New Trends in Medical Reform: Reconstructing the Drug Circulation System and Constructing Diversified Medical Services

On November 16, Li Keqiang, vice premier of the State Council, published an article titled "Continuously Deepening Medical Reform and Promoting the Establishment of a Medicine and Sanitation System in Accordance with the National Conditions to Benefit All People" in Qiushi.

The article points out that it is necessary to accelerate the construction of the basic medical insurance system, the construction of basic medicine systems, and the pilot reform of public hospitals. "These reforms have a bearing on the overall situation and are the key and difficult points in the entire health care reform, and they are also the main direction for reforms. They must concentrate on doing a good job."

At present, the phased reform of the new medical reform in the past three years is nearing completion, but the results achieved by the reform are not satisfactory. Although the basic drug system has achieved grass-roots coverage, its problems in the tender procurement process have not only been widely criticized, but also triggered a series of distortions in the pharmaceutical industry. However, the progress of public hospital reforms has been slow, and no substantive breakthroughs have been made.

The reporter was informed that the special plan for the reform of the 12th Five-Year Plan was being drafted and formulated, and these issues should be taken as the focus.

Reconstruct medicine distribution system

The implementation of the basic drug system is one of the five key tasks identified by the State Council in the "Medical and Health System Reform Recent Implementation Plan (2009-2011)".

Not long ago, the National Development and Reform Commission imposed severe penalties on two pharmaceutical production companies listed in the National Essential Drugs Catalogue on the grounds that the two companies monopolized the sales of such drugs in the country. At the same time, some industry sources pointed out that the withdrawal of other manufacturers due to the low bidding price is also an important factor in forming a monopoly.

It is not uncommon for drug companies to suspend production due to too low bidding prices. The distortion of this price is not only reflected in the fact that drug prices are lower than the production cost, but also the problem of excessively high bid prices resulting in high drug prices. The main reason leading to the distortion of the price of this medicine is considered to be that the administrative mechanism inappropriately intervenes in the market mechanism of drug pricing.

As a result of this administrative intervention, “the monopolistic purchasing attributes of centralized procurement of medicines in the province as a unit.” An expert who participated in the design of the national medical reform policy pointed out: “For the deepening reform of the pharmaceutical distribution system, this is a The problem that must be dealt with seriously.”

In June of this year, the National Advisory Committee for Medical Reform Experts was established as an advisory think tank for the “12th Five-Year Plan” for medical reform. According to the reporter’s understanding, in the guidance document issued by the State Council on the key and difficult issues for medical reform that was issued to consulting experts at the time, there was a clear reference to “reconstructing the circulation system for medicines”.

At present, the drafting of the 12th Five-Year Plan for Medical Reform has entered a critical period. Since November, the State Council's Medical Reform Office has held two meetings in succession to discuss and listen to the research and drafting of relevant plans.

According to reports, prior to the meeting, Sun Zhigang, deputy director of the National Development and Reform Commission and director of the State Council's Medical Reform Office, personally led a team to Nankai University to listen to a report on a special project on "reconstructing China's pharmaceutical production and circulation order."

Building a pattern of multiplex administration

Public hospitals are the main body of China's medical and health service system. At present, the number of public hospital beds accounts for 89% of the total number of hospital beds in the country, and the number of outpatient visits and hospital discharges accounts for 92% of the total. Whether or not the reform of public hospitals will be successful will directly affect the question of whether it is difficult to see a doctor or expensive to see a doctor.

Xu Hengqiu, deputy director of the Health Department of Anhui Province, wrote an article not long ago pointing out that the status of the hospital is caused by unclear government administration, the current pay-as-you-go project cannot restrain medical expenses, the proportion of drug and consumables expenditure is too high, and medical insurance is not in control. Fees and standardize medical behavior to play a role.

Among them, whether or not management is the key to the reform of public hospitals. At present, many places have explored the model of separate management. However, apart from Chengdu, the separation of management and management in most places is still carried out within the health administrative department, and it is even the director of health who directly serves as the director of medical management.

Since the health administrative department is both the supervisory and administrative department and the “owner” of public hospitals, this also affects the degree of openness of the medical market to private capital to some extent.

Professor Gu Jian of Peking University’s School of Government Administration pointed out that the health administration departments have intentionally or unintentionally favored hospitals directly under their jurisdiction, and that public medical institutions are trying to deter their real and potential competitors by virtue of the power of their superior government departments in order to maintain their monopoly position. Naturally no more.

In his article, Li Keqiang specifically mentioned that “we must step up the process of clearing and revising relevant regulations, eliminate policy barriers, implement equal treatment, accelerate the development of non-public medical institutions, and complement and promote mutual promotion with public medical institutions to form the external thrust of public hospital reform. At the same time, establish a sound competition mechanism, do a good job in the supervision of the medical market, and ensure the healthy development of diversified medical services."

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