Deepening the price reform of medical services is an important measure to promote the coordinated development of high-quality medical security and medical services. On August 31, eight departments including the National Medical Insurance Administration, National Health Commission, and National Development and Reform Commission jointly issued the “Pilot Plan for Deepening Medical Service Price Reform.”
The overall idea of the “Pilot Plan for Deepening the Reform of Medical Service Prices” adheres to the people’s health as the center, the clinical value as the guide, and the development laws of the medical industry as the basis, and establishes and improves the medical service price formation mechanism that adapts to economic and social development, better plays the role of the government, fully participates in medical institutions, and embodies the value of technical labor services. system, adhere to the public welfare nature of public medical institutions, establish a reasonable compensation mechanism, mobilize the enthusiasm of medical personnel, promote the innovative development of medical services, improve the quality and level of medical and health services for the people, control the people’s medical expense burden, and ensure that the people receive high-quality, efficient, and affordable medical and health services.
The “Pilot Plan” clearly explores the establishment and improvement of five major mechanisms:
The first is a more sustainable total volume control mechanism. The main purpose is to coordinate and grasp the total amount, structure and frequency of price adjustments to achieve a controllable rhythm and a balanced structure. Priority should be given to strengthening the macro management of medical service prices, so that the macro level of prices matches macro factors such as medical development, social affordability, and regional development differences, and balances the needs of medical development and the affordability of all parties.
The second is a standardized and orderly price classification formation mechanism. Among them, general projects commonly carried out by hospitals have a high degree of homogenization and have a great impact on the overall price level. The government needs to strengthen the role of big data and control price benchmarks; complex projects with large differences in difficulty need to build a governance structure led by the government and involving multiple parties. The government “manages the total volume, sets the rules, and serves as the referee.” Public hospitals form prices within the given total volume and rules, which not only leverages the professional advantages of public hospitals, but also guides public hospitals to strengthen internal refined management.
The third is a sensitive and measured dynamic price adjustment mechanism. The dynamic adjustment mechanism is an important part of the medical service price management system and the key link between macro management and micro pricing. Specifically, it is necessary to establish the triggering mechanism for price adjustment of medical services. There must be rules to follow under which circumstances it can be adjusted and under what circumstances it cannot be adjusted. Comprehensively consider factors such as social and economic development, hospital reform performance, medical insurance, and patient affordability, and sensitively and appropriately grasp the price adjustment window and pace to stabilize price expectations.
The fourth is a target-oriented price project management mechanism. The price item is the basic unit of medical service charging. A good price project must be able to adapt to and support the development of clinical innovation, have relatively standardized and stable connotations, and meet the needs of management, monitoring, and evaluation. The reform direction proposed in the “Pilot Plan” is to be service output-oriented, focus on technical labor services, and gradually form a medical service price project system with better pricing, better execution, better evaluation, and better adaptability to clinical diagnosis and treatment and price management needs.
The fifth is a strict and efficient price monitoring and assessment mechanism. The price monitoring and assessment mechanism is an important guarantee for the smooth implementation of the reform pilot. It is necessary to strengthen the evaluation of the operation of medical service price reform, give full play to the incentive and constraint role of monitoring and assessment evaluation results, and promote the formation of a policy closed loop between the total volume regulation, classification formation and dynamic adjustment of medical service prices, so as to form a positive interactive relationship between price management and hospital operations.
The “Pilot Plan” also requires that it is necessary to optimize the allocation of medical service price management authority, improve the rules and procedures for formulating and adjusting medical service prices, strengthen the construction of medical service price management capabilities, improve the support system for medical service price management, and coordinate and promote related reforms such as public hospital compensation mechanisms, hierarchical diagnosis and treatment, medical expense control, and medical insurance payment, and enhance the systematicness, integrity, and synergy of the reform to form a comprehensive effect.
Finally, the “Pilot Plan” clarifies that the National Medical Insurance Administration will work with relevant departments to select 5 pilot cities, contact them directly for guidance, and actively and steadily advance in an orderly manner; other provinces with conditions can also organize cities divided into districts to carry out pilot projects according to local conditions in accordance with the requirements of the “Pilot Plan” to form reform experience that can be replicated and promoted.