The reform of public hospitals is accelerating.

On June 14, the National Health Commission held a regular press conference. Zhu Hongbiao, Inspector of the Department of Economic Restructuring of the Health Commission, revealed at the meeting that in 2017, public hospitals across the country launched comprehensive reforms. An important sign is the cancellation of drug markups. Public hospitals will be compensated by service charges, drug markup revenue and the government. The three channels of subsidies were changed to two channels of service charges and government subsidies.

Under the new compensation mechanism, government investment has increased year by year. At the end of last year, the direct subsidy income of public hospitals nationwide accounted for about 10% of total income. Zhu Hongbiao pointed out that this means that we still have about 90% of compensation to rely on the provision of medical services.

Recently, the General Office of the State Council issued key tasks for deepening the reform of the medical and health system in 2019, including the dynamic adjustment of medical service prices in accordance with the principle of “total control, structural adjustment, rising and falling, and gradual implementation”.

Zhu Hongbiao pointed out that in the future, we will reduce the cost of medicines and consumables and make room for the standardization of diagnosis and treatment in the future, and establish a dynamic adjustment mechanism for medical service prices. The price of medical services based on the value of personnel and technical labor, lowering the prices of large-scale medical equipment inspections, treatments and inspections, and promoting the establishment of a new public welfare-oriented compensation mechanism.

Reduce drug prices to free up room for price adjustment of medical services

In 2017, the drug mark-up system that has been implemented for more than 60 years was completely cancelled, which has initially curbed the momentum of excessive growth in medical costs. In 2018, Beijing, Tianjin, Liaoning, Anhui, Jiangxi, Shandong and other places across the country have set a schedule for the complete cancellation of medical consumables bonuses.

For example, in June 2018, the "Action Plan for Deepening the Comprehensive Reform of Public Hospitals in Guangdong Province" proposed that the province will completely cancel the medical consumables bonus by the end of 2018. Among them, in the third round of price adjustments launched on December 20 of that year, Shenzhen has completely cancelled the medical consumables bonus.

According to the preliminary calculation of the Shenzhen Municipal Health and Family Planning Commission, after the full addition of consumables, the revenue of consumables of public hospitals in Shenzhen is expected to decrease by 247 million yuan.

A series of drug price reduction policies have been frequently introduced at the same time as the drug markup has been cancelled. For example, 17 anti-cancer drugs have been entered into the National Medical Insurance List to negotiate a price reduction of 56% and so on. The inflated prices of medicines and consumables have fallen, which has also made room for the adjustment of service prices in public hospitals.

Zhu Hongbiao said that through centralized procurement and classified procurement, the falsely high prices of medicines were lowered, and this space was freed up for adjusting the price of medical services, reflecting the labor value of medical staff, and gradually transitioning to a reasonable price.

After the adjustment, the patient's cost burden will not increase overall

After the drug markup is cancelled, the only two channels for public hospitals are service charges and government subsidies. While government investment continues to grow, when the comprehensive reform of public hospitals was launched in 2017, all provinces adjusted the prices of medical services.

Zhu Hongbiao pointed out that such adjustments are more about making up for the reasonable income from the cancellation of the drug markup, but at the same time, the problems of some medical service prices being lower than the cost and the unreasonable price relationship have not been resolved.

A doctor from a tertiary hospital in Hunan Province told the Daily Economic News that in the past, medical charges were low for technical and labor services, while the charges for large-scale inspection and diagnostic equipment were set too high. The actual situation is to use equipment to make up for it. "Manpower" is not conducive to mobilizing the enthusiasm of medical staff.

For this reason, 19 provinces adjusted the prices of medical services again in 2018, and further improved the new compensation mechanism for public hospitals. Shandong, Guangdong, Fujian and other provinces clearly stipulate that prices should be adjusted once a year. Sanming City in Fujian Province, Nanchong City in Sichuan Province and other places set up pharmaceutical service fees to reflect the value of pharmaceutical services and promote rational drug use.

Judging from the adjustments in the price of medical services, there have been decreases and increases.

For example, Beijing's comprehensive reform of medical consumption linkage has been formally implemented on June 15. This is also the standard adjustment of medical service prices in Beijing after the comprehensive reform of medical separation on April 8, 2017, which regulated the price adjustment of some medical service items. The main reduction is the price of inspection items of large-scale medical instruments and equipment; the increase is the price of items that reflect the labor value of medical personnel such as traditional Chinese medicine, rehabilitation, and surgery.

This also makes a significant change in the hospital's income structure. Taking Sanming, Fujian as an example, by the end of last year, the city's medical service income (excluding medicines, consumables, inspections, and laboratory tests) accounted for 42% of medical income.

After the price adjustment of medical services, will it increase the burden of medical care for the common people? In this regard, Zhu Hongbiao said that the adjusted medical service prices must be included in the scope of medical insurance payment in accordance with regulations to ensure that the burden of basic medical expenses for patients does not increase overall.

Steadily increase the salary level of medical staff

The adjustment of the price of medical services and the reform of the salary system for medical staff have also been further connected.

Zhu Hongbiao said that more than 2,800 public hospitals across the country have carried out pilot reforms of the salary system and implemented the "two permits", that is, allowing medical and health institutions to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdrawing various funds in accordance with regulations. It is used to reward personnel and explore the establishment of a salary system in line with the characteristics of the medical industry.

At the same time, the reform of the salary structure has steadily improved the salary level of medical staff, focusing on long-term incentives, focusing on lower-year-old medical staff, and letting medical staff rely on knowledge, technology, and work to obtain sunshine, reasonable, decent, and dignified. Rewards.

At present, some localities have actively promoted related reforms. For example, Yan'an City in Shaanxi Province issued the "Implementation Opinions on the Pilot Program for the Reform of the Salary System of Public Hospitals in Yan'an City", which scientifically approved the total salary of public hospitals and included the annual salary of public hospital leaders in the budget of the same level. Public hospitals allocate themselves within the approved total salary, formulate performance distribution methods that meet the characteristics of the hospital, strengthen internal performance evaluation, link the income of medical staff to the assessment results, and link the income of the leadership team to the average salary of medical staff. The income of the company is linked to the average salary of the leadership team, and the salary gap between the dean, leadership team members and medical staff has been continuously narrowed.

Yan’an Deputy Mayor Zhang Jianbo said that after the reform of the salary system, the average annual income of medical staff in tertiary hospitals was 142,000 yuan, and that in second-level hospitals was 118,000 yuan, both higher than the average income of institutions at the same level.