Pushing the reform of medicine price to create favorable conditions for deepening medical reform

Interview with the National Development and Reform Commission, director of Price Cao Changqing/Sinorama reporter Feng Zhiqin 3 years, the health and well-being of millions of people of the new medical reform program "the Central Committee of the Communist Party of China to deepen the reform of the medical and health system" and "medical and health reform of the recent key Implementation programme (2009-2011) was finally introduced on April 6, 2009 and 7th. After the announcement of the new plan, aroused strong response from all sectors of society. National Development and Reform Commission director Zhang Ping stressed: must "raise awareness, pay close attention to implementation, and fully promote the key work of health reform to achieve results." "Price has the role of transmitting market information and guiding social consumption, and the public generally reflects the" expensive medical treatment "is also directly on the surface of medical prices. Therefore, the importance of price reform in medicine and medical services is self-evident.　　The price division of the National Development and Reform Commission participated in the research and formulation work of the health reform plan, and undertook the main work of reforming the price formation mechanism of medicine and medical service. Cao Changqing, director of the National Development and Reform Commission's price division, said: "The price problem, in essence, is a comprehensive reflection of the contradiction between economic operation and institutional mechanism." Price is also a kind of lever, can adjust various interest distribution relations, promote the healthy development of social economy and the normal operation of institutional mechanism.　　The reform of medicine price is not only the important content of the medical and health system reform, but also the important condition of deepening the medical reform. How to play the role of price lever is very important to promote the reform of medical and health system.　　To this end, this newspaper on how to manage the high prices of drugs, how to monitor the basic health care institutions to implement zero-rate sales, how to promote public hospital reform and diversification of medical and other hot issues, an interview with the price of the secretary Cao Changqing.　　Medicine price reform One of the eight pillars of the "China Investment": The new health reform package covers a wide range, price reform in the entire health care system in what position? In the course of the formation of the project, what are the main tasks of the price department? Cao Changqing: The reform of medical and health system is a complicated system engineering. Price reform is one of the important elements. The opinion of the State Council of the CPC Central Committee on deepening the reform of medical and health system has pointed out the overall goal and main task of the medical and health system reform in China by 2020, and put forward the general frame of "realizing one goal, building four systems and perfecting eight supports". Like a house, "four Liang". It is one of the eight pillars to establish a scientific and reasonable mechanism of price formation of medicine, which is not only an important content of deepening the reform of medical and health system, but also a good condition for deepening the reform of medical and health system. The price problem, in essence, is the comprehensive reflection of the contradiction between economic operation and institutional mechanism. Price is also a kind of lever, can adjust various interest distribution relations, promote the healthy development of social economy and the normal operation of institutional mechanism.　　From this point of view, to solve the problem of high drug prices, we must deepen the reform of the medical and health system and mechanism, at the same time, strengthen the supervision of pharmaceutical prices, promote the reform of the mechanism of price formation of medicine, and rationalize the relationship of pharmaceutical prices, can create conditions for the reform of institutional mechanism According to the central government to deepen the reform of medical and health systemGuiding ideology and basic principles, reforming the mechanism of pharmaceutical price formation, starting from the present situation of China's pharmaceutical industry and the characteristics of medical service, giving full play to the role of price lever, rationally regulating the price level of medicine and medical service, gradually straightening up the relationship of medical price and promoting the establishment and perfection　　To promote the healthy development of health undertakings and pharmaceutical industry, to meet the growing needs of the people's health care. In the process of research and development of health reform, the price division of the National Development and Reform Commission, in accordance with the State Council to deepen the coordination of medical and Health reform interdepartmental Coordinating Group, actively participate in the overall program design and research. Mainly undertook 3 aspects of work: first, the study put forward the medicine price formation mechanism reform idea. In the research process of the general framework of the new medical reform, it is agreed that the scientific and rational mechanism of the price formation of medicine must be established. To this end, the new medical reform program has been launched, during the two-year period, according to the deployment and requirements of the Inter-ministerial Coordination Group, we conducted a large number of research work, held numerous seminars, widely listened to the views of various parties, repeated discussions on some key and difficult issues, and reached consensus, and put forward the basic ideas of reforming the mechanism of pharmaceutical price formation These ideas have been written in the "Central Committee of the CPC, the State Council on deepening the medical and health reform of the views", that is, "opinion" on the "perfect medicine price formation mechanism" part of the content.　　Next, we also need to further refine and manifest these ideas, the formation of "reform of drug and medical services price formation mechanism of opinion", as a supporting document for health reform launched in the year. The second is to study and formulate the basic drug price policy. The establishment of the National basic drug system is an important step in this reform, and it is an important content and condition to ensure the basic medical and health service for all. The initial establishment of the National basic drug system is one of 5 reforms, we must focus on. Price policy is an important part of the basic drug system. The scientific and rational formulation of the price of basic drugs is conducive to the production and supply of enterprises, which is conducive to the rational use of drugs in medical institutions and reduces the burden of unreasonable medical expenses of the masses. To this end, we propose to the national basic drugs from the state to develop retail prices, public hospitals through public bidding procurement, reasonable determination of the purchase price of essential drugs.　　After the publication of the National Basic Drug catalogue, the price competent department will work quickly to approve the published retail pricing, which is an important work in the research and implementation of the medical reform policy. Third, the paper puts forward the price policy of reforming hospital compensation mechanism. Promoting the reform of public hospitals is the focus and difficulty of this medical reform. At present, the public hospital in China's medical market is the main body. The mechanism of "taking medicine and Nourishing medicine" is one of the important reasons for the difficulty of the masses to see a doctor. Therefore, the reform of the "drug-keeping" mechanism is mainly to change the existing public hospital compensation from 3 channels of service charge, drug addition income and financial subsidy to two channels of service charge and financial subsidy. This involves the reform of drugs and the price adjustment of medical services. In this regard, we have conducted in-depth research with relevant departments,Proposed the related price reform mentality. including the promotion of drug sales differential rates or phasing out of drug addition. The abolition of the reduction in drug delivery will be properly remedied through the establishment of fees for pharmaceutical services, the appropriate increase in the price of medical services and the increase in financial assistance.　　At present, we have embarked on the medical institutions to carry out differential rates and the establishment of drug service fees and other issues of the special study, in order to guide the implementation of the relevant pilot work.　　To improve the price management, we should focus on "China investment" from 5 aspects: "Expensive to see a doctor" is a more prominent problem in recent years, the new medical reform from the perspective of price reform, in the solution of "expensive" on the issue of what specific measures? Cao Changqing: "Expensive to see a doctor" is the problem that the masses reflect very strongly. The reform measures proposed in the health reform plan are also to solve the problem of "expensive to see a doctor" and "difficult to see a doctor". "Expensive to see a doctor" is not a simple "high drug price" problem. The medical insurance system is imperfect, which leads to the large proportion of individual burden of the masses; The mechanism of drug-nourishing medicine is unreasonable, which leads to the distortion of the behavior of medical institutions, the higher the price of drugs, the more market and other institutional mechanism factors, which lead to the deep reason of "expensive to see a doctor". But "the doctor is expensive" manifests intuitively for the medicine price is high, the price formation mechanism is unreasonable. Therefore, to reform the mechanism of price formation and strengthen the management of medicine price will play an important role in promoting the healthy development of health undertakings and medical industry, alleviating the burden of medical expenses of the masses and alleviating the "medical cost" of the masses. The reform of medicine price mainly focuses on the following 5 aspects: first, perfecting the management system of medicine price. We should adhere to the combination of government regulation and market regulation, and rationally adjust the scope of government management price. To form competitive medicines and medical services, to release the price from the market adjustment, market competition is not sufficient to play the role of government regulation, to clarify the central and local price management authority, not only to give play to the local price authorities at all levels of the functional role of the Department, but also improve ways and means to maintain the unity of the national market;　　Improve the efficiency and transparency of administrative supervision, standardize the price behavior of medicine. The second is to continue to reduce the false high drug prices. While encouraging enterprises to develop innovative drugs, it is necessary to compress the cost space of intermediate links, strengthen the control of the price difference of the circulation of drugs, promote the merger and reorganization of circulation links, enlarge the scale and reduce the cost. In line with the implementation of the National basic drug system, rational development of basic drug retail prices, to foster the production of basic drugs supply.　　We should use the price lever to restrain the low-level duplication construction, promote the drug "first imitation price, after imitation price" policy, and further reduce the overall level of drug prices in the market. Third, speed up the adjustment of the price of medical services. While increasing government investment and phasing out drug addition, it is necessary to raise the price of medical services appropriately. At present, the price and cost of medical services in public hospitals hang upside down about 20%. The overall level of medical service prices must be progressively increased. Increasing the price of medical services is not an overall improvement, but a rise and fall in the adjustment. For large equipment inspection and treatment of the price to reduce, to reflect the technical value of the doctor's labor services, such as treatment, care, surgeryThe price should be raised appropriately. At the same time, we should reform the charging method, from now on the project fee gradually to the type of disease fees or prepaid fees and other means of transition, through the strict cost of hospital budget management, promote the hospital to improve efficiency, save costs, establish a cost-self-restraint mechanism.　　Further open the charge standard of different levels of hospital, guide patients to the grassroots, to alleviate the high level hospital "overcrowded", Grassroots hospital "empty" contradictions. Four is to standardize medical supplies price behavior. At present, a large number of medical supplies used in the clinic, in patients with medical treatment to bring convenience at the same time, these health supplies, in particular, high value of implant-type medical materials are too expensive, heavy burden on the masses. These medical supplies prices belong to the market adjustment range, many to be in the medical service charges outside the charge of fees, price order is more chaotic. Therefore, we should strengthen the supervision of these products price, especially the management of high value supplies price.　　The price of medical supplies should be rationally formed by controlling the distribution rate of the circulation link and disclosing the market price information. Five is to continue to strengthen the price supervision and inspection. We should adhere to the system of combining medical price survey and special inspection, and continue to rectify the price order of medicine market. We should improve the method of price supervision and inspection and strengthen the system of price publicity.　　Strict price illegal punishment, play the role of social public opinion supervision, set up a standardized medicine market price behavior of long-term mechanism. Because of the more contradictions accumulated in the institutional mechanism, it takes a process to solve the problem of "expensive medical care" for the masses. I believe that with the reform of the medical and health system, the compensation mechanism is gradually perfected and the problem of "expensive doctor" will be solved effectively. [Page] Curb the sale of high-priced drugs to encourage the use of cheap drugs, "China investment": "Drug-raising medicine" led to medical institutions to profit impulse is very strong, hospital high drug flooding.　　What are the new measures for managing and controlling high-priced drugs in the new health reform package? Cao Changqing: "Drug-Nourishing medicine" mechanism to induce hospitals to sell high-priced drugs, open big prescription, aggravating the burden of public medicine costs. There is a consensus on all sides. From the direction of reform, it is necessary to gradually abolish the existing hospital drug policy and promote the separate operation of Medicine. The reform of "drug-keeping medicine" needs a process, the recent policy adjustment to curb the tendency of hospitals to sell high-priced drugs. Mainly includes 3 measures: first, to strengthen the monitoring of high prices of drugs. To perfect the drug price and purchase and sale monitoring system, strengthen the price of high prices and hospital drug use situation analysis.　　For drugs with large clinical dosage and high price, we should carry out cost investigation and audit in time, find out unreasonable cost and profit space, and reduce the retail price in time. The second is to strengthen the control of hospital drug increase rate. The rate of increase in hospital drugs should be lowered gradually before the medicine is abolished. At the same time, the hospital sales of drugs to carry out differential rate pilot. That is, when the hospital sells low-cost drugs, it allows them to increase the rate of higher prices, the hospital sales of high-priced drugs, the demand rate is lower.　　By differential fare increases, hospitals are encouraged to use cheap drugs to curb their tendency to sell expensive drugs. The third is to rationally formulate basicDrug prices. After the national list of essential medicines is determined, the retail price of essential drugs should be reasonably formulated to ensure that the prices of essential drugs are true and reasonable and the overall level is relatively low.　　In basic medical institutions, the use of essential drugs is fully available, and other public medical institutions are given priority to using essential drugs and achieving a certain percentage. "China investment": this round of health reform determines the basic drug system: "For the basic drugs, by the state-made retail price-oriented, local to the province (autonomous regions, municipalities) for the public tender procurement to determine the procurement prices, the government-sponsored primary health care institutions to implement zero-rate sales."　　How is the basic drug retail pricing determined? How to supervise the primary medical institutions to implement zero-difference rate sales? Cao Changqing: The basic drug price policy has an important impact on the production and use of essential drugs, and it is also one of the conditions for achieving essential medicines. The general principle of establishing the price of basic drugs is to keep the reasonable profit of the production enterprises, encourage the production of enterprises, ensure the supply of the market, and strictly control the circulation cost and reduce unreasonable fare increase behavior. Main measures: First, the basic drugs in principle in accordance with the common name of the establishment of a unified retail guidance. Basic drugs are clinical use for many years, a number of competition, production technology mature, stable quality, adequate supply of drugs. To ensure the fair enjoyment of essential medicines should be connected with the level of economic and social development at this stage. The uniform retail pricing of essential drugs is to embody these characteristics of essential drugs.　　Considering the different cost, reputation and service quality of different enterprises, from the angle of satisfying the multi-level demand, we should make a difference in the use and reimbursement for exceeding the unified retail price. Second, the retail pricing of essential drugs is mainly based on the social average cost. The essential medicine is the clinical curative effect already very clear, the quality stable reliable medicine. Therefore, the establishment of the retail price of essential drugs should mainly consider the average cost of production and operation of the society. In the area of cost audit, the management, sales and financial expenses of the enterprise should be limited.　　In order to encourage the production and supply of enterprises, production companies can be allowed to sell higher profit margins. Third, the basic drug circulation link spreads rate should mainly compensate the logistics distribution cost. The basic medicine is the clinical limited choice basic medicine, does not need the production management enterprise to invest how many clinical education and the training and so on expense.　　In the circulation link, the public hospital should take the province as the unit to carry on the public tender purchase, chooses the large-scale, the strength, the service good distribution merchant carries on the distribution, the circulation link difference rate, in principle must according to the compensation logistics distribution cost to approve. The reform plan has already made clear and reformed the operation mechanism of primary medical institutions. Financial investment, drug income no longer as the primary health care institutions to compensate for the operating costs of the channel; The primary medical institutions should not accept the drug discount by 0 of the difference rate, and explore the ways to manage the income and expenditure of the primary medical and health institutions. These are from the system to ensure that the primary medical institutions to implement zero-rate sales of drugs to implement the important measures. Medical institutions are not allowed to accept drug discounts, not to say that they do not allow in the procurement of procurement in accordance with the purchase volume and the conditions of the return of the batchPrice, directly reduce the supply price, but not to allow the hospital to the so-called volume of sales to the hospital after the return of profits, in order to eliminate the zero rate after the hospital through the so-called discount and other ways to achieve drug sales increase. Abolition of drug addition and promotion of medical diversification "China investment": Public hospital reform is the focus and focus of health reform. The new medical reform proposal should "promote the reform of compensation mechanism, gradually abolish the addition of drugs, actively explore various effective ways of separation of medicine, accelerate the formation of diversified medical structure, actively and steadily promote the transformation of some public hospitals, and encourage private capital to hold non-profit hospitals."　　"What measures will be taken to achieve these goals in terms of price reform?" Cao Changqing: Public hospital reform is the focus and difficulty of new medical reform. To this end, the State Council decided to first use 3 years to reform the pilot, in order to explore the promotion of public hospital reform of the basic ideas and methods.　　In promoting the reform of public hospitals, the main task of price policy is to create conditions for perfecting hospital compensation mechanism and forming diversified medical pattern. From the reform of hospital compensation mechanism, we should gradually abolish the policy of drug addition. The health reform proposal, to encourage all regions to explore effective ways and means to reform the hospital compensation mechanism, the direction is to reimburse public hospitals from the medical service charges, drugs into income and financial assistance 3 channels, adjusted for medical service charges and financial assistance two channels. To this end, reform the hospital drug policy, the implementation of the 0 rate of sales.　　After the drug 0 difference rate Sale The hospital reduces the difference income, may through adds the medicine service fee, raises the medical service price and increases the government financial subsidy to solve. The abolition of addition, the addition of drug fees and the promotion of medical services prices is not a "change", this is not a concept of equal replacement. For example, hospitals rely on selling drugs to make up for medical losses, and a 15 yuan net income needs to sell 115 yuan of medicine. If raise the price of medical service, just raise 15 yuan is enough, 115 yuan of medicine does not need to deliberately sell.　　Although the price of services will be higher than in the past, but after the mechanism changes, the doctors put their energies on improving the quality of service, clinical drug behavior will be standardized, unreasonable drug costs will fall, the overall cost of the masses will tend to be reasonable, the harm of drug abuse can be greatly reduced. In order to promote the formation of diversified medical pattern, different price policies are applied to the medical institutions organized by the Government and private capital. The medical services organized by the Government should be based on guided prices downward. Non-profit medical institutions held by private capital are allowed to float properly on the basis of guiding prices. The price of for-profit medical institutions is fully regulated by the market, which is determined by the hospital according to market competition.　　According to the principle of fairness and impartiality, the government obtains the medical services provided by the private hospitals through the purchase of services, satisfies the needs of the masses, and promotes the healthy development of the private hospitals and the formation of the diversified medical pattern. To promote the formation of diversified medical system, not only to adjust the existing medical service market, but also to use the price, taxation and other means, and actively exert the power of market competition, encourageMore private capital will enter the medical service market and increase the supply of medical service to meet the increasing demand of medical service of the masses.