“Pharmaceutical ratio†was once the “killer†of public hospital reform and reduction of patient consumption. Some experts regarded it as one of the important indicators for the performance appraisal and bonus distribution of medical institution managers and professional clinical departments and personnel. To this end, hospital administrators and doctors have tried to control the "drug share", and even individual deans and doctors overcorrected, contrary to the principle of rational use of drugs, greatly reducing the normal use of drugs, or disguised outpatient drug routes - pharmacy trusteeship or out-of-hospital establishment pharmacy! In fact, there is no major change and impact on the normal use of patients' therapeutic drugs. The total consumption (in-hospital medical services plus extra-hospital use) has not been significantly alleviated, but the way of consumption has changed.
Throughout the eight years of the birth and evolution of the drug proportion, from the beginning of the basic drug list, collection to the current two-vote system, etc., the design intention is good, the initial heart is commendable, but now the drug ratio has actually been mutated or deteriorated Danger, such as the use of normal drugs for the treatment of sputum reduction, simply make a fuss about the price of drugs, instead of using new drugs with good effects, high specificity but high prices, although the drug use of patients is reduced, but the effect is unknown. Causes or causes the treatment time to prolong, resulting in an increase in total treatment expenditure, and the expensive treatment continues to exist or even worse.
Seeking truth from facts, the recent introduction of high-priced new drugs in the medical insurance drug list has caused the attention of relevant management experts and scholars, because this is from the meaning of medical insurance design, the maximum benefit of medical insurance funds and the overall stable operation of national or regional medical insurance funds. Said that there is great positive significance. However, there are still some areas of medical insurance management and hospital deans who continue to blindly consider the proportion of drugs as an important means and content to avoid overdraft of medical insurance funds and hospital performance management, and continue to reduce the proportion of drugs. For example, the proportion of medicines in a county hospital in Shandong is 16%! Moreover, the relevant experts have also visited this place, which is really puzzling and shocking!
16%! This makes people sigh at this: the hospital's treatment level is definitely high! It is hoped that in the near future, the idioms of "the clever woman is difficult to be without rice" will disappear in Chinese language! Because no medicine can cure the disease!
Is this true? In fact, people in the industry know that this is a math game. As long as the inspection and other medical services are increased, the denominator in the statistics of medicines is increased, and the amount of medicines used is not reduced, so that the proportion of medicines can be reduced. Assessment target!
This reminds me of an internal statistic that I saw a few days ago. A county hospital in northern Henan accounted for 19.8% of medicines in the first half of this year, and the total income of hospital business was close to 100 million. It was praised by the leaders of the municipal and county authorities in the inspection of the top ten indicators in the first half of the year. I hope that the hospital will continue to insist and press down. Go on. However, a few days ago at the middle-level meeting of the hospital, the president of the hospital was horrified. Everyone must be cautious and careful to prescribe a medical service project. Three points should be used. One is to use the medicine rationally, and it is not against the use of high prices but the effect is verified by experts. New special medicine! Second, don't blindly check high-priced large-scale medical examinations. Third, it is forbidden to open professional services that are not yet capable of operation and operation in our hospital. Fourth, do not repeat the inpatients and open more fees including nursing and treatment. Re-issuing Medicare does not authorize our project!
Why do they say this and do this? According to insiders of the hospital, this is related to the supervision findings of the municipal and county medical insurance offices in the first half of the year. It is understood that the operation of the county medical insurance fund is calculated according to the payment speed of the first half of the year, and it is possible to "flower" or overdraft at the end of October! Most of the public hospitals in the county, like this hospital, are behind such a low proportion of medicines, in fact, hide the secret of "taking" medical insurance funds!
It is understood that since August 1, the county medical insurance office began to "face-to-face" approval reimbursement for the medical insurance inpatients in the county medical insurance designated medical institutions, and issued specific tasks, such as the above county hospitals, requiring a responsible person The unreasonable medical insurance expenditure for the investigation of the month is not less than 1 million yuan. As a result, there was news leaking. On August 1st to 10th, the hospital found an average of 50,000 yuan for unreasonable reimbursement for medical insurance. In other words, the operation of medical hospitals with a very low proportion of medicines must have the possibility and existence of a medical insurance fund! If you do not strictly follow the current data on the proportion of medicines or take the proportion of medicines to take the medical insurance fund to severely stop the sanctions, this year's medical insurance fund losses in the county is a foregone conclusion! By the same token, the medical insurance management departments in other parts of the country should pay attention to the prevention and monitoring of the proportion of deformed drugs!
This is also enough to prove that it is imperative to deepen the reform of medical insurance payment, and it is no longer possible to delay! In the past, the proportion of malformed drugs under the payment of medical items and the form of such payment under the fixed prepayments not only seriously affected the development of medical science and the medical insurance needs of the insured, but also became an obstacle to the orderly operation of medical insurance or nemesis! Compound medical insurance payments based on disease payment and disease group payment, single disease payment, day surgery, per capita payment, bed day payment, and individual project payment must be implemented as soon as possible!
It is understood that some county and city medical insurance offices also pre-subsidize the over-spending of the total annual medical insurance funds of individual medical institutions. The method is to provide 30%--50% of the over-expenditure of the county medical insurance subsidy (of course, there is a balance). However, the author has calculated an account for this. If a hospital like Shandong, which accounts for 16% of medicines, overruns 10 million yuan of medical insurance funds, the actual loss is only 1.6 million yuan of drugs. The rest are service inspection items, and the cost is consumed. Limited, income can be used in the normal operation of the hospital and the payment of employee wages and bonuses, and the hospital will not have overdrafts and losses as long as the dean masters the effective control of the balance at the end of the year. Moreover, the government subsidized 240,000 yuan for zero mark-up. If you give him a subsidy of 5 million yuan for the medical insurance fund, there is no loss for the current county-level hospital (the actual comprehensive reimbursement of medical insurance is more than 50%). Undoubtedly, in the previous medical insurance consumption expenditure, the proportion of medicines has already made a great contribution, and the gross profit of the hospital's business income is as high as 80% or more!
It can be said that it is no longer possible to use the "drug ratio" and "issuing orders". It is time to rest! What do you say?
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