Research To The "Drug Proportion" Control Policy On Price Management For Medical Services

With the improvement of public health awareness,the cost of healthcare in China is increasing,and the financial burden of medical aid is much more heavier.There has been heated discussion on "difficult to see a doctor,expensive to see a doctor" in people's daily life in recent years,and it is also one of the important issues regarding the reform of medical system.Medical charges generally include the cost of drugs,materials,surgeries and other costs incurred in the process of seeking medical services.Among these,the drug cost has always been high.The fact is not only that the drug price is high,but also that some doctors are used to prescribe "big Prescriptions",and from time to time people complain that it costs tens of thousands of yuan to cure a cold.Some studies show that in 2015,the proportion of drug revenue is 39% of the total medical revenue of Chinese hospitals,which is far higher than the average percentage of the OECD member countries by 20%.The high cost of medicine not only aggravates the conflict between doctors and patients,but also leads to the chaotic management of the medical market,which is not conducive concerning the long-term development of China's medical and health undertakings.Facing high medical charges,the state will control the "drug proportion" index as part of the assessment of public hospitals.In 2015,the guiding opinions on comprehensive reform pilot of urban public hospitals clearly required that by 2017,the proportion of drugs in public hospitals in the pilot cities should be reduced to about 30%(excluding Chinese herbal pieces).Public hospitals have been taking varied measures to reduce the proportion of drugs,such as dynamic monitoring of drugs,prescription drug reviews,classified management of antimicrobial use,etc.According to data,the proportion of drugs did decline.By the end of June 2017,the proportion of drugs in public hospitals in Wenzhou City was 36.02%,decreased 4.57% year on year;the proportion of drugs in public hospitals at county level was 41.79%,2.4% lower year on year,but the overall drug expenditure was increasing.Moreover,in response to the need of "drug proportion" control,some hospitals reduced the purchase and supply of inelastic demand drugs,while increased the optional medical examination.The treatment of some patients was even delayed;conversely the burden of patients' medical treatment was increased.The policy effect has been deviated from the original intention.Therefore,it is necessary to research the control policy of "drug proportion".On the basis of summarizing the domestic and foreign literature on drug price control,this article takes the "drug ratio" control policy as a starting point to look at the problem of "medicine-based medical care" mechanism which is difficult to be broken,and combs the background and status of the drug ratio control policy in order to understand the health care reform behind the policy and the current medical fee system,and to explore the starting point of the control policy for the proportion of medicines.From the outset,irrational medical service charges have led medical institutions to over-reliance on drug sales,and dependence on drug sales has led to the burden of medical insurance funds.Further,excessive burden on the medical insurance fund have caused the medical insurance management department to restrict the hospital's medication quota.After understanding the reasons and backgrounds,the micro policy was put into the macro environment for investigation,taking the changes in Zhejiang Province's drug share data as a reference,and combining the actual situation of different hospitals,tracking the path of "drug proportion" indicators from formulation to hospital implementation in order to explain how the hospital responds to the "drug proportion" control policy,and then change the doctor's medical care behavior.Game psychology is applied to explains the change in the interest relationship between doctors and patients under the drug-proportioning control policy,which illustrates how doctors' decisions change,and indicates how the policy will ultimately affect pilot hospitals and patients.Combined with the characteristics of the drug proportion indicator itself and the characteristics of the large-scale environment for medical service charges,look for factors that affect the final effect of the drug share control policy,including the special attributes of medicines brought about by the special nature of medical services,and the defect areas of the medical fee system.The ineffectiveness of drug supervision in the coming years has been found as the reason for violating various price limit policies in the process of drug circulation,increasing prices continuously,and the difficulty of implementing the drug ratio policy.A series of improvement measures were proposed to address the shortcomings of the drug-proportion control policy,including optimizing policy plans,providing policy environment support,and implementing process supervision.The medical and health system is a complex and huge system.The control of the proportion of medicines can play a certain role in reducing the price of medicines and rational use of medicines.However,it is necessary to consider more rationally planned specific policy content,grasp the details and carefully demonstrate in order to achieve the expected results.For the negative effects of policies,we need to make bold assumptions and carefully verify them.When considering,we must combine other supporting policies to avoid conflicts that can offset the effect of the policy.We also need to weigh the advantages and disadvantages to really help the health care reform and solve the "expensive medical treatment" problem from the root,in order to bring benefits to the masses.Through discussions on the control policies for the proportion of medicines,we can also see the shortcomings of other policies,and pay attention to them.From a multi-faceted and multi-angle perspective,we can improve the policy.From the perspective of the entire medical system,it is conducive to the implementation of various policies to achieve the effect of 1 + 1> 2.