To implement the high-value consumables and two-vote system, 15 cities and 30 counties must first try first

Medical Network March 21 finally came, medical supplies 'two-vote system' to be implemented, high-value supplies first.

Yesterday (March 20th), the official website of the National Health and Planning Commission published the "Consolidation of the Results of Breaking Out the Results of Medications and Continued Deepening of the Comprehensive Reform of Public Hospitals" (Guowei No. 4 [2018]).

The "Notice" was jointly issued and issued by the National Health and Family Planning Commission, the Ministry of Finance, the Ministry of Human Resources and Social Sciences, the National Development and Reform Commission, the Chinese Medicine Administration, and the State Council's Medical Reform Office. It has established the key areas and key links for deepening medical reform in 2018 and beyond.

Among them, the "Notice" clearly stated that it is necessary to gradually promote the purchase and sale of high-value medical supplies "two-vote system".

This is also after the 9 points issued by the ministries and commissions in the "Correction of Corrective Treatment of Irregularity in Pharmaceutical Purchases and Marketing and Medical Services in 2016" proposed in the pilot reform provinces and pilot cities in the implementation of the "two-vote system" of consumables. To implement the 'two-vote system'.

In the past two years, the state raised the 'two-vote system' and issued a notice in the name of 'National Health Reform'. This means that the 'two-vote system' for consumables will be widely pushed across the country since this year. Now.

The "Notice" made it clear that the implementation of the "two-vote system" consumables is a high-value consumable. Following the definition of the Ministry of Health of the People's Republic of China, it will soon be targeted to vascular intervention, non-vascular intervention, orthopedic implantation, neurosurgery, electrophysiology, Pacemakers, extracorporeal circulation and blood purification, ophthalmology materials, stomatology, and other top ten high-value medical consumables implement the 'two-vote system'.

Combined with the contents of the “Notice”, the comprehensive reform of public hospitals in the national model cities, model counties (cities, districts, and flags) should intensify reforms, and try first in the key areas and key links, and be the first to break through. ', high value consumables' The gradual implementation of the "two-vote system" is to be implemented first in the medical reform model cities and demonstration counties.

Up to now, the state has published a list of national demonstration cities, and a list of two national demonstration counties.

There are 15 national model cities for comprehensive reform of public hospitals, including:

Beijing City

Shanghai City

Tangshan City, Hebei Province

Changchun City, Jilin Province

Zhenjiang City, Jiangsu Province

Ningbo City, Zhejiang Province

Handan City, Anhui Province

Sanming City, Fujian Province

Xinyu City, Jiangxi Province

Weihai City, Shandong Province

Luohe City, Henan Province

Shenzhen City, Guangdong Province

Yuxi City, Yunnan Province

Baoji City, Shaanxi Province

Qingyang City, Gansu Province

There are 30 national demonstration counties (districts, cities, and banners) for comprehensive reform of public hospitals, including:

Qidong City, Jiangsu Province

Tianchang City, Anhui Province

Youxi County, Fujian Province

Qingzhu Huizhu Tuzu Autonomous County

Beichen District, Tianjin

Julu County, Hebei Province

Xiaoyi City, Shanxi Province

Inner Mongolia Autonomous Region Zhungeer Banner

Haicheng City, Liaoning Province

Nong'an County, Jilin Province

Luobei County, Heilongjiang Province

Changxing County, Zhejiang Province

Yudu County, Jiangxi Province

Haiyang City, Shandong Province

Zhongmu County, Henan Province

Yidu City, Hubei Province

Liuyang City, Hunan Province

Gaozhou City, Guangdong Province

Luzhai County, Guangxi Zhuang Autonomous Region

Wenchang City, Hainan Province

Zhongxian County, Chongqing

Xinjin County, Sichuan Province

Yuqing County, Guizhou Province

Yun County, Yunnan Province

Zhaju County, Tibet Autonomous Region

Zichang County, Shaanxi Province

Longxi County, Gansu Province

Yanchi County, Ningxia Hui Autonomous Region

Kuqa County, Xinjiang Uygur Autonomous Region

Xinjiang Production and Construction Corps Eight Division Shihezi City

The above-mentioned demonstration cities and counties have spread all over the provinces and the vast majority have not yet implemented the 'two-vote system' for consumables. However, according to the “Notice” of the country, they all need to act quickly and become exemplary nationally.

In addition, the “two-vote system” consumables have been promoted or explicitly implemented in Shaanxi Province, Anhui Province, Qinghai Province, Wuhan City, Shaoguan City, Daqing City, Taiyuan City and Changzhi City. The promotion of the entire country will be over and over, and eventually it will gradually be implemented as a drug-like region must be implemented across the country.

In addition, in addition to the 'two-vote system' for consumables, the “Notice” also states that in 2018, the following important medical reforms need to be implemented throughout the country:

1. Continue to control the unreasonable growth of medical expenses, and 44 large administrative hospitals of the 'national team' are also subject to control fees;

2. Compared with the same period in 2017, the proportion of consumption decreased again;

3, The reform of the medical insurance payment method, the country should unify the determination of more than 100 disease types;

4, high-value consumables should explore the implementation of packaged charges, the development of a unified medical service price;

5. Implement centralized purchasing of high-value medical consumables.

These several medical reform tasks all pointed to the purchase of medical consumables for price cuts and controlled use.

The National "Notice" shows that in 2018 medical reform, medical consumables will become an important 'object of the knife', and the industry will also need to be ready to meet the big challenge and prepare for a big shock.

All provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps Health and Family Planning Commission, Department of Finance (bureau), Development and Reform Commission, Human Resources and Social Security Department (bureau), Chinese Medicine Administration, Medical Reform Office:

The comprehensive reform of public hospitals is an important measure to protect and improve people's livelihood. It is the top priority for deepening the reform of the medical and health system. At present, public hospitals have comprehensively promoted comprehensive reforms, eliminated all drug additions, gradually established public welfare, and mobilized enthusiasm. , The new mechanism for safeguarding sustainable operations has achieved significant results. However, the comprehensive reform of public hospitals is a complex systems project involving profound interest adjustments. It still faces some difficulties and challenges, especially the need for new mechanisms for the operation of public hospitals. In order to consolidate and improve, the reform of the 'Three Medicines' linkage reform needs to be strengthened, the reform of key areas and key links needs to be deepened, and the enthusiasm of medical staff needs to be further mobilized. To fully implement the Party's spirit of the Nineteenth National Congress of the Communist Party of China, adherence to the people's health as the center and problems as Guided by the complete cancellation of the use of medicine to supplement medicine and the improvement of the modern hospital management system, it is now consolidating the results of the reform and the relevant work for the continuous deepening of reforms is as follows:

All localities must carry out phased summary assessments of all drug addition cancellations, conduct a thorough and in-depth analysis of the operation status of public hospitals, check whether the reform results are in line with expectations, and make the reform effect 'clear'. Abolishing the reasonable income of public hospitals in reducing drug additions. It is necessary to strictly follow the compensation channels and proportions determined by the implementation plan of the local public hospitals comprehensive reforms to achieve a smooth transition between the old and new mechanisms to ensure the healthy operation of public hospitals. In contrast to the various reform policies identified in the plan, the areas that are not in place need to find out the reasons. Shice, deadline for rectification. Before the end of April 2018, all localities must report the summary assessment report and rectification measures to the State Council's Medical Reform Office. By the end of August 2018, corrective measures must be put in place.

In order to consolidate the results of eliminating medical supplements, the central government will continue to allocate funds to support the comprehensive reform of county-level and city-level public hospitals from 2018 to 2020. It will continue to evaluate the effectiveness of comprehensive reform of public hospitals and allocate special subsidies for comprehensive reform of public hospitals based on the assessment results. The funds are tilted to counties with large populations and poverty-stricken counties at the national level. Rewards and subsidies are given to those places that really do a good job, and where reforms have achieved significant results. Subsidy funds are deducted for places where reforms are lagging behind. All localities allocate subsidies to public hospitals. As an important basis for assessing the completion of evaluation indicators, local governments at all levels should continue to increase support for the comprehensive reform of public hospitals.

All localities must strictly conform to the medical service system planning and resource allocation standards, rationally allocate the number and scale of public hospitals, strengthen the rigid constraints of planning, establish a high-quality, high-efficient, integrated medical service system, and promote the establishment of a hierarchical diagnosis and treatment system. Public hospitals of this type must provide services in strict accordance with functional positioning, and will implement functional positioning, embodying the indicators of public welfare reform and development, financial insurance, payment of medical insurance, total pay and performance pay, and the remuneration of directors, appointments and dismissals, rewards and punishments, etc. Public hospitals Set-up and redevelopment, expansion of hospital beds, purchase of large-scale medical equipment, etc. No matter what kind of funding channels, it is necessary to strictly examine and approve management and strengthen accountability in accordance with the requirements and procedures of regional health planning.

Implementing the "Guidelines for Establishing a Modern Hospital Management System" by the General Office of the State Council (Guobanfa [2017] No.67). Before the end of July 2018, provinces will formulate specific implementation plans. Effectively strengthen party leadership and party building in public hospitals. , Ensure that public hospitals reform and develop in the right direction. Establish and maintain public welfare, mobilize enthusiasm, ensure sustainable public hospitals to operate new mechanisms and improve decision-making, implementation, supervision and coordination, mutual checks and balances, mutual promotion of governance mechanisms as the goal, and strive to implement A good government-to-government organization of public hospitals, a list of regulatory powers, and a list of autonomy for public hospital management. In 2018, the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine were in charge of hospitals, and 20% of all grade 2 public hospitals in the country, 10% The socially-run non-profit hospitals have completed their work on the formulation of the articles of association. They have established a public welfare-oriented assessment and evaluation mechanism for public hospitals to strengthen medical service quality and safety supervision. They have severely cracked down on commercial bribery in the field of pharmaceutical procurement and sales, and resolutely corrected the purchase and sale of medicines and medical services. Unhealthy style.

Governments at all levels must fully implement the basic construction of public hospitals and equipment purchases that meet the regional health plan, the development of key disciplines, personnel training, retired personnel costs and policy-based loss subsidies in line with national regulations, and public health for public hospitals. The task is to provide special subsidies to protect the government-designated emergency treatment, disaster relief, foreign aid, support agriculture, support for public services such as support for border and urban and rural hospitals. Implementation of the Chinese Traditional Medicine Hospital (National Hospital), infectious disease hospital, mental hospital, occupational disease prevention and treatment center, women Inclination policy for specialty hospitals such as hospitals, children's hospitals and rehabilitation hospitals.

In 2018, the unreasonable increase in medical expenses will continue to be controlled, and the growth of medical expenses will be gradually coordinated with the development of the national economy. All localities shall scientifically establish annual medical care based on the economic and social development of provinces, prefectures and cities, and the growth of medical expenses in recent years. The cost growth control indicators are gradually broken down into cities, counties (cities, districts, and divisions), and they do not engage in 'one size fits all'; they must combine the functional orientation of public hospitals at all levels, provide service, and establish a hierarchical diagnosis and treatment system. The detailed breakdown of the fee index into each hospital does not engage in 'one size fits all'. The National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine are in charge of the control of territorial medical expenses.

Continue to implement the "Opinions of the General Office of the State Council on Implementing the Comprehensive Implementation of the Comprehensive Reform of County-level Public Hospitals" (Guobanfa [2015] No.33) and the "Guideline for the General Office of the State Council on Pilot Projects for Comprehensive Reform of Urban Public Hospitals" (Guobanfa [2015] No. 38) to further enhance the systematicness, integrity, and synergy of the reform. In 2018, the proportion of public hospitals in the country (excluding Chinese herbal medicines) and 100 yuan of medical income (excluding pharmaceuticals) in the consumption of health The overall cost of materials continued to decline from the previous year, and the proportion of medical service income (excluding pharmaceuticals, consumables, inspections, and laboratory income) to medical income continued to rise over the previous year.

(1) Deepen price reform of medical services. Conscientiously implement the policy of price reform for medical services. Based on the elimination of drug additions and the simultaneous adjustment of prices for medical services in the earlier period, the government will standardize diagnosis and treatment activities, reduce the cost of drugs and consumables, and make room for further optimization. The price of medical services, and do a good job with the health insurance payment, medical control fees, grading diagnosis and treatment and other policies to ensure the healthy operation of medical institutions, affordable medical insurance fund, the overall burden of the people will not increase. By 2020, gradually establish the cost and income The price dynamic adjustment mechanism based on structural changes basically rationalizes the price relationship of medical services. It deepens the reform of the pricing model for medical services, further expands the fees charged by type of disease, and covers the scope and quantity of service units. Optimizing and standardizing existing medical service price items, accelerates Review the new medical service price items to promote the R&D and application of new medical technologies. With the same high-value medical consumables with similar quality and similar prices, explore the implementation of packaged charges for medical services and formulate uniform medical service prices.

(2) Promoting the reform of medical insurance payment methods in a solid manner. Implementing the “Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Payment Methods of Basic Medical Insurance” (Guobanfa [2017] No. 55), establishing and continuously improving the conditions in line with national conditions and medical services. The medical insurance payment system. Fully implement the multiple compound medical insurance payment method focusing on disease-based payment. In 2018, the country unified more than 100 disease types to guide the implementation of the various regions. Advancing the DRG payment pilot. , Improving per-person payment, per-bed day and other payment methods. Explore payment methods that meet the characteristics of Chinese medicine services, and encourage the provision and use of appropriate Chinese medicine services. Establish incentive and risk sharing mechanisms for 'reserve balances, reasonable over-spending', Improve the enthusiasm of self-management in public hospitals to control costs.

(III) Continuously deepening reforms in the field of drug consumables. Implementing reforms to improve drug production, circulation, and use policies, pursuing drug categorization and purchasing, and encouraging cross-regional and specialty hospitals to jointly procure. In 2018, provinces will implement the “two-vote system” program for drug purchase and sale. Landing, promote data sharing, linking illegal clues, interoperability of regulatory standards, mutual recognition of treatment results, implementation of high-value centralized procurement of medical consumables, and gradual implementation of the “two-vote system” for purchase and sale of high-value medical consumables. drug Supply security system and mechanism to better meet the needs of clinical rational drug use.

(iv) Expanding the pilot reform of public hospitals' pay system. According to the Department of Human Resources and Social Security, the Ministry of Finance, the National Health and Family Planning Commission, and the State medicine "Administrative Authority" hospital "Guidance on pilot reform of the salary system reform" (No. 10 issued by the Ministry of Human Resources Development [2017]) and "Notice on Expanding the Pilot Program for the Reform of the Public Hospital Pay System" (Ministry of Human Resources and Social Development issued by [2017] No. 92) Request to actively carry out pilot projects Work, to explore and establish a public hospital salary system that meets the characteristics of China's medical industry and reflects the value of knowledge, to mobilize the enthusiasm, initiative, and creativity of the medical staff, and to lay the foundation for the development of public hospitals.

From 2018 to 2020, we will implement a new round of action plans for improving medical services and continue to increase people's access to medical services. We will accelerate the promotion of medical services such as appointment medical treatment, telemedicine, day surgery, and daytime chemotherapy to improve the efficiency of medical services. Stroke center, trauma center and other multi-discipline joint diagnosis and treatment mode construction, and smooth open green channel in front of the hospital for emergency treatment. Continue to carry out innovative work in Chinese medicine treatment mode, optimization Chinese medicine Service. Make full use of informatization methods, promote the inspection and inspection results inquiry, push and mutual recognition, carry out mobile payment, discharge the patient's bedside settlement, outpatient consultation and other settlement services, make the patient's medical treatment more convenient and faster. Rely on the regional people health The information platform, which leverages information technologies such as the Internet, big data, and artificial intelligence, can open information channels among medical institutions, realize information sharing of visit cards and treatment information, and form integrated medical services in the medical institutions to allow information to run. The patient ran little.

Public hospitals shall comprehensively reform state-level demonstration cities. Demonstration counties (cities, districts, and flags) shall intensify reforms, and shall first try and take the lead in key areas and key links. The model hospitals of a number of modern hospital management systems shall be determined to promote modern hospitals with points and areas. Management system construction. All localities should actively carry out provincial demonstration work and increase support for national and provincial demonstration areas and hospitals. According to the evaluation results of the comprehensive reform of public hospitals, a model exit mechanism is established to make progress or work on reforms slowly. The demonstration areas and hospitals that have been stagnant have been rectified within a time limit, and the rectification has not been completed in place.

National Health and Family Planning Commission

National Development and Reform Commission Human Resources and Social Security Department

State Administration of Traditional Chinese Medicine State Council Medical Reform Office

March 5, 2018