Among them, Shenzhen pilot was initially set in Futian District, Shaoguan pilot was initially set in Ruyuan County People's Hospital, Ruyuan County Maternal and Child Health Hospital and Ruyuan County Chinese Medicine Hospital, and Zhanjiang pilot was initially set in Guangdong Medical College Affiliated Hospital, Zhanjiang Central People's Hospital and Agricultural Reclamation Hospital, mainly in secondary hospitals.
At present, the state implements the highest retail price management of drugs, and at the same time stipulates that the drug price increase rate of medical institutions is 15%. This ratio comes from the Opinions on Further Rectifying the Price Order of Drugs and Medical Services Market issued by the National Development and Reform Commission in 2006, which stipulates that "the medical institutions at or above the county level shall sell drugs based on the actual purchase price, and the price increase shall not exceed 15%."
In the specific implementation, all localities have formulated clear rules, and some provinces and cities require hospitals to sell drugs in 500 yuan: the unit price of drugs below 500 yuan is15%; If the unit price exceeds that of 500 yuan, only 75 yuan will be added. In this way, most hospitals can control the price increase below 15%.
Some hospital people pointed out that at present, drug income accounts for more than half of hospital income, and the proportion of hospitals below the second level is higher. Cancel the drug price increase of 15%. If it is not supplemented by appropriate subsidy measures, the hospital will not only "earn less" but also bring "huge losses".
According to the relevant person in charge of the Health Department of Guangdong Province, after canceling the price increase of drugs, the hospital's losses will be made up through two channels. In addition to increasing subsidies by governments at all levels, the price of medical staff's labor technology, such as expert consultation fees and operation fees, will be appropriately raised to better reflect the labor value of medical staff.
Under the system of "supporting doctors with medicine", the result of 15% bonus is that hospitals tend to purchase high-priced drugs. If the drug price base is large, the absolute value of the bonus will be greater, and the hospital will earn more profits. However, the cost generated by the addition is finally shared with the patients, and there are social problems such as high drug price, expensive medical treatment and difficult medical treatment.
Can canceling grades reduce drug prices? Is the upcoming reform pilot an effective means to solve the problem? In the interview, experts generally believe that medical reform is only a "medical reform" if medicine is not separated and the problem of "supporting medicine with medicine" is not solved, and it still cannot solve the problems of expensive and difficult medical treatment.
In fact, the cancellation of drug addition has not cut off the medical interest chain, and the income problem of hospitals and doctors has not been solved. Geng Renwen, president of Southern Hospital, said: "15% is not the income that hospitals can earn. The storage, transportation and configuration of drugs in hospitals also generate expenses. The direct and indirect costs may be higher than the drug price 15%, and the accounting is quite difficult. " The storage and management of drugs will produce added value, and the process of medication must be closely coordinated by doctor Yamatonokusushi. The investment in these links will not decrease with the cancellation of 15%, which will definitely affect the actual income of the hospital.
More importantly, most hospitals don't even know what the financial situation of hospitals is after canceling 15%. Government subsidies may not be solved at all.
Liu Zhaonian, executive director of Jiuzhoutong Group, analyzed that canceling 15% bonus may lead to several results under different circumstances. In the first case, the 15% fare increase rate is cancelled, but the hospital still sells drugs, so the actual fare increase results are in the hands of the hospital. Within the range of the highest retail price in China, the price increase of different varieties may be 10%, 20% or even 50%. In this case, two outcomes may occur. First of all, hospitals still tend to purchase high-priced drugs. Although the actual price increase may not exceed 15%, the absolute profit they can get from it is large, and the drug price is still "high"; Another result is to use more low-priced varieties, because the price increase of low-priced varieties is higher than that of high-priced varieties, which has the advantage of reducing the price of some drugs.
In the second case, after the cancellation of the addition, the "zero difference rate" is implemented, and government subsidies become the most realistic choice. But this is also divided into two situations: the government implements a fixed proportion and a fixed amount of subsidies according to the level of drug use in various places. In this way, the more expensive drugs are used, the greater the loss may be, and hospitals will not tend to purchase high-priced drugs, which will reduce the cost of patients while changing the drug use structure; Another possibility is that the government subsidizes drugs according to the sales volume of drugs, and the government subsidizes more drugs, which will be a disguised return to price increases.
"It is necessary to solve the problems of hospital management system and medical resource allocation and improve the drug pricing system. Not only canceling 15% can solve the problem. " Li Canhui, general manager of Guangdong wittman Pharmaceutical Co., Ltd. thinks. Cost plus rate is a concept of marketing, which refers to a certain proportion of enterprise profits, and it affects the pricing of enterprise unit products.
Unit price = product unit cost *( 1+ cost profit rate)
p = C *( 1+r)；
The markup pricing method includes full cost markup pricing and purchase price markup pricing. The former is widely used in the pricing of vegetables and fruits. The method is to determine the unit variable cost, add the average fixed cost to form the unit complete cost, and add a certain markup rate (gross profit margin) to form the sales price. The calculation formula is:
Commodity price = unit complete cost ×( 1+ cost plus rate)
Among them, the cost plus rate = selling price-purchasing price/purchasing cost × 100%.
Purchase price plus pricing is a common practice in retail industry (department stores, chain retail stores, etc.). ). Its calculation formula is:
Commodity price = purchase price/1- bonus rate
Among them, the addition rate = selling price-purchase price/selling price × 100%.
Among the two pricing methods, the determination of the markup rate is the key to pricing. Generally speaking, the mark-up rate is related to the elasticity of demand for goods and the expected profit of the company. For goods with high demand elasticity, the addition rate should be low in order to make small profits but quick turnover; For goods with low elasticity of demand, the addition rate should be not low. In practice, the same industry often forms a bonus rate accepted by most stores.
The addition pricing method is simple in calculation and easy to operate. Under normal circumstances, companies can get expected profits by pricing in this way. The disadvantage is that it ignores the influence of market competition and the relationship between supply and demand, lacks flexibility and is difficult to adapt to the changing situation of market competition. Especially in cost-plus pricing, the determination of bonus rate is only from the company's point of view, so it is difficult to accurately know the market sales situation at the corresponding price level, and it is also difficult to ensure the rationality of fixed cost allocation. Therefore, it is mainly used for those goods that are purchased at one time and the cost is difficult to determine in advance.
Value-added cost plus rate is the cost plus rate of value-added part.
The latest situation:
Fu Wei, head of the Hospital Policy Group of the State Council Medical Reform Office, pointed out that the system reform of public hospitals has made a breakthrough. In terms of getting rid of medicine to supplement doctors, 3077 county-level public hospitals and 446 urban public hospitals cancelled all drug additions, and seven provinces including Jiangsu, Zhejiang, Fujian, Anhui, Sichuan, Shaanxi and Ningxia cancelled all drug additions of county-level public hospitals. 2 1 224 cities in a province adjusted the price of medical services according to the principle of "total control, structural adjustment, rising and falling".
He said that all localities have promoted the construction of scientific compensation mechanism through comprehensive measures such as canceling drug addition, adjusting the price of medical services, increasing government investment, and saving hospital operating costs.
-In terms of centralized procurement of pharmaceutical consumables, according to the requirements of the Guiding Opinions of the General Office of the State Council on Improving the Centralized Procurement of Drugs in Public Hospitals, all localities are studying and formulating a new round of centralized procurement plan for drugs, which will be implemented in the middle and late part of this year 10 as required. Jiangsu Province has centralized procurement of all the ten categories of high-value medical consumables specified by the state, while Qinghai Province has included all drugs and medical consumables in public hospitals in the scope of centralized procurement at the provincial level, effectively reducing the procurement prices of drugs and consumables and leaving room for price adjustment of medical services.
—— In terms of management system, Anhui, Guangdong, Henan, Inner Mongolia and other provinces have established county-level public hospital management committees led by county-level government leaders, which reasonably define the responsibilities of the government as investors and the independent management authority of hospitals as institutions. The pilot cities have also conducted various forms of exploration in rationalizing the relationship between the government and public hospitals, building a corporate governance structure, and delegating micro-management authority.
—— In terms of personnel distribution system, all pilot areas actively promote the establishment of posts and personnel, establish a flexible employment mechanism, and implement the autonomy of hospital employment. Hainan, Fujian and other places have explored some good practices in these areas. At the same time, all localities have also explored the establishment of a salary system that conforms to the characteristics of the industry, encouraging more work and more pay, and the incentive effect of the reform of the distribution system has begun to appear.
-In terms of the reform of the medical insurance payment system, on the basis of controlling the total amount of medical insurance, all localities have generally promoted the reform of payment methods according to diseases, per head, per service unit and per bed day. Yuxi City and Lufeng County of Yunnan Province explored the implementation of DRGs, and Yiyang, Wuzhi County and Xixian County of Henan Province implemented the new rural cooperative medical system, which achieved positive results in controlling medical expenses and standardizing service behavior.