Health and Health Commission: Hospital price control upgrades Cost-effectiveness becomes the key to enterprise PK!

Source: Medical Economics

On January 2nd, the official website of the National Health and Welfare Commission published the “Notice on Printing and Distributing the Regulations on Internal Pricing Behavior of Medical Institutions”. This document, which was jointly issued with the Chinese Medicine Administration, clearly stated that medical institutions are required to establish medical service cost measurement Cost control management system, medical service price adjustment management system, new medical service price item management system, price publicity system, etc.

Emphasis on cost calculation

It is worth noting that this document not only requires medical institutions to establish price management committees. The duties of the medical institution's price management department (or full-time medical service price staff) also include organizing and coordinating and participating in relevant departments to make scientific and reasonable calculations of medical service project costs. ; Participate in the bidding, procurement, and price negotiation of drugs, medical equipment, and medical consumables, as well as the cost demonstration review of new technologies and new therapies before entering medical institutions; participate in the price negotiation of medical insurance fund payment projects and disease types; new to medical institutions Medical service price items, new disease types (including disease diagnosis related groups, hereinafter referred to as DRG), etc. are used for cost calculation and price review. Market-adjusted medical service price items and medical institution preparations have been established for cost calculation.

Some analysts believe that this is in line with the "Notice on Promoting the Reform of Medical Service Prices" issued earlier, "by 2020, gradually establish a dynamic price adjustment mechanism based on changes in cost and income structures, and basically rationalize medical services. The term "price parity relationship" agrees.

As the researchers have pointed out, in the early years, the price standards for medical services were mostly lack of scientific basis and methodological model support. Most adjustment projects and ranges were formulated with reference to other provinces and cities, and scientific empirical research was rare. At the same time, most of the medical insurance payments at that time were passive and proportional payments after pricing. The medical insurance payment standards were highly related to the price setting. The reasonableness of the price directly affected the medical insurance payment standards.

In fact, since the National Medical Insurance Bureau took over the power to formulate pricing policies for medical services from the Development and Reform Commission, related reforms are gradually being promoted. Analysts predict that after the completion of the national medical service price reform survey and evaluation led by the Medical Insurance Bureau, the establishment of a sound medical service price dynamic adjustment mechanism will also be on the agenda. It is estimated that the issuance of the "Regulations on the Management of Internal Price Behavior of Medical Institutions" also echoes this.

DRG accelerates cost-effectiveness as the key to enterprise PK

From the perspective of controlling the growth of medical expenses, it is imminent to change the current project-based payment model and gradually establish DRG and performance-based payment mechanisms.

The ongoing DRG-paid national pilot training of the National Medical Insurance Bureau is also in full swing, which also confirms the country's determination to promote DRG. At present, the 29 DRG-paid national pilot cities have completed the training and are expected to complete in mid-January 2020. Among them, Hebei Province, Shanxi Province, Inner Mongolia Autonomous Region, Liaoning Province, Jilin Province, Anhui Province, Shandong Province, Hubei Province, Yunnan Province, Shaanxi Province, Gansu Province, and Xinjiang Uygur Autonomous Region have also launched provincial-level provinces. Training.

According to data from the National Medical Insurance Bureau, as of August 2019, 97.5% of the co-ordinated areas have carried out total medical insurance payment control, established a reasonable control index system, a sound assessment and evaluation system, and a dynamic adjustment mechanism; 86.3% of the co-ordinated areas have For diseases with relatively clear admission and admission standards and mature diagnosis and treatment technologies, the focus is to pay by disease type. 75.1% of the coordinated areas have paid for more than 100 diseases according to the type of disease; DRG payment national trials have been conducted in 30 pilot cities; 62.3% of the coordinated areas have developed Paid by head, 67.4% of the districts pay for bed-days for diseases requiring long-term hospitalization and stable average daily costs, such as mental illness, tranquillity care, and medical rehabilitation.

For pharmaceutical companies, this has become a typical prepaid payment method will force companies to reshape the sales model. As pointed out by Li Dongsheng, a professor at the School of Economics and Management of Guangzhou University of Traditional Chinese Medicine, medical institutions and doctors will certainly find ways to improve medicine, choose reasonable prices of medicines, and reduce unnecessary medical behaviors. The cause of illness must be within the scope of the total control of medical insurance costs. The treatment and the right medicine can get benefits by saving medical insurance costs.

To this end, companies also need to sort out product lines in accordance with market conditions, cooperate with DRGs in accordance with the fixed payment model of each similar disease group, and create a product portfolio for a certain disease group or field to respond to changes.