The article is from the public number: Eight Points (ID: HealthInsight) , the title picture comes from: Oriental IC.
Late 2019A friend called Jianwen to call his 89-year-old mother hospitalized with a stroke and was forced to be transferred three times within a month. On each transfer, the mother did not escape. However, in terms of hospitals, either the number of hospital stays is limited or the cost of hospitalizations is capped.
Friends say that they are not calling to complain, but to ask, what is the reason? Can it be solved? How long does it take to resolve?
We are media peers and we all take a gradual improvement stand. We do not believe that the sun and the moon change for a new day. However, his problems also challenged our confidence-
The eight-point Jianwen has been on the first anniversary of its launch. As media people, we think we can use the framework of rationality in the field of medical and health to sort out the complicated reality. And I believe that everything has a solution, even a suboptimal solution.
Back in 2019, China ’s medical reform is booming: centralized collection of medicines, negotiation and dynamic adjustment of medical insurance catalogs, launch of the medical insurance version of DRGs pilots, medical consortia and medical community two-level diagnosis and treatment mechanism, giving national treatment to medical treatment and promoting doctors Free flow, national unified electronic medical insurance card and electronic health card, domestically produced new drug PD-1 inhibitors marketed …
All these magnificent grand plans, but unfortunately met a tragic individual event at the end of this year.
This again shows that no matter how we believe in the power of reason, reality still challenges our faith with its sadness and depth, and its natural imperfection and uncertainty.
Tragic events have been common in the history of world medical reform.
Whether it is the British NHS system that is a “model of socialist medical care” or the NHI system that is a model of “egalitarianism”, individual patients have run into a wall in a seemingly powerful and perfect system, and even died of incurable treatment. tragedy. Look at Germany, France, Japan, and Scandinavian countries. These national health insurance systems, which are among the best in the WHO medical system rating, have been continuously and conflict-filled in their establishment, amendment, and evolution.
We see that the tragedies and conflicts in the real world have provided the impetus for reform and provided rare political opportunities and time windows for countries around the world. In China, the tragedy that occurred at the end of 2019 is an occasional consequence of a long historical evolution. Although they have put pressure on reformers, they have also injected greater external impetus into the reform.
From the height of the temples to the distance of the rivers and lakes, the voice of the whole people for medical reform has risen. This is an unprecedented opportunity.
China has launched a city since 1998The township employees ‘medical insurance initiated the New Rural Cooperative Medical Care in 2003 and the urban residents’ medical insurance was launched in 2007, thereby covering almost all citizens with the three major systems. This path is in line with the path of medical reform in other countries in the world-that is, start with coverage, and first achieve the social ethical goal: all citizens have the right to medical security, and the state should achieve medical insurance coverage for all citizens.
In addition to ethical goals, a unified medical insurance system covering the entire population also has natural economic advantages-it can promote the birth of a “single purchaser”, and with its strong bargaining power, it can compete with hospitals and pharmaceutical companies as the main body. The supplier negotiates strongly, thereby forming a market price for the medicine that is beneficial to patients and payers.
In China, this reform is not smooth.
The three major medical insurance systems of urban employees, urban residents and NCMS have not been fully connected for a long time, and it is difficult to form a true single purchaser for a long time. As a result, over the past decade, payers have lacked the bargaining power with suppliers.
In 2018, the National Medical Insurance Bureau was established, bringing together three major medical insurance systems to become a true single purchaser. People soon saw that, like all countries that have adopted a single medical insurance system implicitly and implicitly, the National Medical Insurance Bureau broke out on two fronts at the same time: First, the supply and demand negotiations were initiated for the drug supply side. The price of medicines in China collapsed in 2019. First, for hospitals and doctors, this supply and demand negotiation has just begun, and it is particularly complicated and difficult.
Why?
There are two reasons. First, compared with tangible pharmaceutical products, medical services based on human capital and labor are naturally difficult to quantify. DRGs have achieved the ultimate quantification of medical services, but there are still many areas that are difficult to reach.
Second, public hospitals as the main body of China’s medical services have long been a role-dividing existence: since the 1980s, the concept of free markets has prevailed, and China’s public medical system once embraced the market mechanism. In the decades that followed, public hospitals, on the one hand, remained in the system and were strictly managed as public institutions, but on the other hand, they were completely pushed to the market and become companies that fight in the market.
So, for a long period of time, China ’s decentralized medical insurance funds based on prefectures and cities have faced more than 10,000 public hospitals called public and private. In this highly decentralized medical market supply and demand negotiations, medical insurance parties have been in a state of impotence for a long time.
In 2018, the National Medical Insurance Bureau was established, and the situation has undergone a major reversal.
This side of the negotiation table,Hundreds of health care negotiators have been concentrated into a powerful single negotiator and purchaser; the other side of the negotiating table, as a hospital on the supply side, has not yet formed a clear and centralized negotiation agency mechanism.
This situation is on the surface detrimental to hospitals and doctors, but it is actually detrimental to the overall situation. This is because the “medical insurance-hospital” negotiation is by no means a struggle between life and death, but lies in seeking a continuous and dynamic balance of supply and demand-this is the dialectics of the world. The process of balancing, that is, the process of forming reasonable medical service prices. After the artificially high drug prices are lowered, doctors should get a more competitive income from sunlight. The result of the balance will not only determine the cost of the payer, but also the behavior model of the supplier. The medical service behavior of the supplier will also affect the medical experience of hundreds of millions of patients in China.
Looking forward to 2020, we may see:
China’s medical reform is still dominated by medical insurance.
The main line of reform will continue the two major supply and demand negotiation markets of medical insurance—medicine, medical insurance—hospitals, the latter of which will be especially important—a powerful single purchaser at the national level, with centralized representatives established in each province Hundreds of medical insurance fund units based on the city’s medical insurance co-ordination will continue to conduct negotiations with pharmaceutical and hospital suppliers on a continuous and normal basis.
A long-separated public hospital system will be gradually pulled back to the veritable public service system by the powerful “single purchaser”. This kind of situation we saw when the NHS was founded in the 1940s-the British government gradually publicized the hospital, and eventually turned the doctors of the original local hospitals, private hospitals and charity hospitals into government employees.
A public hospital system that is gradually being pulled back to the real public service framework. Through its own service capabilities, it will strive to compete for medical insurance funds. (including patient out-of-pocket expenses) ) . However, this system is bound to establish a centralized and effective negotiating agent system. Otherwise, the rights of hospitals and doctors cannot be protected, and the rights of patients cannot be ultimately protected.
A private medical market that is developing slowly but is still evolving. Its prosperity and opportunities will mainly depend on the emancipation and free movement of doctors ‘human resources-only in the face of freely flowing doctors’ human resources can private and public health care have a truly equal competition rule.
A fiercely integrated market for medicine and medical equipment. Thousands of pharmaceutical companies today will continue to reduce in the coming years. Eventually, this number may be reduced to less than a thousand. These businesses willProduct R & D and upgrades provide patients with more effective products instead of gray market means to build true competitiveness. Likewise, they need to be prepared to face ongoing supply and demand negotiations with a single buyer.
A small-scale but extremely important medical informatization market. This is because all supply and demand negotiations, the establishment of all rules, and the reorganization of interests can no longer rely on abstract moral constraints and slogans, but must rely on real, complete, effective, and shared information and data.
An evolving Internet healthcare market. Similarly, this market will not grow too fast until doctors’ human resources are truly liberated.
An ambitious internet pharmaceutical market. Similarly, its real outbreak still has to wait for reform and breakthrough in the two major supply and demand markets of medical insurance—medicine, medical insurance—hospital.
Finally, a patient population that is always tangled between gratitude and complaint, eagerness and disappointment. From the largest statistical level, this group is equivalent to all the nationals of our country. In all the grand and exquisite health insurance systems, they seem to be in a vague position. As consumers, their needs are largely determined by hospitals and doctors. As payers, they passively choose medical insurance as their agent. . This group, including you, including me, is the real protagonist of all systems and the ultimate indicator of the effectiveness of all reforms.
Standing on the first day of 2020, we wish everyone a blessing when they are sick, they can find medicines, they can afford it, and they can get good medical services.
In the long river of human history, life is more accidental than death when facing illness.
For example, medicine is one of the most important weapons for mankind against death, and the modern pharmaceutical industry has a history of only 200 years. In 1820, quinine, the first generation of a special treatment for malaria, was produced. Before that, once a malaria outbreak occurred, a large population would die.
Even now, it’s sometimes impossible to explain exactly who will get the disease. In a sense, those who died unfortunately were substitutes for the rest of us in this world, and because they were selected, we are still alive. The experience of their treatment will ultimately benefit us.
Bless them, that is, bless ourselves.
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