A new era of medical reform | 'Cost control is king' | Arrival

Medical Network April 16 'Leave money' The hospital can't play. The pressure and challenge to the dean are unprecedented.

In the new era of the new medical reform, the reform of the medical insurance payment system was forced, and the hospital began to 'poor money', and forced the hospital to expand from the 'extensive scale expansion development model' to the 'fine cost management connotation quality and efficiency model', and the cost was king. The time has come.

Extensive scale expansion and development mainly depends on increasing investment in production factors such as capital, manpower, and material resources, that is, by expanding the area of ​​medical land, expanding the area of ​​medical housing, purchasing a large number of medical equipment, and increasing the number of medical staff to achieve scale expansion and development, thereby realizing the hospital Income growth. Hospitals rely on extensive scale expansion and development model, which also brought rapid rise in medical expenses, the risk of medical insurance funds 'wearing the bottom' increased, and at the same time it also brought the 'expensive to see a doctor'. Analysis of the motivation of excessively extensive scale expansion and development. Summing up the characteristics of extensive scale expansion and development.

(I) Analysis of the Motivation of Extensive Scale Expansion and Development

1. The establishment of a universal health insurance system stimulates medical consumer demand

The establishment of a universal medical insurance system, especially the hospital reimbursement system, has greatly stimulated people's medical needs, expanded the number of beds, and attracted more patients to become the hospital's source of disease and increase the importance of income. This has greatly stimulated the expansion of hospital scale.

2. Improve equipment competitive advantage stimulated the purchase of medical equipment

Hospital competition pressures, new technologies are added to new equipment, and technological equipments are competitively enhanced. Hospitals are competing to purchase large-scale medical equipment. There are also low prices for technology, relatively high equipment revenues, and endogenous demand to stimulate competition to purchase medical equipment. Especially in the gray interest chain of the purchase of medical equipment, equipment purchase has entered a peak period.

3. Performance incentives to stimulate expansion

Government financial subsidies do not do a good job of investing in the public welfare of hospitals. Most of them depend on the hospital's self-reliance. The implementation of a performance-based wage system linked to the number of incomes or projects requires the hospital to accommodate more beds by increasing the size of beds, expanding the area, and adding advanced medical equipment. For patients, doing more checks and treatments stimulated the department's income drivers.

4. Government Livelihood Project Promotes Hospital Expansion

Since the new medical reform, the central government has increased financial resources to support the construction of county-level hospitals, which has stimulated local investment in hospitals to a large extent, mainly through reconstruction and expansion as a livelihood project. External factors have stimulated the expansion of hospital scale. Some local governments have relocated hospitals to The new development zone can be used as a livelihood project. It also stimulates the land price and housing price in the development zone. Both the fame and the income of the hospital are higher than each other. The income of the hospital is high compared to the income of the GDP. The 'hero' is still part of the chief's Achievement view.

(II) Main features of extensive scale expansion and development

1. Extensive scale expansion stimulates hospital revenue increase

By expanding the scale of the hospital, it has increased the scale competition effect of the hospital, stimulated the increase of the hospital's income, increased the hospital's income, and promoted the hospital to pursue more investment.

2. Medical insurance payment control is relatively loose

The main reason is that hospitals have been driven by economies of scale. The main reason is that payment and settlement are relatively loose at the initial stage of medical insurance, and the payment and settlement methods are simple. This has played a significant role in promoting the hospital's extensive income scale expansion.

3. The public is excited about medical needs

The universal medical insurance system has greatly stimulated the people's medical consumption demand, and in view of the contradiction between the unlimited demand for medical consumption and the infinite income-driven nature of the hospital, it has stimulated the dual effects of adverse selection by both parties.

4.drug Compensatory compensation for consumables

Because doctors have long training periods, high risks, and high labor intensity, especially the low prices of medical charges, positive nominal wages cannot fully reflect the value of medical services, and compensation for drugs and consumables has played a major role in compensating for gray interest compensation. Triggered by Medicinal herbs Medical care.

Since 2016, medical insurance control measures have begun to take off. In particular, this year the State Council’s institutional reform, the establishment of the 'National Medical Protection Bureau', 'three guarantees in one' and 'four right to one', the pressure will force the hospital 'shearing' .

1. Medical reform reveals news

Only when the irrational drug prices, medical materials, and medical technology inspection fees are effectively reduced, can the price of medical technology services be raised. The medical insurance department has a medical fee service price. Pricing rights will surely lead the new healthcare reform.

2. Inflict more control charges 'strictly'

The limited nature of the health insurance fund and the people health The unlimited medical demand contradicts the hospital's revenue-driven indefinite nature. It is determined that the medical insurance payment system will inevitably shift from the current post-payment system for medical projects to the DRG pre-paid system based on the type of disease. The public hospital control fee will usher in a storm. Assaulted, control fees must be more 'strict'.

3. Forced the false high drug price 'Reduce'

The “three-in-one” integration of the National Development and Reform Commission's pharmaceutical management duties, the National Medical Insurance Bureau will become a 'big buyer', as a buyer, medical insurance can be used as a drug seller's production and circulation enterprise Price negotiation. Medical insurance will be enhanced in the future in drug pricing and bargaining power. In order to save health insurance funds, the two-vote system for drugs and the unified procurement system will surely fall even more. The high drug prices will be severely curbed and 'reduced'.

4. Forced hospital Improve doctors' treatment

Strengthening the supervision of doctors' medical service behavior will inevitably bring great impact to doctors. Hospitals rely on drugs, and the grey income chain of supplies will be gradually cut off. By checking indiscriminately, the income of overtreatment will shrink, and the demand for positive treatment from doctors will increase. Plunging the hospital to enhance the treatment of doctors.

Hospitals 'extensive scale expansion and development model', the cost pressures have intensified the hospital's profitability, it is difficult to return to public welfare, but also caused by the medical costs of medical technology and doctor-patient relationship is the source of tension. Faced with the pressure of the new medical reform, Medical insurance payment reform is unprecedented in controlling costs. The hospital's 'extensive scale expansion and development model' faces enormous challenges. Fine cost control is inevitable for the times of the king.

1. Refinement of cost accounting

At present, most of the hospital's cost accounting is to departments, and the new situation is arbitrarily forced. The cost calculation of refined diseases, project cost accounting, and the need for equipment cost accounting are greatly increased, which greatly expands the scope of cost accounting. At the same time, it should address marginal costs and controllable costs. Direct cost, department cost accounting, adaptation department, team, disease, project single equipment cost management needs.

2. Accurate cost control

Costs are calculated as 'useful' and 'combined with management'. Cost accounting provides a reference for cost management and control. Accurate personnel costs, drug costs, consumables costs, equipment costs and other cost controls will inevitably increase. This poses new challenges to the informationization of hospital cost accounting. The management and control of precision materials by Eisai controls the leakage of supplies; it can strengthen the management of consumables, establish auxiliary accounts, track the use of billable consumables and non-billing consumables, realize the intelligence of Eisai management, and greatly reduce the number of Timing of timber management, accurately and effectively reducing the proportion of Eisai. Single-disease and DRG control, for single-disease payment of medical insurance and reform of DRG payment system, standard cost of docking with clinical pathway, combined with medical insurance payment standard, single Diseases and disease groups are calculated based on income, cost and income, accounting for the proportion of drug support, ratio of consumables, medical examinations, and precision of medical technology.

3. Normalization of cost analysis

On the basis of accounting data, through in-depth analysis, analysis of the changes in the level of costs and composition, study the factors that affect the cost of the rise and fall and the reasons for the change, to find ways to reduce the cost of the analysis method, the cost analysis must enter the normalization.

4. Sustained cost assessment

Through cost analysis, assessment department costs, disease cost accounting, equipment costs, actual indicators compared with plans, quotas, budget indicators, comprehensive evaluation of cost management performance.

5. Scientific assessment of performance

Cost management needs to be more effective and requires performance support. Therefore, performance appraisal is the key. Effective integration of cost control and performance, expansion of cost performance appraisal content, contribution rate of per capita human cost, contribution rate of cost-effectiveness, per-yuan equipment The cost contribution rate, the bed cost contribution rate, the average outpatient cost contribution rate, the cost evaluation results such as the cost of the discharged patient, etc., are related to the performance pay of the department, and increase the cost-effectiveness.

In short, in the new era of new medical reform, deans faced the pressure that “health insurance must be charity, patients must be satisfied, medical insurance must be controlled, employees should be treated, and hospitals should be effective.” Not only should hospitals pay attention to the cost control of hospitals, they also need to pay attention to the hospital market. Positioning, open source development is the hard truth, votes are more important than face, health economic rules, 'leave the money' hospital can not play, the pressure and challenge to the president is unprecedented.