The Medical Insurance Bureau is formally listed: Separates accelerated medicines, and currently invites tenders or repeals. The pattern of subversion will change greatly.

Medical Network June 1 Long-range call came out, Yesterday, the Super Medical Insurance Bureau was finally listed!

According to the "People's Daily" report, on May 31, the National Bureau of Medical Security was formally listed. Hu Jinglin, Ren Shizi, Shi Zihai, Chen Jinyu, Li Yuren, Deputy Director.

Picture from: People's Daily

In March of this year, the State Council’s institutional reform program was formally announced to clearly establish the National Medical Insurance Bureau.

Due to its extensive coverage, the National Health Insurance Bureau's every move has become the focus of most attention in the industry in the recent period.

After the establishment of the National Medical Insurance Bureau, it will become the most concerned government department of pharmaceutical companies.

Because the National Medical Insurance Bureau can dominate drug Centralized procurement, medical insurance catalogs and other market access; the drug bid price will be directly tied to the medical insurance payment standard; drug costs will be determined directly; the right to control the cost from the source will directly control the use of auxiliary drugs for previously used drugs. Right and so on.

It can be said that medical insurance will directly affect pharmaceutical companies from multiple angles, and it will even affect the fate of the company. The helm of the insurance company is the National Bureau of Medical Insurance.

The official establishment and listing of the National Medical Insurance Bureau broke the three-fold pattern of medical insurance and will further promote medical reform, speeding up the separation of medicines.

The separation of medicine is a reform goal that was proposed in the medical reform program as early as in 2009. However, in the past two years, the separation of medicines has really started. The state has successively introduced a series of medicines to separate prescriptions.

As early as January 12, 2016, the State Council issued the “State Council’s Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents” (GF (2016) No. 3). The reform of medical insurance will be promoted to 'play a basic role in health insurance reform. ' The height, and asks the medical insurance's packaged payment (the contract package)' to cover all medical institutions and medical service.

Experts believe that under the new medical insurance payment system, the performance assessment of doctors in hospitals will inevitably undergo a major change: In the past, over-diagnosis, prescription, and high-priced drugs would bring greater benefits to hospitals and turn them into reasonable ones. Prescribe drugs, open cost-effective drugs, bring better benefits for the hospital.

Under the incentives and constraints of the new Medicare payment mechanism, hospitals will naturally generate proactive reductions in drug purchase prices and less incentives to establish drugs. This provides an operable policy basis for achieving 'drug separation'.

On February 9, 2017, the General Office of the State Council issued the “Several Opinions on Further Reforming and Perfecting the Drug Production, Distribution, and Use Policy” (Guobanfa (2017) No. 13) pointed out: 'Outpatients can independently choose between medical institutions or retail sales. pharmacy For purchasing drugs, medical institutions must not restrict outpatients from purchasing medicines from prescriptions to retail pharmacies.

On June 28, 2017, the General Office of the State Council promulgated the “Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Payment Methods for Basic Medical Insurance” (Guobanfa [2017] No. 55). Requirement: Each locality must select a certain number of diseases to implement According to the type of disease, the country selected some regions to carry out DRGs payment pilots, and encouraged various localities to improve per-headcount, bed-day and other payment methods.

The document clearly states that 'by 2020, the reform of the medical insurance payment system will cover all medical institutions and medical services, and nationwide implementation of multiple compound medical insurance payment methods adapted to different diseases and different service features, with a marked decline in the proportion of payment by project.'

For many years, China's health insurance payment reform has taken a very important step at the operational level.

As we all know, for a long time, the sales of prescription drugs in public medical institutions accounted for more than 80% of the total domestic retail sales of pharmaceuticals. Hospitals are monopolized in the buyer’s market, resulting in a large number of pharmaceutical companies. enterprise There is no bargaining power in the market, only satisfaction hospital The various requirements.

For this problem, before this, Saipan Blue had a discussion on the article “The Health Insurance Authority will take over, the current drug tender control will be repealed” (click to read). For a long time, medical insurance paid for service items, and the executive vice president of the Chinese Pharmaceutical Enterprise Management Association. Niu Zhengqian had written an analysis that, under the existing project-based health insurance payment mechanism, to a certain extent, although it can mobilize the work enthusiasm of medical service providers, it is easy for doctors to induce demand and urge medical institutions to provide over-medical treatment.

At the same time, for a long time, China's medical insurance paid for the hospital's payment according to the project, doctors have excessive diagnosis and treatment, large prescriptions, favor the phenomenon of high price drugs, to obtain a gray income, and consistent with the hospital's 'drugs to medical care' business approach. There is no endogenous driving force for reducing the cost of medicine and medicine, and the restraining effect of medical insurance institutions on medical institutions is very limited. Although the parties call for medicine to be separated for many years, the progress is slow.

Niu Zhengqian said that under the new medical insurance payment system, the performance assessment of doctors in hospitals will inevitably undergo a major change:

From the past, over-diagnosis, prescription, and high-priced drugs have brought great benefits to the hospital, transformed into reasonable medical treatment, reduced the use of drugs, and opened cost-effective medicines to bring better benefits to the hospital. In the new medical insurance payment mechanism Under the incentive and restraint, the hospital will naturally produce an initiative to reduce the purchase price of drugs and reduce the endogenous power of the drug.

This provides an operational policy basis for the realization of 'drug separation'. Traditional drug marketing methods that have long relied on high pricing of drugs to drive sales through channel space will also be subverted, and will create business practices for drug manufacturers. Revolutionary influence.

Some experts told Cypress that with the increasing number of diseases with clear clinical pathways, it is bound to increase the number of disease-paying diseases. In the future, 95% of medicines are expected to be covered by disease. This kind of pay-based multi-payment method.

Professor Gu Wei from Peking University School of Government Administration said earlier on this topic to Seibo Blue that the newly established National Medical Insurance Bureau has integrated the management of medical insurance funds, and the NDRC's drug and medical service price management rights will definitely accelerate the 'three medical linkages'.

With the official listing of the National Bureau of Medical Insurance, which administers the 'Tendering, Medical Insurance, and Drug Price,' the medical division will accelerate. The National Medical Insurance Bureau is also destined to play a significant role in the medical improvement process and will completely affect all medical people.

Zuo Yonggen, an associate professor at Shandong University, has long studied medical reform policies, drug policies, and pharmacoeconomics. The Health Insurance Bureau's listing is related to his research field. Within 90 minutes of hearing the news, he wrote a "Quick Review" through his personal public number. article.

Zuo Genyong believes that the establishment of the Medical Insurance Bureau is conducive to rationalizing the complex interests of the government for many years. It can integrate urban workers, urban residents, new rural cooperative medical care, medical assistance and other medical insurance, and will be the three major powers of medical insurance funds, prices, and procurement Blending, it is likely to reshape the new landscape of interests in the health industry (health care, pharmaceuticals, etc.).

From the background of the leadership team, Zuo Genyong speculates on possible policy signals:

For example, the Secretary Hu Jinglin from the Ministry of Finance has a research background in economics and doctors, which is conducive to better communication with the Ministry of Finance to allocate funds for medical funds, and thus make arrangements;

Deputy Director Shi Zihai comes from the National Development and Reform Commission, has a Master of Economics research background, served as the Director of the Price Division of the National Development and Reform Commission, which may indicate that price management is the highlight of the Medical Security Bureau in the future;

The deputy commissioner Chen Jinlu from the Ministry of Human Resources and Social Sciences, concurrently serves as the vice president of the China Medical Insurance Research Association. This may indicate that industry associations and think tanks may play a role in the future Medical Insurance Bureau;

The deputy director Li Wei came from the former National Health and Family Planning Commission and has a background in medical research. This may indicate how reforms involving medical personnel (doctors, nurses, and pharmacists) may become policy options.

Four leaders, three are economic background, one is a medical background. This may indicate that the future of medical insurance policy design economics will become the mainstream, but the medical thinking will also be balanced. That is, will focus on medical insurance Fund safety, reduce costs (that is, medical insurance control fees) problem.