2021 is the beginning of the 14th five year plan and a new starting point for the long-term goal of 2035. This year, China continued to deepen the reform of the medical and health system and continuously improved the level of basic medical security, providing strong support for the construction of a healthy China.
In July this year, the general office of the State Council issued the key tasks for deepening the reform of the medical and health system in 2021. It is pointed out that we will continue to promote the transformation from medical treatment to people's health, and strive to solve the problems of difficult and expensive medical treatment.
"three medical linkage" to break the "supporting medicine with medicine"
Making the people see, can afford and have a good health is not only the focus of consolidating the foundation of people's livelihood, but also the top priority of promoting the reform of the medical and health system. To fundamentally solve the problem of difficult and expensive medical treatment means that we must gnaw down many "hard bones" such as uneven distribution of medical resources, falsely high prices of drugs and consumables, and "supporting doctors with drugs".
In the "key tasks of deepening the reform of the medical and health system in 2021" issued this year, "further promoting the experience of Sanming medical reform" is listed as the first key task of deepening medical reform this year.
Sanming City is located in the central and western mountainous areas of Fujian Province. Its total economic output and local fiscal revenue rank lower in Fujian Province. In 2011, the deficit of Sanming employee health insurance overall planning fund reached 208 million yuan, and the local finance could not find out the bottom. Forced by the situation, Sanming City continued to break through the barriers of old interests and institutional obstacles, and broke a new way to solve the problems of medical reform.
Since 2012, Sanming City has implemented key drug monitoring, joint limited price procurement, and completely cancelled the drug consumables bonus. The proportion of hospital drug consumables revenue in the city decreased from 60.8% before the reform to 32.5% in 2020.
In order to cure the chronic disease of "supporting doctors with drugs", while squeezing the falsely high price of drug consumables, Sanming City has implemented 9 price adjustments of medical services and implemented the target annual salary system for all staff, which better reflects the labor value of medical personnel. After the reform, the proportion of hospital medical service income in the city has increased from 18.37% before the reform to 41.5% in 2020. The total salary of hospitals in the city increased by 3.08 times compared with that before the reform, and the average annual salary of medical personnel increased from 56500 yuan to 169300 yuan.
Through the "three medical linkage" of medical insurance, medicine and medical treatment, Sanming medical reform has achieved "tripartite win-win": Lbx Pharmacy Chain Joint Stock Company(603883) less money to see a doctor, improved health level and more sense of gain; The salary of medical staff has been improved, and their sense of career acquisition and identity have been enhanced; The medical insurance fund has reduced waste and maintained a surplus for eight consecutive years, with a cumulative balance of 714 million yuan.
The general secretary once pointed out: "Sanming medical reform embodies the people's supremacy and the courage to be the first. Its experience is worth learning from local conditions."
"In the process of promoting Sanming's experience, we should promote the reform of" three medical linkage ". We should ensure the centralized purchase of drugs and consumables, adjust the price of medical services, follow-up and connection of medical insurance payment, and the salary reform of medical personnel. We should design and implement policies at the same time." Li Bin, deputy director of the National Health Commission and deputy director of the Secretariat of the leading group for medical reform of the State Council, said.
improve the multi-level medical security system
Since the establishment of China's basic medical security system, the coverage has been continuously expanded and the security level has been gradually improved. At present, China has established the world's largest basic medical security network. By 2020, 1.36 billion people had participated in basic medical insurance, and the participation rate was stable at more than 95%.
In 2021, China will continue to improve the unified basic medical insurance and serious illness insurance system for urban and rural residents, and further improve its security capacity. At present, the direct settlement of hospitalization expenses across provinces has covered all provinces, all kinds of insured personnel and main expatriates in China.
In April this year, the general office of the State Council issued the guiding opinions on establishing and improving the outpatient mutual aid guarantee mechanism of basic medical insurance for employees (hereinafter referred to as the opinions). The opinion proposes to establish an overall plan for the general outpatient service of employee medical insurance, and gradually include the general outpatient service expenses of frequently occurring and common diseases into the payment scope of the overall plan fund; Eligible retail pharmacies are included in the scope of the pooling fund. The cost of purchasing medical devices and medical consumables at designated drugstores can be Internet plus. The "Internet +" medical service can also be included in the scope of basic medical insurance. The general outpatient service covers all insured personnel of employee medical insurance as a whole, and the payment proportion within the scope of the policy starts from 50%. All localities are required to give preferential payment to the retired elderly on this basis.
For insured employees, this means that more general outpatient expenses can be reimbursed, and medical insurance can also be used to buy drugs in pharmacies and see a doctor online; The proportion of medical reimbursement for the elderly can be more
While benefiting more Lbx Pharmacy Chain Joint Stock Company(603883) , how to ensure the sustainable development of the medical insurance system is also an important topic of medical reform in the future. At this stage, there is still a gap between the level of medical insurance and the demand of Lbx Pharmacy Chain Joint Stock Company(603883) , and the problems of unbalanced and insufficient security still exist, which requires the use of limited money.
The executive meeting of the State Council held on September 15 pointed out that during the "14th five year plan" period, we should further promote the reform of the medical insurance system, do our best and do what we can, and adhere to the basic concept of medical insurance throughout, gradually improve the level and achieve sustainability.
According to the national medical security plan for the 14th five year plan (hereinafter referred to as the plan) issued by the general office of the State Council. The plan defines the overall goal of universal medical insurance during the 14th Five Year Plan period, and points out that by 2025, the medical security system will be more mature and finalized, basically complete the reform tasks of important mechanisms such as treatment guarantee, financing operation, medical insurance payment and fund supervision, as well as key areas such as medical service supply and medical insurance management services, and realize the improvement of multi-level medical security system.
"In the future, based on basic medical insurance, we will consolidate the basic medical security system, improve the medical insurance and assistance system for major and serious diseases, strengthen the complementary connection between basic medical insurance, supplementary medical insurance and medical assistance, enhance the basic and comprehensive security function, encourage the development of commercial health insurance and the orderly development of medical mutual assistance, and meet the people's multi-level medical security needs." Shi Zihai, deputy director of the State Medical Security Bureau, said.
use life-saving "new drugs" faster and more economically
"We should make new and good drugs more accessible and benefit the masses." Shi Zihai said that since its establishment, the state medical security administration has adjusted the list of Medicare drugs for three consecutive years. At present, 2800 kinds of drugs have been included in the list of Medicare drugs.
Since its establishment in 2018, the National Medical Security Bureau has dynamically adjusted the list of Medicare drugs once a year. In 2021, on the basis of increasing innovative drugs and antitumor drugs, drugs for rare diseases will also be transferred. At the same time, through the negotiation and access of rare disease drugs, the price of rare disease drugs has been greatly reduced. Li Tao, deputy director of the state medical security administration, introduced at the China rare diseases conference in 2021 that a total of 7 rare diseases drugs were successfully negotiated in 2021, with an average price decrease of 65%.
At the same time, the centralized procurement of drugs with volume is gradually normalized and institutionalized. Since the opening of centralized drug procurement in "4 + 7" pilot cities in Shanghai in December 2018, the national drug joint procurement office has successively organized 6 batches and 7 rounds of national centralized procurement. The average price reduction of "centralized purchase" of drugs is more than 50%, and the average price reduction of "centralized purchase" of consumables is more than 80%, which has reduced the burden of the masses by more than 250 billion yuan.
Taking heart stents as an example, from January 1, 2021, public hospitals across the country began to use the first centralized variety of national high-value medical consumables, cardiac coronary stents, and the price decreased from the past average price of 13000 yuan to more than 700 yuan. In the first 11 months of 2021, 1311400 selected coronary stent products were used by medical institutions across the country, exceeding the agreed procurement volume of 1.07 million in the whole year. This alone saved the procurement cost of 14.288 billion yuan and further reduced the medical burden of patients.
The State Medical Security Administration said that during the "14th five year plan" period, it will continue to be based on the affordability of the fund, adapt to the needs of basic medical needs and clinical technological progress, dynamically adjust and optimize the list of Medicare drugs, and timely include drugs with high clinical value, obvious benefits for patients, excellent economic evaluation and qualified traditional Chinese medicine into the scope of payment.
"Since 2018, the state has organized the centralized procurement of more than 200 varieties of drugs, and the average price drop of the selected products has reached 54%." Wang Wenjun, director of the planning, finance and Regulations Department of the state medical security administration, introduced that by the end of the 14th five year plan, each province should purchase more than 500 varieties of drugs through national and provincial centralized belt volume, and more than 5 categories of high-value medical consumables.
In order to ensure that the limited medical resources are used on the "blade", the regulations on the supervision and administration of the use of medical security funds implemented on May 1 this year also drew a "untouchable red line" for the use of medical insurance funds, and initially formed a long-term mechanism to combat fraud and insurance fraud.
"From January to August this year, 211500 illegal institutions were dealt with nationwide, and 8.884 billion yuan of medical insurance funds and liquidated damages were recovered." Wang Wenjun said that during the "14th five year plan" period, the State Medical Security Bureau will continue to strengthen fund supervision with relevant departments, adhere to zero tolerance, full coverage and no dead corner, and strive to build a long-term mechanism for fund supervision.
(China Economic Weekly)
