At the end of the year, some hospitals’ "surprise control of fees" caused inconvenience of medical staff and patients’ inconvenience, and entered the public view through multiple online platforms.

The reporter learned that medical cost control is a long-term policy. The relevant indicators were determined in 2015 and were not introduced at the end of this year. The cost control is not due to the "medical insurance fund bottoming out." Its main purpose is to squeeze out unreasonable increases in medical expenses and reduce the burden of expensive medical treatment for the masses without affecting the effectiveness of medical treatment. But why did some hospitals have the phenomenon of "surprising control fees" and "surprising money saving" at the end of this year? For the formulation and implementation of the policy, the reporter interviewed relevant department heads, experts and medical workers.

Cost control cannot affect treatment, indicators need to be scientifically decomposed

The “Guiding Opinions on the Pilot Comprehensive Reform of Urban Public Hospitals” issued by the Office of the State Council in 2015 and the “Thirteenth Five-Year Plan for Deepening the Reform of the Medical and Health System” issued by the State Council in 2016 both pointed out that by 2017, the pilot city’s public hospitals will account for the The ratio (excluding pieces of traditional Chinese medicine) has dropped to about 30% overall; the health materials consumed in the medical income of 100 yuan (excluding the income from medicines) have dropped to less than 20 yuan. The latter also made it clear that by 2017, "the growth rate of medical expenses in public hospitals across the country will strive to drop below 10%."

After the policy is promulgated and the target is clear, how to implement it without affecting the people's medical treatment is a test of the fine management level of the health authorities and hospitals.

In this regard, Gu Xuefei, an associate researcher of the Health Development Research Center of the National Health and Family Planning Commission, believes that the reform indicators require detailed stratigraphic decomposition and cannot be “one size fits all”. For example, indicators such as the proportion of medicines and the proportion of consumption are not comparable between general hospitals and specialized hospitals, and between hospitals of different levels. The assessment based on a single index does not conform to the basic laws. At the hospital level, it is necessary to change the extensive management method under the long-term implementation of the project-based collection and payment system, optimize the clinical path, improve the efficiency of the hospital, and obtain a reasonable and appropriate balance for distribution.

Dai Tao, deputy director of the Medical and Health Technology Development Research Center of the National Health and Family Planning Commission, believes that the medical cost control goal proposed by the medical reform is an overall requirement for a region, and cannot be simply understood as a requirement for a medical institution; it should be based on the nature of different hospitals. detailed analysis. The practice of evenly distributing cost control indicators to various hospitals in individual places is simplistic.

Annual total control, especially detailed implementation in daily work

The goal of striving to reduce the increase in medical expenses to less than 10%, has it been refined into the daily work of the hospital?

The person in charge of the Medical Reform and Management Office of the Sichuan Provincial Health and Family Planning Commission stated that a notice was issued at the beginning of this year to set differentiated cost control targets. For example, the increase in medical expenses in Chengdu, Deyang, Suining, and Yibin should not exceed 8%, and the increase in Meishan should not exceed 7%. , Other cities (states) require control within 9%. It also analyzes the cost control situation on a monthly basis, and reports the increase in medical expenses of each unit in each region. At the same time, 32 committee-supervised hospitals are monitored in real time through the "three medical supervision platform", and the supervision results are notified in time.

But even so, near the end of the year, the Sichuan Health and Family Planning Commission found that the increase in medical expenses still exceeded the requirements of the national policy. Therefore, on November 10, the "Emergency Notice on Strengthening Accountability and Strict Control of Unreasonable Growth of Medical Expenses" was issued, aligning the cost control requirements with Hospital rating, person-in-charge assessment, and employee salaries are linked.

The person in charge said that Sichuan is an underdeveloped western province with a large population, and the shortcomings of people's livelihoods are outstanding in the health field. In recent years, the medical demand of the masses has been increasing. In 2016, the number of medical consultations in the province reached 460 million, an increase of 43.75% over 2008; the total medical expenses of public hospitals in 88 impoverished counties from January to November 2017 increased by 19.91% year-on-year. Medical expenses were not controlled. Reasonable growth is a long-term task.

There are also some hospitals that have refined their policies to work throughout the year, achieving the goal of cost control and avoiding "surprise control of fees" at the end of the year. For example, Chengdu Hospital of Integrated Traditional Chinese and Western Medicine (Chengdu First People's Hospital) formulated ten major measures at the beginning of the year to strengthen the supervision of the entire process of key drugs and high-value consumables, and focus on monitoring the procurement and application of high-value consumables. Comprehensive consideration of various factors, medical cost history, medical service needs, etc., scientific calculations, and reasonable determination of the hospital's annual and phased goals for medical cost control." The relevant person in charge of the hospital said.

Wang Hufeng, director of the Medical Reform Research Center of Renmin University of China, believes that the completion of indicators varies from place to place. In some places, supervision is not usually carried out. At the end of the year, when the indicators are "exploded", they will immediately engage in "surprise-style" fee control. This approach is not advisable. The requirements and indicators of the medical reform should be broken down into the entire year, implemented month by month, and adjusted at any time. It should not be loosened and tightened, otherwise it will be detrimental to the hospital and the patients.

Strictly "consumption ratio", but also to squeeze out the long-term falsely high purchase price of consumables to control medical consumables to make the "consumption ratio" reach the standard. On the one hand, it is necessary to control the unreasonable use of medical consumables, and on the other hand, control the purchase of consumables. cost.

Zhu Hengpeng, director of the Public Policy Center of the Chinese Academy of Social Sciences, believes that in addition to excessive use of consumables in some hospitals to control fees, it also reflects that consumables have been priced unreasonably for some time. Although the price of consumables is determined by the public bidding of the health department, the phenomenon of inflated prices has persisted for a long time.

There are many circulation links for medical consumables, and many prices are long-term falsely high. This problem needs to be resolved as soon as possible. Some areas began to implement measures such as the cancellation of hospital consumables bonuses and the "two-invoice system" for consumables procurement.

According to the relevant person in charge of the Guizhou Provincial Health and Family Planning Commission, efforts have been made to reduce the falsely high prices of consumables and implement online sunshine procurement of high-value medical consumables. Encourage the use of domestic consumables with high quality, low price and high cost performance under the premise of ensuring quality.

Chengdu, Sichuan, will implement a "two-invoice system" from production to circulation and from circulation to medical institutions to issue invoices once, to reduce intermediate links and reduce falsely high prices. The relevant person in charge of the Sichuan Provincial Health and Family Planning Commission introduced that the Sichuan medical consumables centralized online procurement platform, the procurement principle is: domestically produced products are mainly domestic, the same quality is given priority to low prices, and the online products are mainly used.