A New Round Of Medical Service Price Adjustment Pilot Is Coming, And Macro Price Is No Longer "Patched" Under Macro Management

? ? ? On the evening of August 31, the state health insurance bureau, the National Health Commission, and the national development and Reform Commission jointly issued the pilot program for deepening the price reform of medical services (hereinafter referred to as the "pilot program"), pointing out that deepening the reform of medical service prices is an important measure to promote the coordinated development of high-quality medical security and medical services, Objective to explore the formation of replicable and popularized medical service price reform experience. By 2025, the pilot experience of deepening the reform of medical service prices will be extended to the whole country. The medical service price mechanism with classified management, hospital participation, scientific determination and dynamic adjustment will be mature and finalized, and the function of price leverage will be brought into full play.

Jiang Changshong, director of the medical price and bidding procurement Research Office of the National Medical Security Research Institute of Capital Medical University, said that the price reform scheme can also be regarded as the continuation and adaptation of history. In 2016, the national development and Reform Commission, the national health and Family Planning Commission, the Ministry of human resources and social security, and the Ministry of finance also issued the opinions on promoting the price reform of medical services. The idea of this adjustment is different from that of five years ago. The overall policy has changed into a new mechanism and new idea of "macro management, classified pricing, dynamic adjustment, standardization of projects, monitoring and assessment".

The price of medical services is an important price for people's livelihood, involving 1.4 billion people, 7.87 million medical personnel, and more than 50000 medical institutions, involving hundreds of millions of interests every year. With the continuous deepening of the medical reform and the development of the situation, the price management of medical services has also undergone profound changes. The relevant person in charge of the state medical insurance bureau pointed out that the "pilot program" combined with the overall design of deepening the reform of medical service prices proposed an upgraded version of the dynamic adjustment mechanism, which is not only a continuation of the historical task, but also innovation and optimization at a new starting point. The reform of medical service price will be a gradual, point-to-face and long-term process.

On September 1, Jin Chunlin, director of the Shanghai Health and health development research center, said in an interview with the 21st century economic reporter that the price of medical services involves many stakeholders and the situation is complex. The pilot scheme proposes to make the macro price of medical services under the macro management, which is no longer only a continuation of the existing practice, but simply around the project and cost increase and decrease, It is necessary to consider the performance management, the doctor's salary system and the technical characteristics of medical service quality.

No more addition and subtraction

Since 2016, various localities have carried out several rounds of price adjustment and optimization of medical services in a stable and orderly manner in accordance with the cancellation of the mark up of drugs and medical consumables and the control of drug consumption procurement costs in public hospitals, which has played a positive role in promoting the transition of compensation mechanism of public hospitals, promoting the progress of medical technology and supporting the development of medical undertakings.

However, it is worth noting that there are still some deficiencies in the price formation mechanism of medical services, such as weak macro management, insufficient leverage function, and the need to strengthen coordination. It is urgent to seize the favorable opportunities of the state to promote high-quality development of public hospitals, standardize medical behavior, promote reasonable medical inspection, and implement centralized procurement of pharmaceutical consumables to solve the problem through reform.

According to the relevant person in charge of the National Health Insurance Bureau, in recent years, with the cancellation of the mark up of drugs and medical consumables, and the implementation of centralized procurement with quantity, many rounds of medical service prices have been adjusted steadily and orderly, which has promoted the optimization of medical service prices to a certain extent. With the continuous deepening of medical reform and the development of the situation, medical service price management can not only continue the existing practice, but also focus on the number of items and price level.

In fact, the high-quality development of public hospitals, the aging of the population, the lack of macro-control and other aspects require a systematic adjustment of the current medical service prices.

In recent ten years, the rapid development of public hospitals in China, the medical income of public hospitals, medical insurance funds and financial subsidies flowing to public hospitals have maintained an average annual double-digit rapid growth. The great abundance of medical resources has made positive contributions to the relief of the burden of medical treatment. In the future, the development mode of public hospitals will shift from scale expansion to quality and efficiency improvement, which puts forward higher requirements for increasing fine management of public hospitals, optimizing medical income structure, improving efficiency and saving costs.

Secondly, we should actively respond to the new challenges faced by the sustainability of medical security level. The aging of population has become the basic national condition of China in the future. The proportion of the elderly population is rising rapidly, the total fertility rate is falling, and the number of birth population is going down. In addition, the changes of disease spectrum and the rise of consumption level, medical insurance financing and expenditure are facing multiple challenges. It is necessary to give better play to the function of price leverage and improve the efficiency of medical resources utilization, We should ensure that the masses have access to high-quality, efficient and affordable medical services.

A director of oncology surgery of Xi'an 3A hospital pointed out to the reporter of the 21st century economic report that the previous adjustment was only based on the cost and other adjustments. The assessment of doctors was often like piecework, and the quality of doctors' medical level was not much reflected.

In fact, there are some problems and shortcomings, such as the medical service price management focuses on micro pricing, insufficient macro regulation, and the leverage needs to be strengthened; The degree of participation of hospitals, doctors and other professional groups in the price adjustment is not high, and the price reflects the value of technical services is not enough; The price items of medical service are too detailed and the regional differences are large, which are deviated from the clinical practice and patients' feelings; There is a lack of effective connection between medical service price mechanism and medical staff salary, financial investment compensation mechanism, and the comprehensive effect is insufficient. It is necessary for medical service price to be closely related to the implementation of new development concept and the construction of new development pattern, and to make efforts to dredge deep-seated institutional contradictions.

Therefore, the state medical insurance bureau points out that it is necessary to further clarify the start-up conditions, constraints and trigger mechanism of dynamic adjustment, and realize the closed-loop system through "index system + regular evaluation", so that macro management can better guide micro price adjustment, and micro price adjustment can better serve macro management. Second, a different dynamic adjustment mechanism has been established for the price adjustment of general projects and complex projects, which makes the trigger mechanism of general projects more concise, the price trend more stable, and the trigger mechanism of complex projects more sensitive. Within the controllable range, it highlights the key points, takes small steps and makes rotation adjustment. Thirdly, flexible price adjustment window should be allowed to be selected flexibly for special price adjustment in coordination with major reform tasks, major public health events, and guiding prominent price contradictions.

"Bridge to bridge, road to road"

In the reform of medical service price, centralized procurement with quantity has always been the focus of attention. Some media interpreted the deepening of medical service price reform as "patching up" the reform of centralized procurement of pharmaceutical consumables, and recovered the unreasonable income squeezed out by the latter through the increase of medical service price, thus realizing the translation, conversion and movement of medical expenses in disguise.

The relevant person in charge of the national health insurance bureau pointed out that this interpretation is not accurate. Centralized procurement with quantity creates a favorable opportunity for the price reform of medical services, but in the specific promotion, it is still necessary to "bridge to bridge, road to road"“ Centralized procurement with quantity has created a favorable opportunity for the price reform of medical services. The reform of centralized procurement of pharmaceutical consumables has lowered the price, lightened the burden on the people and created conditions for adjusting the price of medical services

To be specific, centralized purchase with quantity is aimed at "selling with money" of pharmaceutical consumables, with the purpose of purifying the market environment, squeezing out the price moisture and reducing the unreasonable burden of the people; The reform of medical service price is aimed at its own shortcomings, aiming at building a more scientific and reasonable price mechanism and giving better play to the leverage function. However, the two reforms have their own internal logic, which can not become a simple "seesaw" relationship.

Jin Chunlin pointed out that under the centralized procurement system, the space for public hospitals to compensate through consumables and drugs has been gradually compressed. However, the proportion of financial subsidy income of public hospitals in China is still small, accounting for 9.5% of the total revenue in 2016. Therefore, the price of medical services has become an important support for the reform of compensation mechanism of public hospitals in China, and the lack of dynamic adjustment mechanism of medical service prices has become a bottleneck restricting the current reform.

In fact, the specific task of medical service price has changed. From 2015 to 2019, all localities cooperated to cancel the addition of drugs and medical consumables, and adjusted the prices of medical services simultaneously. Canceling the addition of drug consumables reduces the legal income required by public hospitals to maintain normal operation under the old mechanism, and the corresponding space is directly used to adjust the price of medical services, which is in line with the completion of the transition of the compensation mechanism of public hospitals. After entering the new stage, public hospitals have fully implemented the "zero margin" sales of pharmaceutical consumables. Centralized purchase and price reduction can save the procurement cost of public hospitals. Thus, the space for medical expenses released from this should first release reform dividends to the people, so as to enhance the people's sense of gain and happiness.

The relevant person in charge of the national health insurance bureau also pointed out that from the survey, all localities have focused on increasing the prices of consultation, surgery, nursing and traditional Chinese medicine services, which are mainly technical services, in recent two years. Recently, some professional survey reports also show that the average annual cash salary of public hospitals has been higher than the average wage of urban employees. As for how to better reflect the value of technical services, medical service price reform and public hospital salary system reform should be strengthened, the salary level and distribution mechanism of public hospitals should be reasonably determined, the reform dividend should be transmitted to the majority of medical staff, and the direct link between medical staff's salary and project price and income generating ability should be avoided.

Jin Chunlin pointed out that deepening the price reform of medical services is not a simple issue of price adjustment. Instead, it is not to replace the reform with unilateral price increase, but to formulate medical service prices from the perspective of macro management“ This involves hospital management, including performance management, medical staff salary reform, and the specification of specific medical service items

As for the future rise and fall of medical service prices, Jin Chunlin pointed out to the 21st century economic reporter that both are possible and need to be considered in a comprehensive way.

Yang Song, an analyst of Tianfeng securities, also believes that the direction of price reform should rise and fall, but it is expected to be dominated by rise. According to the formation mechanism of price classification, the government should manage the price benchmark well for general medical services. For complex medical services, the price adjustment will be more flexible and targeted, better reflect the value of technical services, and transmit the reform dividend to the majority of medical personnel. From the perspective of local practice, according to the "Yunnan Province 2021 provincial public medical institutions medical service price adjustment plan" published in 2021, Yunnan Province has increased 1113 items, with an average increase of 36.4%; 187 items were reduced, with an average decrease of 20.1%. On the whole, most of the current medical service prices have been set for a long time, and it is expected that the future adjustment will be dominated by rising.

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