Separated medicines must clarify three basic viewpoints

At the press conference of the Ministry of Health, Zhong Dongbo, director of the Hospital Operation Supervision Department of the Department of Medical Services Supervision of the Ministry of Health, said when talking about the reform of public hospitals, the most fundamental reform of public hospitals is the reform of the mechanism. The practice of separating medicines and breaking down the mechanism of "taking drugs to support medical care" is a particularly important aspect of the institutional reform of public hospitals.

Zhong Dongbo emphasized that in the implementation of the separation of medicines, it is necessary to clarify three basic viewpoints: First, the most important part of medicine separation is the separation of mechanisms, and cutting off the interest relationship between medicines does not simply separate the institutions. Second, the separation of medicines does not mean zero drug additions. Through the reform of payment methods, the management of revenue and expenditure can achieve separate medical effects. Third, the “medical” that separates medicine is not only a medical institution but also a doctor. Since all medical actions must eventually fall on each doctor, the rationalization of the doctor's incentive mechanism is also very important. The doctor's salary system, assessment system, and supervision of prescription behavior are also crucial for the separation of medicines.

At present, many localities are integrating local practice with the reform of public hospitals as an important part of the "separation of medicines." Zhong Dongbo said that through the preliminary exploration of local practice and exploration, the four major modes are summarized:

The first is the reform of the payment method, which is the reform proposed in the Guiding Opinions on the Pilot Project of Public Hospital Reform, which promotes payment by case, pays by the head, and advances in total amount. In the case of changing payment methods, medicines are changed from profit sources to costs, and the hospital itself has the incentive to regulate drug use behaviors and to control costs as much as possible in the case of good disease.

The second is the management of revenue and expenditure. In this model, the cost of medicines is not related to the interests of the organization itself. This is a mechanism that encourages neutralization. In this case, the hospital began to use drugs based on medical routines and patient conditions.

The third is to separate the hospital pharmacy, and the differential income of the drug is compensated to the hospital by the government.

The fourth is zero sales of drugs. In this way, the use of drugs has nothing to do with the hospital's income, and the loss of medical services originally covered by the increase in drug use is compensated by price adjustment or financial subsidies.

Zhong Dongbo recognized the "payment method reform" model. He explained that China is advancing basic medical insurance, and medical insurance has control over hospitals. In this context, the reform of payment methods can simultaneously solve the two main bodies—the incentive mechanism of hospitals and doctors. For the hospital, it is to control costs; for doctors, drug abuse will increase the cost of the hospital, and the hospital will also regulate the doctor's behavior.

Zhong Dongbo said that in the next step, the Ministry of Health will make a summary assessment of the advantages and disadvantages of different models and applicable conditions, and launch a relatively feasible approach in the country. At the same time, he stressed that the situation in different parts of the country is very different and it is difficult for the whole country to be “across the board” and multiple modes should be allowed to coexist.