How to adjust the doctor's salary?"Price change" is ongoing

For medical professionals for reading reference

For price reform, the supplier of medical services is "not suffering from unevenness."

In August last year, the National Medical Insurance Bureau answered the reporter in the "Pilot Plan for Deepening the Price of Medical Service" that the medical expenses space for consolidating price reduction should first release the reform dividends to the people to enhance the people's sense of gain and happiness of the people. sense.

The reduction of the cost reduction has reduced the burden of ordinary people, and has won the window for reform for medical services. When the reform potential energy continues to accumulate, the pilot of deepening medical service price reform has also entered the stage of kinetic energy. How to transmit reform dividends to the majority of medical staff?

Recently, when answering the suggestions of the people's congress representatives, the National Medical Insurance Bureau proposed that it will further guide localities to implement the dynamic adjustment mechanism of medical services. While taking into account the burden of patient costs, it will better reflect the value of technical labor.

Hot focus: How is the preparation of "price reform" progress?

On August 31, 2021, eight departments such as the State Medical Insurance Bureau and other eight departments issued the "Pilot Program for Deepening the Price Reform of Medical Services", which clearly explained the 3-5-year pilot to explore the formation of recalled and promoted medical service price reform experience. In November of the same year, the list of five pilot cities was announced.

From the end of 2021 to June this year, the five pilot cities of Leshan, Ganzhou, Suzhou, Xiamen, and Tangshan successively released the implementation plan for the reform of medical services. From the perspective of the specific plan announced by pilot cities, the establishment of total control, classification pricing, dynamic adjustment and other mechanisms are the main content of the first round of medical service price adjustment.

At the level of total regulation, Ganzhou City uses the city's public medical institutions in 2021 (not includes medical income of drugs, consumables, inspections, and testing income) as historical bases. During 2022-2025 The total amount is controlled at a level of 10%of the historical base.

At the level of classified pricing, the Suzhou plan mentioned that for universal projects, the analysis of the cost of service elements will determine a reasonable price benchmark; for complex projects, hospitals and doctors will propose professional opinions and suggestions to participate in government guidance prices; For special -demand and new projects, the hospital is priced autonomously.

At the level of dynamic adjustment, the Ganzhou plan proposes that for universal projects, in principle, a dynamic adjustment evaluation is carried out every year; for complex projects, regular scores of medical expenses growth rate and service income ratio of public medical institutions are regularly scored. When the starting range is reached, the dynamic adjustment is triggers.

In addition to the main content of price adjustment, the five pilot cities have clearly clarified the reform timeline, operating rules and related supporting policies.

Key analysis: Why is the salary of doctors highlighting?

Zhang Xiao, director of the Medical Insurance and Social Security Research Center of Southeast University, said in an interview with First Financial and Economics that there are structural problems in my country's medical prices.

On August 31st last year, the relevant person in charge of the Medical Insurance Bureau told the media that professional investigation reports showed that the average annual cash salary of public hospitals was higher than the average salary of employees in urban units.

In this regard, Jin Chunlin, director of the Shanghai Health and Healthy Development Research Center, said that the income of doctors in tertiary hospitals is indeed not low, especially in the third -level hospitals of large cities, but this is generally based on the excess working hours of "996" or even "007" Essence In addition, the current medical price is unreasonable for regional and project comparison relationships. Take nursing fees as an example. Many hospitals have only 100 yuan a day, which must be low, but the hospital itself lacks evidence.

Zhong Chongming, a researcher at the Medical Insurance Payment Research Center of the China Medical and Health and Culture Association, told the "medical community" that the reform of medical services price reform is a more direct and directional policy compared to the reform of medical insurance payment methods, but the supplier of medical services has been long for a long time. The contradictions are continuously intensified in the crickets of the price of medical services.

my country has not yet formed the pricing mechanism of medical service projects centered on technical labor value, risk, and technical difficulty. After the cancellation of drug additional income, the operating income of public hospitals has been impacted. The price is seriously deviated from the cost of project and the value of technical personnel.

In January 2017, with the consent of the State Council, the Ministry of Human Resources and Social Security led the pilot work of the paying system reform of the public hospital to study and improve the salary system of public hospitals that adapt to the characteristics of the medical and health industry. In June 2021, the Executive Meeting of the State Council reviewed and approved the "Guiding Opinions on Deepening the Reform of the Public Hospital's Remuneration System", clarified the establishment of a reasonable internal distribution mechanism, and tilted to key positions and core personnel.

Zhong Chongming told the "medical community" that "price reform" is a "treatment list management" for medical suppliers. Object.

Difficulty to solve: How to determine the value of technical labor services?

Xu Shuqiang, the director of the Department of Reform of the State Health and Health Commission, previously disclosed that for large -scale high -level hospitals as high -quality development pilots in public hospitals, technical service income accounted for the proportion of medical income. The "Fifteenth Five -Year Plan" period strives to reach about 60%.

When the National Medical Insurance Bureau responded to the reporter's question recently, the price adjustment of medical services should highlight the support for the value of technical labor services. Public opinion on all parties is paying attention to, the focus of technical labor is clear, how to operate.

Jin Chunlin said that it is necessary to increase the support of technical labor services. First of all, it is necessary to determine how much the technical and labor service value is worth it to allocate each service item. If this is not sure, others will become empty talks. How to determine the specific technical labor value? "The technical value is biased towards the qualitative, and the value of labor is biased towards the right. Both must consider the dimensions of cost composition, operation of supply and demand." Zhong Chongming pointed out.

Taking the first round of pilot cities Xiamen as an example, in December 2020, Xiamen upgraded the price of 15 items such as medical personnel's technical labor value, including general outpatient consultation fees, traditional Chinese medicine syndrome discrimination fees, and the increase in some of the medical services. Payment scope, while lowering the price of 26 large -scale instrument and equipment such as the X -ray computer body layer (CT) flat sweeping and magnetic resonance (MRI) flat sweeping, further optimizing the income structure of medical institutions.

Zhong Chongming told the "medical community" that the process of determining the specific labor value is relatively complicated. It is necessary to refer to the labor prices of the division of labor in other industries in the society and the consumer price index. The across region tolerable price levels float range. However, the overall direction is relatively clear, that is, the adjusted results should promote the development of labor value, and it is conducive to supplementing the shortcomings of the general supply of the majority of patients.

Some people in the industry mentioned that the price of medical services in the past has always emphasized the total amount of control, but the new medical price reform has a certain growth requirement for the medical and health cause itself.

The resistance of price reform is very obvious. This resistance manifests that patients are worried that they are more expensive to see a doctor, and the supplier of medical services "does not suffer from unevenness". Policy makers, especially the policy makers in the local coordinating area, may also hesitate. "Conflict will definitely have it, but you must adhere to the confidence and principles of reform." Zhong Chongming bluntly said.

The price is the "bull nose" of the entire medical reform. The price reform of the medical service service is not only a economic compensation mechanism for hospitals and medical staff. It is more important. It is to form an orientation for the allocation of sanitary resources and rationally use. Jin Chunlin pointed out.

Source: medical tank in the medical world

Author: Wang Xiao

School pair: Zang Hengjia

Editor: Wang Hang

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