** Payment Reform: Do not pay for drugs indiscriminately

At present, of the 16,000 inpatients in the year, 65% of the patients are “arranged” to see the doctor. The average medical cost is 5% to 8% lower than that of patients who have not been included in the clinical pathway management, and the proportion of self-payment is reduced by 10%. The average length of stay is shortened. In 0.5 days, the hospitalization rate was 0 in two weeks after discharge. In 2012, the satisfaction rate of the people reached more than 95%.

Ways to reform first and instigate comprehensive reforms are the characteristics of Henan's county-level public hospital reforms. Since May of last year, 30 county-level public hospitals in the province have been paid by disease trials. Up to now, 82 cases (including 124 treatment methods) have been introduced for disease treatment of new rural cooperative medical insurance. A total of nearly 50,000 inpatients have been admitted to the hospital. The cost of hospitalization is 10% lower than that of the same type of disease. It is directly New rural cooperative medical institutions and patients save more than 47 million yuan in medical expenses. Next year, pay according to the disease type in the county-level public hospitals in the province.

The reform of payment methods involves the interests of patients, medical personnel, and new rural cooperative medical institutions. To this end, five counties, such as Yiyang and Wuyi County, initiated unified reform pilots for various systems such as compensation, management, and distribution in accordance with the unified design of the World Bank's Rural Health Development Project. In August this year, Henan took the pilot experience as the starting point and launched the comprehensive reform of county-level public hospitals.

After the cancellation of drug additions, drug prices have dropped, and inspection fees and consumables costs have risen. Wuyi County piloted comprehensive payment reforms and adjusted the prices of medical services in a timely manner, thus eliminating the “two heads”. According to Mu Guoxing, deputy director of the Wushu County Health Bureau in Jiaozuo City, Henan Province, the reform of the payment system changed the incentive mechanism for medical services, eliminated excessive medical practices such as over-prescription and major inspections, and established a reliable system guarantee for canceling drug additions. .

The hospital put forward a “path quote”. The NCMS and the hospital negotiated the final price and signed a service contract with the hospital. According to the performance, the comprehensive reform of county-level public hospitals in Yiyang and Wuyi of Henan Province has a major feature: Lower costs have agitated the reform of institutional mechanisms and reversed the drawbacks of “remedying medicine”.

The evaluation report led by Meng Qingyue, director of the China Health Development Research Center of Peking University, believes that this is a “new type of payment method that has not yet been seen in the country” and the reform proposes a new way of “with medicine to supplement the medical care” mechanism, which can fundamentally Solve the problem of "remedy for medicine."

The data show that after the reform, the proportion of medicines in the five counties dropped to 45%. With the abolition of the advancement of drug addition reforms, medicines have completely become the “costs” of hospitals, and the income of medical staff is no longer obtained from the initiation of medicines, but from treatment, Obtained in nursing and management.

Under the new incentive mechanism, active control of fees and quality assurance have become the conscious behavior of medical staff. Mai Xiaoli is the head nurse of the pediatric ward of Yiyang County People's Hospital. She said: "Before nursing was taught by hands, there are rules and regulations at every step. It is operating under the guidance of a computer, and my heart is even worse."

“Previously relying on selling medicines to obtain revenues, the proportion of medicines has reached 67%. Now that the proportion of medicines has dropped to around 30%, medicines have become a cost, and the proportion of expenses for surgery, treatment, and nursing has increased from 33% before the reform to the present. 51% of the medical personnel's labor value is reflected. The compensation for the new rural cooperative medical system has reached 60%, and the income structure has become more reasonable.” said Zhao Yinzhi, director of the People’s Hospital of Yiyang County.

Ma Xiaowei, vice minister of the Ministry of Health, pointed out that the reform of payment methods as an entry point and the elimination of medicines to supplement medical services can change the incentive orientation of medical behaviors, change the income of medicines, consumables, and inspections into costs, and promote hospitals and doctors' scientific diagnosis and treatment and control of costs. However, the elimination of the mechanism of medicine supplementation and medicine needs a process that requires medical insurance, price, and financial linkage.

The reforms are like doing puzzles. Coordination among various systems is particularly important. During the International Health Conference held in November, Thomas Palu, deputy director of the Human Development Bureau of the Southeast Asia and the Pacific Region of the World Bank, and Human Development of the World Bank in Northeast and Central Africa The deputy director of the Bureau, Anis Balis, visited Henan Province to understand the progress of the World Bank's rural health development and reform project in Henan.

Thomas Palu believes that China’s health care reform is worthy of praise. It is the determination of the government’s reform. It has great implementation and rapid progress. Basic medical insurance has covered 95% of urban and rural residents. This is a very remarkable thing. At the grass-roots level in China, the hardware has made a great improvement and the funds invested by the central government have played a role. However, reforms are not simply building houses. They also need to establish mechanisms to make hardware work. The establishment of intrinsic mechanisms such as incentives and performance is more important than external investment. Reforms are like doing puzzles. The coordination between systems is particularly important.

If hospitals still charge by project and make up for medicine, this incentive may lead to over-service and expensive medical treatment. All these need reform. In addition, price and hospital management must provide service cost information. This is the most ideal path for public hospital reform. Henan has learned about some service cost information through the negotiation of medical insurance and hospitals. The government departments and the NCMS institutions have some basis for the mastery of costs, and some changes have taken place in the hospital's profit-sharing behavior. Positive incentives have provided the basis for further reforms.