The "proportion of drugs" has gone bad? Hospital assessment needs to be refined!

　　The reform of the medical insurance payment mode from charging by service items to paying by budget management is spreading across the country in full swing. The basic principle of the reform is to transfer part of the financial risk from the payer level to the medical service provider by setting a package price in advance. Therefore, there is a great impetus for hospitals to reduce economic losses in DRG/DIP reform.

　　The original intention of "drug proportion" is to scientifically adjust hospital charges and reduce patients' medical expenses. However, as a tool for hospitals to assess medical insurance, the proportion of drugs has changed into a reason for some hospitals to issue laboratory examinations without indication.

　　At a time when hospitals are about to weaken the impact of the reform of medical insurance payment mode on hospital revenue by accelerating turnover and cost transfer, it is particularly important to deeply explore the further reform ideas of drug proportion.

　　01. Hospital assessment needs to be refined

　　The extensive assessment index of drug proportion, instead of reducing the burden of individual drug costs, has witnessed a rise in medical consumables and diagnosis and treatment costs. Because of the relatively high cost of drugs for medical insurance negotiation, the proportion of drugs will increase. Therefore, although "life-saving drugs" are finally included in the medical insurance, if they cannot be purchased in hospitals, they can only get through the "last mile" through the special case office where anti-cancer drugs are not included in the assessment scope of drug proportion temporarily. What's more, some doctors play an "edge ball", instead of taking the medical insurance channel to prescribe drugs, and let patients go to the pharmacy to buy drugs at their own expense, which not only increases the burden on patients, but also affects the doctor-patient relationship when medical costs are transferred to patients.

　　As an indicator, the proportion of drugs is neutral in itself, which is an objective reflection of things. When an indicator is overemphasized or concerned, it will "deform" the hospital's medical behavior and affect the basic interests of patients.

　　Even if the proportion of drugs itself does not exceed the standard, insurance fraud means such as "hanging up the bed", operating beyond the scope, curing minor diseases, over checking drug use, overcharging, splitting charges, and swapping charges may still emerge in endlessly.

　　The extensive management policy failed to distinguish the difference of drug use among patients with different disease severity, the difference of patients diagnosed and treated in different departments, and the different effects of different drugs.

　　With the progress of information technology and the further improvement of the unified medical insurance platform, the medical insurance department can master the payment information of all medical insurance drug consumables, as well as the prescription records of each prescriber. By analyzing these data, we can quickly find individuals whose prescription patterns are significantly different from the industry average of peers at the same level. Further manual review can identify whether these "discrete values" are irrational drug use.

　　02. Clinical comprehensive evaluation

　　The administrative department of the hospital needs to manage the unreasonable prescription behavior of individual doctors more strictly. If the hospital and the doctor are bound by interests and cannot be effectively supervised, the payer outside the hospital needs to intervene. In this regard, the clinical comprehensive evaluation system of drugs has been placed high hopes.

　　In the past two years, the clinical comprehensive evaluation of drugs has been paid attention to by all parties. The State has organized the formulation of management guidelines, and relevant technical institutions or industry associations have been entrusted to formulate technical specifications such as evaluation methods and standards. An expert committee for clinical comprehensive evaluation has been established to organize comprehensive evaluation around the selection of the national essential drug catalog, the list of drugs encouraged to be imitated, and the list of drugs encouraged to be applied for research and development for children.

　　Next, we need to make full use of big data resources such as drug use monitoring data. If we can comprehensively use the drug market access, the results of large-scale multi center clinical trials, the "real world" data of drug clinical practice, as well as domestic and foreign literature and other materials, we can conduct qualitative and quantitative data integration and analysis around the dimensions of drug safety, effectiveness, economy, innovation, suitability, accessibility, etc., and formulate priority and test proof standards for drug selection and use in medical institutions.

　　For example, the value of drugs can be evaluated in detail, the use value of drugs in different indications can be analyzed quantitatively and qualitatively, and a set of multi-dimensional indicator system suitable for the local medical system environment can be developed. It can also be classified and managed according to "strong recommendation", "weak recommendation" and "not recommendation" drugs, making room for drugs with higher clinical comprehensive value, and ultimately improving the drug proportion indicators.

Shandong Zhushi Pharmaceutical Group Co., Ltd., founded in 2003, has more than 5000 registered employees. After years of development, it has developed into a diversified industrial cluster integrating medical devices, polymers, cosmetics, health food, daily necessities and biological reagent production, enterprise management consulting and training, real estate economy, pharmaceutical transportation, pharmaceutical printing, etc.

Adhering to the concept of life, health and happiness, the Group provides you with full chain health services.

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