Release date: 2015-10-12 Anhui county-level public hospitals reformed the implementation of zero-difference rate sales of drugs, reducing the burden on patients. The picture shows Chen Maoshan (second from left), director of the oncology department of Feidong County People's Hospital, and the resident doctors agree on the treatment plan for patients. The picture shows the director of the hospital's pediatrics, Ji Chengying (third from left), for the diagnosis of the child. The burden of patients has not dropped? The implementation of zero-difference rate sales of drugs will be combined with the “three fees†(drug fees, consumables, inspection fees), and the average monthly emergency and hospitalization fees will decrease. Xu Wensheng, a resident of Feidong County, Anhui Province, suffers from diabetes and high Blood Pressure . He needs to take insulin and antihypertensive drugs every day. It costs tens of thousands of yuan a year, which makes him extremely sensitive to drug prices. In Feidong County People's Hospital, Xu Wensheng told reporters that the price before the implementation of the zero difference rate of insulin glargine injection was 236.99 yuan / support, the current price is 194.34 yuan / support, the cost of a drug dropped by 42.65 yuan. Xu Wensheng pointed to the electronic display in the outpatient hall and said that the price of many drugs is now much cheaper than the pharmacy at the door of the community. The so-called "zero difference rate" of drugs refers to the cancellation of the price of medicines sold to patients by hospitals according to the purchase price. In September 2012, Anhui Province took the lead in launching the reform of county-level public hospitals in the country. Through the measures such as the zero mark rate of drugs, it completely cut off the interest chain of medicine supplementation, reduced the burden of patients' medical treatment, and did not reduce hospital income, so that the outpatient service of primary hospitals Both the amount and the number of hospitalized patients have increased. At present, 74 counties (cities, districts) in Anhui Province are included in the reform of 144 county-level hospitals, and all drugs are sold on a “zero rate†basis on time. "The drop in the price of medicines is of great benefit to patients who need to take medicines all the year round. It is a great economic burden. I used to be reluctant to dispense medicines, sometimes I have tight hands, I feel better, my medicine is cheaper. Now the medicine is cheap. And, according to the amount of drugs on time." Xu Wensheng said. At the same time, the reform of the county-level public hospitals in Anhui Province, while implementing the zero-difference rate of drugs, also combined the payment by the disease with the “three fees†(drug fees, consumables, inspection fees). Chen Daohuan, a surgical patient who is going through the discharge procedure, told the reporter that because of the operation of rectal cancer in the Feidong County People's Hospital, it took less than 4,000 yuan before and after the hospital. Feidong County is implementing the large-scale sickness insurance for urban and rural residents' cooperative medical care, and the individual pays more than 20,000 yuan for partial sub-reimbursement compensation, which makes the people get benefits again. As the hospital strengthened the control of “three feesâ€, the average cost dropped from 5,848 yuan in 2014 to 4,270 yuan now, down 26.9%. According to statistics, in 2013, 144 county-level hospitals in Anhui accounted for 47.8% of medicines, down 4.3 percentage points from the previous year; sub-hospital emergency and hospitalization expenses decreased by 3.46% and 1.3% respectively; sub-hospital emergency medicine costs decreased by 5%. The above-mentioned average hospitalization drug fees decreased by more than 10%, and the hospital's average CT and MRI examination fees decreased by 15.6% and 23.6% respectively. Hospital income is not small? Cancel the drug addition and reduce the cost of examinations, the number of patients has increased significantly, medical income has increased, medicine income has decreased, and the proportion of medicines has decreased. From December 15, 2012, Anhui unified the implementation of new medical service prices, focusing on improving the prices of medical treatment, nursing, surgery and other items that reflect the value of medical staff's technical services, and reasonably reducing the price of large equipment inspection and treatment. The price of nursing is increased by 50%, the price of surgery is increased by 20%, and the inspection fee for large equipment such as CT and MRI is reduced by 20%. A consultation fee is set up and the registration fee is incorporated. According to the relevant person in charge of the Anhui Provincial Price Bureau, the examination fee is charged according to the general outpatient clinic and experts (including the chief physician and deputy chief physician). The specific criteria are: 35 yuan per person for the general outpatient clinic of Western medicine and 55 yuan for the expert. The general outpatient clinic of traditional Chinese medicine is 40 yuan per person, and the expert is 60 yuan. The emergency examination fee and the hospitalization examination fee are raised according to the outpatient examination fee. The examination fee is included in the scope of payment for the medical insurance policy, and each payment is 33 yuan, and the rest is paid by the individual. This also means that if you look at a general clinic, the minimum personal consultation fee is only $2. The implementation of zero-difference rate of drugs, chronic diseases such as hypertension and diabetes directly benefited, and the cost of long-term medication dropped significantly. Li Guanglai, director of the Department of Internal Medicine of Feidong County People's Hospital, introduced that in 2014, the hospital's light medicine fee will make 11.12 million yuan for the benefit of the patient, and the large equipment inspection fee will be 1.29 million yuan. At the same time, the new rural cooperative medical system will pay for the disease and reduce the "three fees". Standardize the clinical application of essential drugs. Shao Weihua, head of the Finance Department of Feidong County People's Hospital, said that the elimination of drug additions and the reduction of inspection costs have brought about the biggest change in the number of people who see the disease. In 2014, compared with 2012 before the medical reform, business income increased by 11.61%, including medical income increased by 26.56%, pharmaceutical income decreased by 2.84%, and drug proportion decreased by 12.96%. The reason is that the number of outpatients increased by 59.29%, the number of hospitalizations increased by 9.75%, the bed utilization rate increased by 18%, and the average hospitalization day decreased by 0.8 days. The data showed that after the reform, the number of emergency department visits in county-level public hospitals in Anhui Province increased by 10.97%, and the number of discharged hospitals increased by 7.56%. The income from nursing, surgery and bed fees reflecting the value of medical technology services increased by 33.3%, 17.6% and 16.81% respectively. According to a statistics from the Anhui Provincial Health Planning Commission, the total revenue of 144 county-level hospitals in the province increased by more than 8% year-on-year in 2013. Wang Yuanjin, the president of Dingyuan County General Hospital, calculated the income in the first half of 2015. The provincial and county financial subsidies, the subsidy for medical expenses, and the increase of surgical nursing expenses totaled a total of 18.179 million yuan. To reduce the cost of inspection of large medical equipment, the hospital reduced revenue by 14.581 million yuan. Once in and out, the hospital's income has increased by 3,161,100 yuan. “After the medical reform, the salary of medical staff has increased by at least 10% to 20% compared with the previous one.†Ge Lianyun, director of the Department of Neurology, Dingyuan County General Hospital, said, “The hospital hardware facilities have been improved, the medical service capacity has improved, and medical services have increased. The scope of services has expanded." Is the government compensation reduced? The implementation of zero-rate sales to reduce the income of 25%, into the provincial budget and livelihood projects, the annual allocation of subsidy funds directly to the county-level finance, county-level finances to the hospital on a monthly basis In 2014, the Feidong County People's Hospital paid a total of 11.12 million yuan for the patients, and the average daily profit was 30,465 yuan. After the cancellation of the drug add-up in 144 county-level public hospitals in the province, how can this part of the money be replenished? On September 23, 2014, Anhui Province issued the "Opinions on the Comprehensive Reform of County-level Public Hospitals", which clearly stated in the article "Promoting the separation of medicines and establishing a sound operation compensation mechanism". The county-level hospitals implemented zero-rate sales to reduce income. In the 25% part, the subsidy base determined by the provincial financial basis will be subsidized by general transfer payment, and the county-level finance will review and implement the subsidy fund according to the regulations of the county-level hospitals, and will be allocated to the hospital on a monthly basis. 75% of the part is still compensated by collecting outpatient and inpatient examination fees, and the standard of medical examination fees and the amount of medical insurance payment remain unchanged. Anhui will implement 25% of the revenue reduction of the county-level hospitals in the zero-rate sales, and include them in the provincial budget and the people's livelihood project. The annual subsidy fund is 251 million yuan, which is directly allocated to the county-level finance, and the county-level finance is approved monthly. hospital. A person in charge of the Anhui Provincial Medical Reform Office introduced that in 2013, the financial assistance of county-level hospitals at all levels was 1.24 billion yuan, an increase of 27.8% over the previous year. Shao Weihua introduced that in 2014, hospitals implemented zero-difference sales and reduced revenue by 16.30 million yuan, and government subsidies of 8.11 million yuan. In the first half of this year, hospitals implemented zero-difference sales and reduced revenue by 7.567 million yuan, and government subsidies of 4.94 million yuan. Feidong County People's Hospital had a total income of 89.2 million yuan in the first half of this year, including financial aid income of 5.56 million yuan; medical income of 48.47 million yuan, accounting for 54.34%; and pharmaceutical income of 31.5 million yuan, accounting for 35.3%. In the first half of this year, the total expenditure was 84.46 million yuan, and the balance of revenue and expenditure was reduced by 4.74 million yuan. Since the start of the reform, the local government of Anhui has gradually increased its investment. The county-level finance investment in county-level hospitals increased by 44% year-on-year. More than 90% of counties (cities, districts) also include county-level hospital retirees' funds into the budget. In the next step, Anhui will continue to raise the level of financial security, guarantee six construction and development expenditures such as capital construction and large-scale equipment purchase, and further rationalize the price of medical technology services, reduce the inspection and treatment prices of large medical equipment, and reach the county-level public hospitals in 2017. The proportion of medicines and consumables in total hospital revenue is controlled at around 35%. Anhui established a drug procurement mechanism to regulate the basic use of drugs at county-level hospitals. At the end of 2012, all the drug-level hospitals in the county-level hospitals achieved centralized procurement and bidding. The price of the winning drugs was 36.6% lower than the government-guided price, compared with the average price before the centralized bidding. The actual decline is about 10%. In 2014, Anhui also included high-value consumables and large-scale medical equipment in all public medical institutions, including county-level hospitals, into the province's centralized procurement scope, further reducing procurement costs. Zhu Hengpeng, a researcher at the Chinese Academy of Social Sciences - County hospital financial subsidies can not eat "big pot rice" In 2015, county-level public hospitals in all counties (cities) across the country were dispelled by medicine. How can the hospital's reduced income finance be compensated? Zhu Hengpeng, a researcher at the Chinese Academy of Social Sciences, believes that the establishment of a fiscal compensation regularization mechanism, but the county hospital financial subsidies can not eat "big pot rice." China's health and financial input system is implemented by “grading management and sharing of mealsâ€. County-level hospitals are compensated by county-level finances, and the establishment of a financial compensation regularization mechanism is an important guarantee for the normal operation of county hospitals. However, China has always lacked clear rules and standards. At the same time, the corresponding performance appraisal and assessment mechanism has not been established, and no relevant content has been mentioned in previous policy adjustments. Zhu Hengpeng believes that in the absence of ex ante rules and ex post assessments, local governments allocate financial subsidy project expenditures among public hospitals, often based only on the public “identity†of public hospitals, regardless of their service quality and service efficiency, and finance. Subsidies have become the "big pot" of public hospitals. They are not rewarded and not punished. The efficiency of financial investment is not guaranteed. Source: People's Daily Raw material of veterinary drugs
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County hospital reform, where does the money come from?