Medical reform signal: medical insurance will no longer pay for the gray cost

On October 16, according to media reports, in the afternoon of October 10, on the first floor of Beijing yanqihu International Convention and Exhibition Center, there were a large number of people gathered in the lecture hall No.1. Many participants who came to the venue later could only stand at the back of the venue and listen to the meeting, while some people sat directly on the steps on both sides of the venue. What kind of report meeting is being held here? Why are so many people concerned? 

Is this statement a signal of future trend? What does it mean for hospitals and doctors that health care doesn't pay for gray costs? Medical insurance doesn't pay for gray fees! There are two aspects in the next step. The first is to firmly support innovative drugs. "Innovative drugs will be included in the medical insurance catalog on a regular basis through the dynamic adjustment of the medical insurance catalog... We are determined to make room for the price reduction of generic drugs purchased in a centralized way to support innovative drugs. " The second is that the medical insurance department is determined not to pay for the false high sales expenses. "In the future, the medical insurance department adheres to the trend of strategic purchase and value purchase. Some comrades may say that the medical insurance is centralized purchase because of lack of money. I want to make a formal clarification and statement. Now the overall operation of medical insurance is stable, and there is balance between revenue and expenditure, not centralized purchase because of lack of money. Our values are only to buy the right gray content, not to buy the false high content, which is also the flag. It is clear to say with all sectors of society that without money, medical insurance will not pay for the false high grey cost, and money will also not pay for the false high grey cost. Including innovative drugs, we encourage him to enter the medical insurance catalog, but you don't engage in gray fees, and we won't pay! " It is understood that the characteristics of strategic procurement are the lowest total procurement cost, the establishment of win-win relationship, the establishment of procurement capacity and checks and balances are the basis of cooperation between the two sides. And value purchase is to buy only the right, not the expensive. In the words of the medical insurance bureau, it is "our values are to buy only the right, not the high gray content". Of course, if this idea becomes a reality, it will indicate that the problem of high drug price in recent years will be solved completely, and the golden sales model will go to the grave. Irrational drug use and corruption promoted by gold sales will also be buried together.

For an enterprise, it will be clean and make valuable drugs, for a hospital, it will be practical and run a hospital, it will no longer rely on drug sales to maintain survival and development, for a doctor, it will be practical and do the doctor's medical treatment, see a doctor and prescribe drugs, it will no longer use drugs for the sake of benefits, it will only choose the right one but not the expensive one. So, what has the medical insurance bureau done in the field of drugs since it was founded more than one year ago? There are mainly two things, one is negotiation and procurement, 17 varieties are negotiated, the other is 4 + 7 volume procurement, 32 varieties are negotiated for the first time, and 25 varieties are finally negotiated. This expansion is only expanded from Beijing, Tianjin, Shanghai, Chongqing and 11 cities in Shenyang, Dalian, Xiamen, Guangzhou, Shenzhen, Chengdu and Xi'an to the whole country, but the varieties are not increased as expected, and medical machines are not increased. The proportion of drugs used in the construction is still small. In order to expand smoothly, in spite of the state organization alliance procurement, the concept of quantity procurement and quantity price linkage remains unchanged; the supporting policies of quality assurance, supply assurance, use assurance and payment recovery assurance remain unchanged. However, fine-tuning has been made in two aspects, namely, "first, three companies are allowed to win the bid; second, since the expansion is on the basis of 4 + 7 nationwide, we have also relatively weakened the competition in terms of rules setting, hoping to guide the orderly competition of enterprises, and the three winning enterprises have no rigid requirement to level the lowest price."

This time the medical insurance bureau has the final say that "medical insurance is not paying for the gray cost". It is a beautiful statement, but there are still some problems to be faced and solved. To say it bluntly: "grey cost" is not only medicine, but also equipment and health materials. Even if the water of medicine, equipment and health materials is squeezed dry, there is no rebate, it means that "grey cost" is completely cut off, whether the diagnosis and treatment are reasonable, whether the use of medicine and health materials is reasonable, that is to say, the medical service is too complex, and excessive medical treatment is judged in medicine. It's a very difficult thing to do. But no matter what, as hospitals and doctors, they should hear the sound of the horn of medical reform, and actively make necessary changes, because the declaration that "medical insurance does not pay for gray expenses" is also a major trend of future medical reform.