How to stay for the collection of Jacking?May wish to see these suggestions

The balance retaining policy is a key link for incentives to guide medical institutions and doctors to use the selection of drugs in Guobi. The Opinions of the State Medical Security Bureau on the National Medical Security Bureau on the centralized procurement of drugs in the National Organization of Drugs (Pilot Medical Insurance Control Measures "(Medical Insurance Fa [2019] No. 18) pointed out that the incentive and restraint mechanism of improving the incentives and restraint of" reserves for balance and reasonable sharing " The risk sharing mechanism is encouraged to use the selected drugs. This article provides some thinking and suggestions for relevant decision -making through research on national, provincial, and municipal drug collection retention policies, analyzing the influencing factors of the reserved reserved amount.

1. The background of the residual reserved policy formulation

The retirement policy for the collection of medical insurance funds for the National Pharmaceutical Collection mainly involves two parties. One side is the medical insurance department of the policy formula and the financial department. The main purpose is to motivate medical institutions to use the selection of drugs in China Cai, and at the same time strengthen the management of medical insurance funds, improve the efficiency of medical insurance funds, and ensure the safety of medical insurance funds. The other party is a medical institution of the policy executive. Under the national collection policy, medical institutions need to complete the selection of the specified variety agreed procurement, obtain balance retention funds, and improve the performance wages of medical staff, so as to promote the healthy development of the hospital.

When the competent authority formulates the removal policy, it is necessary to ensure that the amount reserved in balance will not be too small to achieve the role of incentive medical institutions, and it will not be too much to cause a burden on the medical insurance fund. When implementing the national mining policy, medical institutions must not only ensure that the agreed procurement of the national organization's centralized procurement of drugs is completed on time, but also should be implemented as much as possible to obtain a higher balance reserved funds.

Second, analysis of factors influencing the restoration policy

The balance reserved policy is to reduce the cost of medical insurance funds (the balance base) for the budget of medical insurance funds, and return the given -point medical institution according to a certain proportion (the proportion of balance retention), and share the reform dividend with medical institutions and medical staff. The calculation formula is as follows:

Residual reserved amount = (Budget of the Pharmaceutical Medical Insurance Funding-the amount of drug medical insurance expenditure) × balance retention ratio.

Among them, the Budget of the Pharmaceutical Medical Insurance Fund = Average Purchasing Base × The Weighted Average Price Price of General Famous Pharmaceuticals before the collection × The actual payment ratio of the medical insurance fund in the regional medical insurance funds × the proportion of the use of participating in the region of General Famous Pharmaceuticals in the Pharmaceutical Pharmaceuticals;

The amount of the medical insurance expenditure of the collection of drugs = (the selected product agreed × the selected price+the amount of the non -secondary product) × the actual payment ratio of the regional medical insurance fund × the proportion of the use of the general name for the regional insurance for the region of the universal drug.

It can be seen that the calculation formula of the balance reserved amount can be seen that the medical institution can increase the number of balances in three ways: one is to increase the budget of the collection of drugs and medical insurance funds through the expansion of the agreed procurement base; During the implementation period, the amount of medical insurance expenditure is reduced by reducing the amount of non -secondary products.

1. Budget for the collection of drugs and medical insurance

The agreed procurement base is the actual purchase volume of a certain variety predicted during the reporting period that the medical institution is during the report. The agreed purchase volume of the selected products is determined according to the number of Chinese elected enterprises and the number of medical institutions (that is, the agreed purchase quantity base), that is, the agreed purchase volume = the agreed procurement base × proportion, the proportion is determined according to the number of Chinese elected enterprises.

Assuming that the amount of reports of the national collection varieties is accurate, the selection enterprise in a certain national collection variety is 4 or more, then the agreed purchase volume is 80%of its base, that is, the purchase volume of the selected products and the purchase volume of non -secondary varieties procurement. 80%and 20%respectively.

Under the incentives of the residual retention policy, the actual selected product procurement of the medical institution may exceed the agreed purchase volume, and if it is over 10%, then the actual selected product procurement volume shall be procurement (80%) and exceed the agreed purchase volume (10%). Two parts. However, according to the national balance retirement policy, the selected products that exceed the agreed purchase volume should not be included in the balance reserved budget.

In order to maximize the amount of residual retention, the medical institution needs to reflect the part of the selected product beyond the agreed purchase volume, such as turning the procurement volume agreed in the above -mentioned product to 90%. Therefore, when the number of medical institutions, the agreed purchase base tends to expand appropriately.

2. The amount of drug medical insurance expenditure

After the selection of drugs and execution time in various provinces, the procurement volume and middle -election price of the selected products are determined, so the main factor affecting the amount of medical insurance expenditure in the collection of drugs is the amount of non -secondary products during the implementation of medical institutions during the implementation of the country. If a variety of categories of a medical institution wants to have balance reserves, the use amount of this variety is non -secondary products. The average price of the pre-mining of universal drugs-The purchase volume of the selected product agreed × the elected price.

When S is not = 0, the country's variety can obtain the maximum balance reserved amount; when S is not = S0, the balance of the balance of the country's variety is 0; when S0 is> S0, the country's variety balance balance is the balance of the variety of varieties. The reserved amount is negative, and the amount of reserved the balance of the varieties of other countries will be offset.

3. The proportion of residual reserves

The ratio of balance retention depends mainly on the assessment results of each designated medical institution and the determination of the balance of residual retention. The National Medical Insurance Bureau and the Ministry of Finance issued the "Guiding Opinions on the Research on the Research on the Basic Purchase of TCM Insurance Insurance funds for centralized procurement of Chinese medicine insurance" in June 2020. (See Table 1). It mainly evaluates the situation of medical institutions to implement the regulations of drug collection, reasonable control of drug costs, and implementation of reform policies. When formulating specific assessment plans for coordinating areas, the key indicators are not adjusted. The reference indicators can be adjusted according to the actual conditions of the provinces (autonomous regions, municipalities) or coordinated areas. The rights of various indicators are set by provinces (autonomous regions, municipalities) or coordinated areas. (1) Formulation of the assessment indicators of designated medical institutions.

Provincial (district, municipalities) or coordinated areas can choose reference indicators, determine the assessment method, and the weight of each assessment indicator according to the actual situation. When formulating policies, the competent authority needs to ensure that the calculated balance reserved amount is sufficient to motivate medical institutions, and at the same time will not cause a burden on the medical insurance fund. For the calculation of the scheme, select the most actual solution. The following mainly analyze the three indicators.

The first is the growth rate of drug expenses for medical institutions. The growth rate of drug expenses for designated medical institutions is a comparison of drug expenditures this year and drug expenditures of the previous year. Pharmaceutical costs for designated medical institutions are not only related to the price of drugs, but also related to the number of patients receiving patients. Compared with the "growth rate of the average drug cost of medical institutions", it can also objectively reflect the situation of reasonable control of drug costs. In addition, as people's lives are becoming more and more rich, the cost of drug costs also has its natural growth law. It may be that the growth rate of the average number of drug costs of medical institutions may increase than the previous year, but it is also lower than that of the city's medical institutions. Therefore, the two growth rates can be compared during the assessment. Deduades according to rules.

Second, the proportion of procurement and procurement amount is not the middle -elected product. There are two indicators in the assessment indicators of medical institutions involving non -secondary products, which are non -secondary product procurement proportion and non -secondary product procurement amount. Based on the residual reserved policy, the price of non -Chinese selected medicines that are lower than the selected drugs and the consistency evaluation is not included in the calculation. In the case of a certain amount of pharmaceutical procurement, the proportion of non -secondary products procurement accounts for a larger proportion than non -selected products, and it is easier to exceed the red line of non -secondary products. Then when choosing a reference indicator, the proportion of the purchase amount of non -secondary products in the assessment of medical institutions is more stringent than its purchasing volume.

(2) Analysis method of determining the proportion of residue.

According to the assessment results of fixed -point medical institutions, there are two main categories of residual retention ratio. First, the proportion of the same residual reserves of medical institutions with qualified medical institutions is given, that is, as long as the medical institution is passed, whether the medical institution has a 60 -point or 100 points, the balance of the balance is the same. The second is that the qualified medical institutions divide the level according to the specific assessment scores, and give different balance retention ratios according to different levels. The higher the evaluation score, the higher the balance of the balance (see Table 2).

In Table 2, compared with the plan, the second plan can also inspire medical institutions to complete the procurement volume of drug agreed in the country's selection of drugs on time, and better implement the national collection -related policies, get higher assessment scores, so as to win more High balance retention ratio.

4. Statistical scope of national categories

(1) Statistical scope difference.

When calculating the amount of balance reserves, it is found that the statistical scope of different national priced varieties will affect the calculation results of some medical institutions' assessment indicators and balance reserves. The scope of statistics is divided into two types in accordance with "whether the statistics have not agreed to procurement volume": one is only the national optical varieties that only have the agreed procurement of the medical institution; the other is all the national optical varieties purchased by the medical institution.

(2) The effect of statistical scope on the calculation of balance reserves.

When the assessment of medical institutions and the calculation amount of balance reserves, the scope of statistical scope of different types of types of national mining mainly affects the four factors of the residual reserved policy. First, the amount of non -secondary products in the calculation of the balance of the balance of the balance; the second is the 30 -day repayment rate of medical institutions in the evaluation indicators of the medical institution; the proportion of the procurement of the products in the third non -middle -elected product;

When calculating the balance of the balance, there is no "agreed procurement base" without agreed to the purchase volume, which also means that there is no "collection of drug medical insurance budgets". Therefore, as long as the non -secondary drug is purchased, the balance of the balance of the variety is negative, which will reduce the total balance reserved amount of the medical institution.

During the implementation of the National Cai, medical institutions are more concerned about varieties with agreed purchases, and the types of national pricking species without agreed purchases may appear in monitoring blind spots. Then, in the assessment of medical institutions, the possibility of not up to the evaluation of the use of non -secondary products is higher than that of the specified variety of procurement.

(3) Medical institutional response measures.

If the competent authority is calculated by the amount of residual reserves, all the national mining varieties purchased by the statistical medical institution indicate that the requirements for the implementation of the national collection policy for medical institutions are more stringent. There are two reasons: First, there is no agreed to purchase volume, there is no "integrated drug medical insurance fund budget", and medical institutions can only purchase products in the selection, otherwise it will reduce the balance of balance; The implementation of the implementation must also be monitored to the use of the national collection and non -secondary products that have no agreed purchasing volume. There are two ways to respond to the medical institutions: First, when the number of national varieties is reported, a reasonable amount of drugs that need to be purchased in the national mining cycle; the other is that when the national optical variety that needs to be purchased without the purchase volume is required, the selected varieties are given priority This also meets the implementation requirements of centralized national drugs.

Third, think and suggest

Based on the analysis of the above -mentioned residual reserved policy calculation formula and the evaluation indicators of medical institutions, the following thinking and suggestions are proposed for medical institutions and competent departments.

1. Medical institution

(1) Reasonable amount, appropriately enlarged.

First, the variety of reports should be as comprehensive as possible, covering as much as possible, as much as possible for the national mining varieties expected to be purchased. At present, medical institutions are mainly based on the historical procurement database of the national collection varieties. History has no purchase and the National Utinity cycle is expected to have no amount of reporting. If the amount is not reported, there is no medical insurance budget for this variety. As long as the non -secondary product is purchased, the balance reserves of the medical institution will be reduced. The second is to appropriately enlarge the amount of national variety references (that is, the agreed purchase base). The agreed purchase volume is the amount after the agreed quantity of the agreed purchase volume is converted according to a certain percentage. Medical institutions are selected for priority procurement during the collection of national collection. If the amount of reporting is accurate, the purchasing volume of the selected drugs is closer to the agreed purchase base, but the amount of task of excess completion is not available for balance. Therefore, medical institutions can appropriately amplify the amount of national variety report (agreed procurement base), so that the converted agreed purchase volume is closer to the procurement of the selected drugs. Pay attention to two points: First, accurately predict the procurement of the national procurement cycle; the other is that the number of Chinese elected enterprises can only be determined after the amount of reporting. Properly expand according to the proportion of the largest number of entrepreneurs in the middle school.

(2) Reduce non -secondary drug procurement.

In the process of implementing national drug collection, medical institutions should try to minimize the purchase of non -secondary drugs. First, in the assessment of medical institutions, the proportion of non -secondary purchases and procurement amounts is less than 50%. Second, when calculating the amount of balance reserves, the less the purchase amount of the non -selected drugs, the larger the amount of residual retention. If the amount is negative, the balance of the balance of the medical institution will be deducted.

(3) Do a good job of monitoring of Guobai.

It is recommended that medical institutions to comprehensively monitor all the selection of national collection varieties, not just varieties with agreed procurement. If all the varieties of national mining are incorporated in the calculation of the balance reserved reserves, then the varieties that have no agreed purchasing volume need to monitor the 30 -day repayment rate, non -secondary product use amount, non -secondary product procurement ratio and proportion of procurement volume and proportion of products procurement. The proportion of non -secondary products procurement.

2. The competent authority

(1) Determine the proportion of balance retention according to the assessment level.

When determining the proportion of residual reserves in the medical institution, it is recommended to divide the level level according to the score value of the medical institution, and give different balance reserves ratio. The higher the evaluation score of medical institutions in the implementation of the national drug collection, the greater the more residual reserves, and the more the amount reserved in balance obtained, which is also in line with the purpose of incentive guidance of the balance retention policy. In addition, according to the actual situation of the provinces (autonomous regions, municipalities) or coordinated areas, the proportion of medical institutions that qualify for the assessment can be approved. For example, areas where medical insurance funds are tight can be issued in accordance with a ratio of 30%; areas where medical insurance funds are sufficient or wants to greater inspiration to motivate medical institutions can issue balance reserves in balance at a ratio of 50%. However, this incentive method may not be as good as the incentive effect of giving the proportion of residues in grades.

(2) Prediction in advance, precise decision -making.

All provinces (autonomous regions, municipalities) may choose reference indicators, adjust the assessment method, and determine the weight weight of the index according to the actual situation. In order to enable the amount of reserves to be reserved, it can play a role in motivating medical institutions and will not have a burden on the medical insurance fund. It is recommended to calculate the residual reserves of different reference indicators, different assessment methods, and different indicators in advance. Provincial (autonomous region, municipalities) or coordinating regional actual situation residue plan.

Fourth, somewhat

In summary, the analysis of the residue retaining policy found that when the medical institution implements the national collection policy, it can increase the amount of medical insurance funds budget for medical insurance or reduce the amount of drug medical insurance expenditure in the use of non -Chinese selected drugs in order to obtain Higher balance reserved funds, thereby increasing the performance salary of medical staff, etc., and promoting the healthy development of hospitals.

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