Drug addition, can reduce cost

Feb 24, 2016

Source: People's Daily

As an important reform of public hospitals, reform of public hospitals at the county level to cancel the drug addition has pushed across the country.

As of December 1, 2015, 116 counties of yunnan province (excluding kunming), 211 public hospitals at the county level comprehensive start comprehensive reform, cancel the drug addition, a zero rate of sales.

The reform of public hospitals at the county level which brings change, and what are the problems to be solve? Reporter recently in yunnan an public hospitals at the county level for on-the-spot interview.

Drugs are not addition effect how

Inspection fee down expenses for medicine, operation fee is up, was hospitalized burden fell slightly

\"Expenses for medicine, X-ray and CT examination is reduced, can reflect the labor of medical technical service operation, fee, infusion fees and other fees rose.\" Yunnan zhanyi county people's hospital, physician Cui Yongxian, so cancel the change of the medical expenses after drug addition were summarized.

Cui Yongxian tells a reporter, after the reform reduced burden of patients, patients on long-term a large number of drugs is a good thing. \"Some patients with disease of heart head blood-vessel don't take medicine in time in order to save money or reduce the dosage of less, help to improve curative effect.\" Cui Yongxian said.

Reporters asked a number of patients are said to see a doctor does it is not clear. Patients with Ma Caixiang tells a reporter, relative to reduce expenses for medicine, let her have more coverage \"feeling\".

Dean Li Laifu zhanyi county people's hospital said, because the drug income in the total revenue accounted for only about 32%, and cancel the drug addition and then increase the medical service cost, the real benefit is only 20% of all medical costs 32%, and reduced down only to see a doctor about 6% of the total cost, most patients would not have obvious feeling.

According to calculation, zhanyi county people's hospital, a year after the cancellation of drug addition probably reduce the income of about 4.4 million yuan, according to government subsidies 10% 10% computation burden, hospital, people can turn a profit of 800000 yuan.

\"The original fee of RMB 2.5, adjusted up to 2.5 yuan.\" Li Laifu said the fee increase can better reflect the value of labor, medical technology and doctors somewhat psychological comfort for the doctor.

\"But the doctor wage income doesn't change, because according to the regulation, the doctor income and expenses for medicine did not hook.\" Li Laifu said.

Under the \"medicine for the medical system, and 15% bonus to easily lead to the hospital to purchase expensive medicine, drug prices base, bonus is the absolute value is big, the hospital earn more profits. Due to the addition of cost eventually spread to the patient, in drug prices artificially high, and the cost of medical care of social problems.

\"Cancel hospital after drug bonus will no longer get any profits from selling drugs.\" Li Laifu thinks, cancel the drug addition to a certain extent solved the public hospitals at the county level \"in medicine hospital\" problem.

Therefore, relative to reduce medical expenses, patients with cancel the drug addition more important purpose is to break with medicine medical profit mechanism, establish maintenance public welfare, to mobilize enthusiasm, ensuring the sustainable operation mechanism.

How the hospital operating income

80% 80% on medical service, financial subsidies, hospital digestion by 10%

Cancelled according to the state development planning commission of planning, hospital drugs addition to reduce the reasonable income, about 80% will by reasonable adjustment of medical technical service price, 10% for fiscal subsidies by the government, the other 10% through the hospital management to digest, the measure is of great significance to optimize the price of medical service system.

Before the reform, and drug addition income is an important part of hospital business income, is the hospital staff wages, bonuses and maintain normal operation of hospital cost is an important source of. And after the reform, the hospital income sources of the three channels: drug fees, government subsidies, medical service, change of government subsidies, medical service two channels.

Professor at renmin university of China health policy and management, the health research center director Wang Hufeng told reporters that the goal of the reform is a new mechanism to replace the old mechanism, but reform cannot hurt patients, hospitals and medical personnel any one party.

Who plan bureau, zhanyi county Yang Hang introduction, to promote the reform, two level in zhanyi county, qujing city county people's hospital of drug addition income is 4.4 million yuan in 2014 to aid base, 10% of them in accordance with the standards of municipal subsidies, subsidies at the county level 3% and 7% for matching grants, zhanyi county's financial subsidies of 300000 yuan, the cities and counties in two levels of subsidy funds are fully in place.

According to Li Laifu, in order to avoid the individual health program fee, cause a disease patients burden is too big, adjust the medical fees has chosen more common medical project. \"There the whole process of the commodity price departments for the whole supervision.\" Li Laifu said.

\"Level of the hospital accreditation for the standardization of hospital management process has strict requirements, so want to continue to save operating costs, pressure is great. If according to the standard, the hospital, in fact, there are many projects need to improve, people also increased, but now can only be suspended.\" Li Laifu said, at present in order to save costs, only in the electricity and water saving, improve equipment utilization and service life, etc, but it's not big.

How to break the deep problems in the future

Cut drug firms and improper benefit between doctors, promote the reform of upstream pharmaceutical production areas as the key

Zhanyi county people's hospital, vice President of the king by the thought, this time cancel drug addition, only solved the problem of the medicine for the hospital. \"Traditionally costs in two pieces: one is the medical fee, the second is for medicine. In fact, the grassroots' medical fee and it is unable to match the doctor pay labor, but solve the problem of excessively high price of drug, not just by cancelling drug addition.\"

\"Same composition drugs to change a name, change the trademark packaging, advertising, to do again price is double; low-cost medicine companies simply don't make a few bucks, want to go to hospital medicine found not, but can only buy a few dollars to the high price of medicine.\" The king by the thought, the medical reform not only to the hospital, the moving knife upstream pharmaceutical production areas should also be reformed.

Wang Hufeng professor said, in order to solve this problem, beginning in 2016, during the period of \"much starker choices-and graver consequences-in\" will do systematic reform for pharmaceutical production circulation.

In addition, many industry insiders said the cut after the interests of the relationship between drug addition and hospital, cut drug firms and illegitimate interests between doctors conveying the same key.

The king by the thought, after cancel the drug addition, public welfare of public hospitals at the county level to further highlight, but public hospitals at the county level the development of the next step is to take into account. \"If there is no government financial aid, the hospital belongs to the operating loss, improved health care and hospital, purchasing large medical equipment and so on all need to increase investment, must need to grass-roots financial increase this investment.\" This means that the public hospital finance system is to form a complete set of reform, the requirement of hospital fine management is also higher.

Correspond to cancel the drug addition, the situation of basic-level hospitals do not leave people still has not been reversed. \"Good went to higher level hospital, the doctor patient also ran to the big hospital, diagnosis and treatment of reform objective is difficult to achieve.\" Said the king by the way, after the health clinic staff accordingly increased, the labor intensity of medical staff continue to increase, how to improve the treatment of medical staff, so as to realize the basic unit hospital retaining talent, still needs further exploration.

S the reporter's note

Get the pain points Aiming at the difficulty

Government subsidies of 800000, the per capita benefit is only two yuan. Advancing the reform is not easy, so you can't deny the significance of this one small step: public hospitals at the county level to cancel the drug addition, not so much in order to reduce the burden of patients, than to break to raise the hospital medicine. Health care success or failure, however, the key is whether get pain points, aiming at the difficulty, effectively resolve the difficulty and high cost of treatment, patients with popular said is obtained.

Is excessively high drug prices, while is grassroots doctors legal income is not high, how to break the situation of \"medicine expensive medical base\", still need to deepen the reform, let it drop down, let the high high up.

If the drug price increases we have become accustomed to change a name, the hospital can't buy cheap drugs to reporters more touches. Upstream, health care reform can not only change the hospital, medical field also needs reform. Cancel the drug addition is reduced drug \"circulation fee\", how to squeeze drug prices itself \"moisture\" even more crucial.

In addition, most nurses legal income does not reflect its value, is someone not crooked. Let the doctor have individual income, higher social status, below is the society, should also is one characteristic of health-care reform.