Medical network - April 6, has taken a hot topic of medical institutions, is undoubtedly, drug addition to cancel after hospital (especially the 3 armour hospital) how finances not loss; And the focus of society is - medical service charge how much and how many patients need to be paid. 

 

Held on March 28, 2017, the national health work TV will convey the 10 key task for deepening health reform this year, and out of the public hospital abolish all drug addition clear timetable - end of July is not cancel the reform of public hospital drug addition cities should publish implementation plan, September 30 to opened the public hospital reform in an all-round way. It seems that as one of the three pillars of hospital income and drug addition were fully cancelled is inevitable. 

 

So, in addition to cancel after hospital losses or not? Have the industry experts said in "2017 China hospital competitiveness BBS" analysis on the 2016 China statistical yearbook of health and family planning data points out, based on the 2015 general hospital income and spending data at all levels, central hospital average income is 3.85 billion, provincial hospital, 1.46 billion; Balance and spending data is, central, 3.72 billion, 130 million, 1.41 billion, provincial balance of 050 million. However, in combination with drugs and consumables revenue to see in the table, is not optimistic. In central hospital, for example, drug addition is 15%, and in fact about 13%, material is around 8%, probably there are nearly 300 million drugs and consumables bonus income. 

 

It is obvious that without health care support, no additional government subsidies, as the cancellation of the drug addition, the book will face a loss of the public hospital. 

 

Therefore, as the expert points out, for smoothly promote the comprehensive reform of public hospitals, in addition to cancel after the public medical institutions of economic compensation by the "service charge, government subsidies, and drug addition income" three channels to "service charge and government subsidies" two channels, local governments would be considered government compensation policy, and adjust the medical service price synchronization. 

 

Around the strength of the economy, however, decided the public hospitals (especially 3 armour hospital) to the difficulty of the reform. According to the medicine economic news "reporter investigation, government subsidies ability strong on the north, and deep, patients on medical service charges upward pressure on smaller; However, in other areas of government subsidies ability is limited, should take 3 armour hospital financial pressure and patients pay cannot too big, to guarantee a higher level of medical treatment, is a very difficult thing. 

 

According to incomplete statistics, as of March 29, has been in tianjin, zhejiang, shanxi, jilin, at least 16 provinces and cities issued to promote the implementation of the medical services price adjustment scheme. 

 

It is imperative to "adjust the price" 

 

Guide the reasonable resource configuration 

 

In the last year, the national development and reform commission and other four departments concerning the opinions to push forward the reform of the medical service price notice has been put forward to gradually straighten out medical service price comparison relations, the key to improve diagnosis and treatment, surgery, rehabilitation, nursing, traditional Chinese medicine embodies medical staff technology such as labor value of medical services price. In addition to implement tiered pricing, according to the level of medical institutions and physicians level and factors such as market demand, set different prices for medical service, the price gap, guide the reasonable medical treatment; With medical control of the medical care payment, such as policy of mutual connection, ensure that basic medical expenses burden in patients with general do not increase. 

 

According to understand, to straighten out the medical service price, more are to carry out the study on the relationship between the medical service price comparison, comprehensive analysis of different medical service project, different level medical institutions, the comparison between different region relations, in order to establish a scientific and reasonable system of target price and cost. 

 

Recently held in Shanghai in 2017 the department of health and health conference news, since last year included in the national provincial comprehensive reform pilot in Shanghai, I set out to partial cancellation of drug addition, at present the city's public hospital drugs (except Chinese medicine yinpian) bonus rate has fallen to 5%, while 660 medical services price adjustment. Pricing since march last year, the overall compensation rate was 85%. 

 

Will take effect on April 8, the Beijing medicine comprehensive reform plan separately, and presented the similar approach: raised beds, nursing, general treatment, such as surgery, Chinese medical personnel technical services represent value project price; To lower the price of CT, mri and other large equipment projects, and cancel the drug addition by purchasing lower drug prices and drug sunshine, keep the total medical costs in the basic balance. 

 

Beijing development planning commission of relevant personage says, adjust the price, is to guide the rational allocation of medical resources. Unreasonable medical service price comparison relations, to a certain extent and configuration lead to medical institutions tend to engage in more profitable projects, and loss of service project service ability is insufficient. According to introducing, the Beijing development planning commission and municipal finance bureau of city and district hospital cost accounting, found that 75% of service items are below cost price, so the current price system adverse influence on the rational allocation of medical resources. Especially in 3 armour hospital widespread the phenomenon of large clinic and small hospital, and three focuses on health care difficult critically ill medical location does not match; At the same time, the insufficiency of hospital nurses, nursing staffing, and drug dosage, check more, and this long beds, nurse, and operation is closely related to the service of the items below for a long time there is a close relationship between service costs. Therefore, the reform plan design, the price is trying to adjust is different price comparison relations between medical service project, narrowing the differences of different service project cost recovery, to guide the equilibrium configuration of medical resources, promoting the medical service level. 

 

Medical service pricing "Beijing model" and "Shanghai model" 

 

 

From this year and shenzhen has been cancelled comprehensive major public hospitals of the registration fee, and the 833 item charge fee adjustment. Heating/cooling of hospitalized patients have six of these projects, in addition to including CT, MRI and PET - CT 252 large equipment such as treatment program fee, at the same time 357 4 level operation cost increases by 50%, consultation and save cost also increases. According to the measure, flat after adjustment. At the same time, in the case of shenzhen residents, reimbursement rates as high as 90%, so the impact is not big. 

 

Guangdong has issued by the guangdong province deepening comprehensive reform of medical care system implementation plan "is to relax for children under 6 years old in the clinical diagnosis and biopsy and detection, clinical surgical treatment for pediatric medical personnel technical services characteristics and value of medical services limited, adopted a policy of not more than 30% of the charge. It is understood that last year in shenzhen three 2617 price of public hospital structure optimization adjustment. 

 

"The north" area of difficulty 

 

The hospital more independent pricing project 

 

More notable is, the relationship between the medical service price comparison at the same time, must consider local fiscal synchronization compensation level, the ability to pay medical insurance fund, and the acceptance of the patients. 

 

In finance is relatively abundant, medical insurance fund and government subsidies can hedge part of the reform pressure. 

 

To compensate for medical institutions such as Beijing due to the cancellation of drug addition and the registration fee and the loss of income, and set up medical service charge is included the city basic medical insurance for urban workers and urban and rural residents basic medical insurance to pay limits. 

 

And as in 2012 has to cancel all the costs of public hospital drug addition in shenzhen, at the time synchronization improve inspecting fee charging standard at the same time, by the health care as a whole fund pays part of inspecting fee increase. Shenzhen's public hospital fiscal subsidies accounted for the proportion of total revenue, increased from 17.2% in 2009 to 30% now, and the proportion increase, almost can fill 15% of drug addition. 

 

Therefore, in the economic level of the cancellation of drug addition for hospital management, the pressure is not big. 

 

But for middle or lower levels of economic regions, having canceled 15% drug addition, public hospitals, especially the 3 armour hospital financial pressure is very big, because the local medical insurance fund pays ability is limited, the government fiscal subsidies and cannot be compared with those areas in Beijing, Shanghai, shenzhen, can only rely on hospital management and the improvement of the works to fill the gap, pressure of big is obvious. On the specific operation, rhetorically from each according to his ability, the hospital also surprisingly recruit risks for each, but how effective can only wait and see. 

 

Among them, the hospital independent pricing project more attention gradually. Loosening of medical service prices, in addition, led by the department in charge of the straightening out of the medical service price comparison relations, but also on the classified management of the medical service price. In accordance with the relevant provisions, the public medical institutions to provide basic medical services of the government pricing, and provide the special medical services and other market competition more fully, stronger demand for personalized health care services, is to adopt market regulated. 

 

In early march in guangdong published 47 items shall be formulated by the medical establishment of autonomous prices the market regulation of medical services, in addition to the profit-making of public medical institution, the province other medical institutions must not outside the market adjusted medical service project to erect a market adjusted medical service price project. Specific projects, mainly related to nutrition and health education of confining growth period, and online inspecting fee, psychological counseling, family assistance, medical hairdressing, etc. 

 

And as hebei choose down, let go of part of the medical service price management authority. In 2014, the county level public medical institution and the urban community public health institution price management delegation to the city divided into districts; County in the price of grassroots medical institutions will be down on the county administration. Will first pilot districts of the city, the municipal public hospital medicine price reforms to entrust districts municipal government for approval. Last year and this year, and is divided into two group of let go of the public medical institutions such as assisted reproductive 72 individual medical service item price, independent pricing by the medical institution. Notable is also eased the Beijing and tianjin hebei province experts examined remote diagnosis and consultation of medical institutions and to ji consultation, operation expenses, medical institutions at the provincial level expert remote consultation, etc. 

 

The personage inside course of study also reminded, according to the current regulations, the implementation of the basic medical insurance fund pays market regulation of medical services, also need by orgnaization of agency of insurance considering the medical service cost and the social various aspects ability, negotiate with the medical establishment reasonable payment standard, guide the rational price formation.