a "reference basis"; "" After designating and adjusting the prices of the relevant items, the localities should report to the NDRC and the Ministry of Health in a timely manner." In this way, the original by the local authorities to authorize the price of the situation will no longer exist.
"Now the hospitals cost statements are not yet converged, from the program to be first reviewed by the price department, and then reported to the Beijing Municipal Committee, after all, this matter should be carried out carefully. Finalized, at least until the second half of the year." Beijing Municipal Development and Reform Commission price director Zhang Yuan avoided the "30% reduction" explanation, but at the same time to give a signal - the Beijing Municipality before the proposed price reduction intention is likely to be pushed back.
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Government reduces fees for CT and other large medical equipment (2)
2006-4-18 10:54:19
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Special Feature: Shunde Small and Medium-sized Enterprises Government Procurement Promotion Association
Source: China Medical Frontier Magazine
Industry Attitude
Zhang Yuan, Director of Price Division, Beijing Municipal Development and Reform Commission:The final program will be determined in half a year
China Medical Frontier: As the head of the price authority, what do you think about Beijing's initiative to adjust the inspection of large-scale medical equipment, and is the ratio of this reduction appropriate?
Zhang Yuan: This is the Health Bureau proposed, we now have to do a review of this (rate of reduction), and then determine. Now the hospitals reported the cost are not remittance it, so the specific drop how much, are still unknown.
China Healthcare Frontiers
: According to your expectation, when will Beijing's price reduction program be finalized?Zhang Yuan: Because the program still need to review, the first half of the year can come out is good. Ultimately, we have to report to the municipal government, after all, this matter should be carried out carefully. The finalized, still have to wait a while.
China Healthcare Frontier: Now that Beijing hospitals have different views on the matter, how will the NDRC respond?
Zhang Yuan: Now the hospitals are reporting costs, the specific level of adjustment has not been determined, they should not have any opinion.
"China's medical frontiers": that is to say, the original 30% of the reference is just an assumption?
Zhang Yuan: You can't say that, because it didn't say what level to adjust to before. Now we are just doing a cost audit, nothing else has a clear opinion. As for what to say, are not correct.
China Healthcare Frontier: If the price really needs to be adjusted, will the government give some corresponding compensation to the hospital?
Zhang Yuan: This aspect we have not yet considered, you need to ask the financial. Because the subsidy to the hospital is by the government finance to consider comprehensively.
China Healthcare Frontiers: Where do you see the complexity?
Zhang Yuan: One is the cost measurement of the price, and the other is the compensation mechanism. These two issues are the most difficult to deal with.
Zhang Jingbo, vice president of Beijing Tiantan Hospital:
In the long run, it makes more sense to popularize digitization
For a patient to do a CT or MR, the hospital usually has to produce two sets of films: one set of films for the patient to take away, and one set of films to be kept by the hospital. The first one is the one that the patient has to take away, and the other is the one that the hospital has to keep. There are two levels of consideration: First, the patient needs to be re-examined, and if lost, the hospital can be accessed in a timely manner. Most hospitals do not have PACS system, based on the "reversal of the burden of proof" considerations, hospitals, such as the bottom, once a medical dispute, the hospital is also very passive. Secondly, from the perspective of research and teaching, the film will be retained as a hospital research and teaching materials, so this system has been continued.
But what consequences will arise? A set of tablets, according to the scanning of different parts of the different layers, the number of tablets out of the different. The bidding price for a film is $30, and the average patient has to produce four films, more often than not a dozen films, so the cost of a set of films ranges from $120 to several hundred dollars, and two sets of films may cost hundreds or even thousands of dollars. All these costs have to be borne by the patients. In addition, the film itself is toxic, in the process of developing, but also to apply a large number of developer, fixing agent, which brings a very big pressure on environmental protection.
So is there a practical solution? I think there are two ways to follow: one is the mutual recognition of hospitals to reduce the number of tablets used; the second is the application of electronic computer technology, such as improving the hospital PACS system, less or no tablets. By then, the patient will take away only a CD-ROM, which is both environmentally friendly and cost-saving. Because the cost of a white disk is only 2 dollars, plus the added value, the estimated total price is only 80 dollars. By then, the patient can save a lot of examination costs, the hospital can also be stored in the form of electronic images of the examination results can be printed instantly when needed. In this way, the hospital no longer needs to store film library, management costs are reduced.
In addition to this, electronic data has a very big advantage, which is that it can be processed in the background. The traditional film is photographed by a camera and is a bitmap, while the images saved through the PACS system are vectorial, and will not be distorted even when enlarged. Relying on this vector image, the hospital can not only compare and contrast multiple films, but also use the system functions provided to carry out background processing, and even through the computer to carry out three-dimensional reconstruction.
So, to solve the problem of the people to see the doctor, on the one hand, through the sociological solution, on the other hand, more need to rely on the field of natural sciences of the new technology. The two combined, in order to effectively reduce the cost of large equipment inspection.
Mao Yu, president of Beijing Ditan Hospital:
Hospitals can't "pick up the slack"
Reducing the cost of large-scale equipment, for the time being, can only solve the urgent problem, not a long-term mechanism.
Why do you say this, we can look at it from several aspects:
First of all, the benefit of this price reduction is limited. When I was at Tongren Hospital, the outpatient volume reached more than 4,000 (person-times) per day, of which about 130 (person-times) were for CT. This is more. For MRI, there were about 30 visits per day, totaling only 180 visits. Relative to the 4,000 outpatient visits, it is still less than 5%. That is to say, this CT price reduction may not play a substantial help in alleviating the problem of expensive medical treatment for most people.
Secondly, there is indeed room for price reduction for CT and MRI, but how much is appropriate? I think this is something to be discussed. Hospitals every purchase of a large-scale examination equipment, in addition to bear the consumption of its daily operation, but also to pay the high cost of accessories, supplies and other costs. For example, the core component of CT - balloon, exposure 150,000 times often have to be replaced, and the pricing of each balloon are in the four or five hundred thousand dollars or so. Another example of film, Beijing is currently the implementation of centralized bidding procurement, but the actual bidding price than our own procurement price is higher: bidding price of 31 dollars each, we buy each only 19 yuan. Visible, accessories and consumables have a lot of space to reduce prices. But now, this piece has become a heavy burden on the hospital can not bypass.
So, it's not impossible to reduce prices, but the key is to think it through: in the whole chain that leads to expensive medical care, the government should analyze, in the end, how many points in the role? Each point and what percentage of concessions can be made, not enough concessions can not, too many concessions he can not afford. Now many deans believe that hospitals can reduce prices, but the rate of reduction can not be too large, in fact, is also based on this consideration.
Take the Ditan Hospital, although our monthly CT examination volume of more than 150 cases (every Monday, Wednesday, Friday open CT machine), but this piece of income is "real" can be operating funds. If the price is reduced here, the actual loss to the hospital is far greater than the price of drugs. Because 85% of the drug revenue is spent on costs, while 100% of the CT revenue is at the hospital's disposal. If you put it in other hospitals, I believe their losses will be even greater. For example, in Tongren Hospital, when I was the Vice President there, more than 140 people underwent large-scale equipment examination every day. Calculating on the basis of a price reduction of RMB 70 yuan per person per examination, the daily income would be reduced by RMB 9,800 yuan. As the Tongren Hospital is also open on weekends, if we take the two weekends by one day, 300 days a year, Tongren Hospital at least 3 million yuan less income.
In addition, the indirect impact of the price reduction of CT examinations on the hospital should not be ignored. As the Ditan Hospital is to internal medicine system treatment, the proportion of drug income is relatively high. In the case of government compensation is not in place, if the CT examination fee decreased by 30%, then the Ditan Hospital even if the drug income remains unchanged, the proportion of its total income may still be from the original 63% to 65%. In this way, it is inevitable that the people and the higher management will have a negative impression: we have appealed and emphasized half a day, but the proportion of drug income in the Ditan Hospital has risen instead of declining.
So I'd say it's okay to let the hospitals bear the burden of this price reduction alone, but the premise must be that the government can provide adequate compensation. On the contrary, if the government's financial compensation is insufficient, the hospital's autonomy is not effectively improved, and still "big head receives big head spends", then the hospital is likely to self-pressurize through other channels. For example, the use of expensive imported reagents to patients to do some routine checks, the industry has exactly the same kind of unspoken rules, "the use of reagents expensive, you can charge high fees".
This statement is not sensationalized. Because the cost of CT examination from the composition of the examination, the machine examination relative to the cost of drugs or cheap, a drug to be more than 500 dollars, and open a machine, do an enhancement, but also more than two hundred dollars. Recently, Zhejiang, Jiangsu forced on large-scale equipment inspection price reduction, the people's reaction is not satisfied, the main reason is that they "big head is not down, down a small head", "small head" and then folded into a certain percentage, and ultimately benefit to the hands of the patient is only The reason for this is that they are not going to reduce the amount of money that they spend on the test, but they are going to reduce the amount of money that they have to spend on the test.
Perhaps it is for this reason that the Beijing Municipality has proposed two price reduction programs: the first program is to reduce the basic charges for the price point, the second program is to reduce the price point for the actual cost. But no matter what program is taken, the fact is that the squeeze is the hospital's profits. And the wool comes out of the sheep, large-scale equipment check the reason why the price is difficult to come down, the root cause is still the procurement and maintenance of the cost is too high. If the government can start from the source, so that the upstream manufacturers and suppliers also let a certain amount of profit, the price of hospital services will naturally be adjusted downward.
Of course, in the long run, the key to alleviating the high cost of medical care is still to use these machines well, so that the people who should be examined do not spend money on complaining; the people who should not be examined do not spend a penny. In fact, this is the main content of the medical management.
Wang Hongbin, director of Beijing Chaoyang District Hospital No. 2:
The controversy surrounding the price reduction of CT examinations has many similarities with the recent price reduction of medicines, i.e., can we make the people feel that it is not too expensive to go to the doctor through this kind of price reduction?
My view is that it doesn't matter how expensive or cheap something is in medicine, it mainly depends on whether it is reasonable or unreasonable.
Some tests are indeed unreasonable, but some cannot be concluded too soon. Because of the characteristics of medical treatment is this: some diseases you can not simply from the symptoms to determine, and many patients complain, I sneeze spent hundreds of dollars, do not know that the doctor saw him this sneeze, combined with his physical symptoms, will be associated with what triggers. However, the general public will often think that the doctors' practice is entirely motivated by money-making considerations, which is absolutely one-sided. It should be recognized that the vast majority of doctors are responsible for the patient's consideration for his examination and treatment.
So what is the relationship between the doctor and the patient, the relationship of interest, the relationship of responsibility, or the relationship of feelings? This is worth thinking about.
On this premise, then say the CT examination price reduction on the hospital's possible impact. In my opinion, this price cut, the short-term impact on all hospitals are the same, that is to make the hospital's medical losses more serious. Not long ago, Shandong Medical University had a study statistics: in the hospital of all medical charges, 60% -70% is upside down, is below cost; and for large hospitals, more 80% of the pricing is below cost.
Although secondary hospitals are also losing money, the reaction may not be as strong as that of tertiary hospitals. Here are two reasons: First, to the second level to see the patient are mainly common diseases, frequent patients, the need to do large-scale equipment to check the number of patients is limited. Secondly, the number of large medical equipment owned by secondary hospitals is also very small, like our hospital now only CT, no MRI, which invariably reduces the pressure of cost recovery.
And this price reduction is not necessarily a bad thing for secondary hospitals. Imagine, big hospitals in this area would have been very high cost, if the income and then significantly shrink. Then the face of high manpower, equipment depreciation, utilities and other cost burdens, they a possible way to decompression is to reduce the staff, and was reduced by most of the talent and will be diverted to secondary hospitals. This is not precisely to make up for our talent disadvantage?
So, if you look at the long term, the secondary hospitals are more happy than sad.
Beijing Hui Min Hospital, vice president of Gan Xuepei:
CT price reduction to drop from the source I personally feel that the CT price reduction should be justified.
The hospital to buy CT is so expensive, one to be a few million, so, how many patients we do to recover costs? Maybe when we recover the cost, this machine should also be scrapped, the maintenance. Nowadays, just change a balloon to be several hundred thousand dollars, plus labor, water and electricity, film, the government can actually calculate, but also to engage in a research, the whole of Beijing hospitals equipment procurement cost is how much? How much is the running cost? The last remaining life of those years, it can create how much profit margin?
Hospitals like ours, buy CT is our own money, not the state allocated money. So, you want to drop can, but to drop from the source. In the manufacturer's supply, the state should be a gatekeeper, a set of equipment, a reasonable retail price in the end how much? Because now almost all equipment is locally produced, locally assembled, you bring down the retail price, we naturally come down this price. You can not say that both ends of the squeeze me, that side of the manufacturers sell at a very high price, this side of the government and let less money, we medical staff to take their own hard-earned money to take social responsibility for the government, this is unfair.
Now the national government advocates to reduce the burden on enterprises, although we are not enterprises, but the government only hundreds of thousands of dollars a year of funding, that is enough for us to do? Sacrifice our profit margins on the right? Let us bear the social responsibility, the government responsibility is justified? Can we afford the financial burden of so many patients? It's only right that whoever needs it spends the money. Patients with minor ailments and pain in the ass, you can go to the grassroots small hospitals ah! Don't use that kind of highly sophisticated equipment. To protect the basic medical care, this is not also the government's intention?
Such as our secondary hospitals, this is limited income, but also bear the low-income, disadvantaged people's medical assistance, we pay no less than the third level of hospitals, but the payroll is worse than a few grades. We are not taking the money, black pot quite a lot of back.
In addition, the second level of hospitals and the second level of hospitals are not quite the same, for example, like the willow, Fuxing, Haidian hospital, their business volume and the frequency of use of the machine can be comparable to the tertiary hospitals, our machine utilization rate are very low. Like Furen, like us, these are kind of a class of their own, because the business volume is limited, CT comes in, and a lot of them are running at a loss. We've done the math once before, and the large equipment and instruments from purchase to scrap, basically nothing to earn, at best, can be a little stronger than a tie.
Assuming that the government pays for the bill now, our salaries and bonuses are paid by the government, and the equipment is borrowed from the government, then all the money we earn can be given to the government. The government lets us collect as much as we want, and the people, even if they don't have the money, we'll still give it a look. The problem now is that there is no such compensation mechanism, then, the government should be cautious in reducing prices, scientifically approved.
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