Health Planning Commission： The average increase of total medical expenses in public hospitals must be below 10%.

　　BEIJING, May 11 (Xinhua) On the topic of comprehensive reform of public hospitals, Liang Wannian, full-time deputy director of the State Council Medical Reform Office and director of the Department of Physical Reform of the National Health and Family Planning Commission, said today that in order to effectively control the unreasonable growth of medical expenses in public hospitals, the average growth rate of total medical expenses in all public hospitals in China should be controlled below 10%.

　　Today, the National Health and Family Planning Commission held a special press conference in May. At the meeting, a reporter asked, in this year’s government work report, it is proposed to comprehensively push forward the comprehensive reform of public hospitals and require all public hospitals to cancel the drug addition. What are the specific requirements?

　　Liang Wannian said that it is a hard task for the medical reform in 2017 to comprehensively push forward the comprehensive reform of public hospitals, and all public hospitals will cancel the drug addition, which is also a clear requirement put forward in this year’s government work report. By the end of 2015, all county-level public hospitals had pushed forward the comprehensive reform of public hospitals. Of course, the reform was continuously deepened. By the end of 2016, 200 pilot cities across the country have carried out comprehensive reform of urban public hospitals, and the remaining 138 cities will all implement comprehensive reform this year. This year’s medical reform task has defined two points: first, before July 31 this year, all cities must come up with an implementation plan for comprehensive reform of urban public hospitals; Second, before September 30, all urban public hospitals in the country will cancel the drug addition (except Chinese herbal medicines), and now it is being promoted according to this schedule.

　　He pointed out that not long ago, the National Health and Family Planning Commission and other seven departments jointly issued a document, which put forward clear and specific requirements for comprehensively pushing forward the reform of public hospitals and completely canceling drug addition, and there were many quantitative regulations.

　　He said that the first is the issue of fee control. How to effectively control the unreasonable growth of medical expenses in public hospitals has put forward clear requirements, requiring that the average growth rate of total medical expenses in all public hospitals in China should be controlled below 10%. At the same time, all provinces and cities are required to decompose the indicators of cost growth into each city, and then each city should decompose the indicators of cost growth into each medical institution, and all localities are required to rank and report the cost growth of each medical institution and each place. The state will also supervise, rank and report the situation in various places.

　　The increase of expenses controls the total increase. In the past, we may be concerned about the increase of average outpatient expenses and hospitalization expenses, but the total cost of this transition to the region cannot exceed 10% compared with last year. However, each medical institution is different. Some medical institutions do have a large number of patients in this area, and there are also needs for development. They can be higher or lower. This is broken down by local authorities and the total amount is controlled at 10%. For example, if we do graded diagnosis and treatment now, we may hope that the growth rate of medical expenses in primary medical institutions will be higher, while the growth rate of medical expenses in large hospitals must be lower, and the overall balance will be below 10%. Therefore, the central government requires the province to break down the indicators according to different situations, and the provinces break down the indicators according to the conditions of different hospitals. We propose a total requirement of 10%, which further puts forward the requirement of cost control than in the past.

　　He stressed that, secondly, all drug additions should be abolished and comprehensive reform of public hospitals should be carried out. There are 44 hospitals affiliated to the National Health and Family Planning Commission, distributed in 11 cities, and there are 6 directly affiliated hospitals in state administration of traditional chinese medicine. At the same time, we have put forward requirements for these 50 hospitals under the management of the commission and directly under the management, and all of them must participate in the comprehensive reform of local public hospitals this year, and carry out the reform according to the relevant policies of local public hospital reform, including prices, medical insurance, compensation and so on. Shanghai and Tianjin have completed this kind of reform. This year, Beijing’s medical reform, 11 hospitals under the State Health Planning Commission and 6 directly under the State Administration of Traditional Chinese Medicine, a total of 17 hospitals all participated in the comprehensive reform in Beijing. Hospitals under the jurisdiction of the commission and directly under the jurisdiction must set an example and play a vanguard and exemplary role.

　　He pointed out that the first four batches of pilot cities for comprehensive reform of urban public hospitals were required. In 2010, there were 17 pilot cities, including Shanghai, Beijing, Shenzhen and Luoyang. By 2014, it will be expanded to 34 pilot cities, 100 pilot cities in 2015 and the fourth batch of 200 pilot cities in 2016. We also put forward specific requirements for the first four batches of pilot cities for comprehensive reform of urban public hospitals. For example, by the end of 2017, the proportion of drugs in public hospitals in the first four batches of 200 pilot cities (excluding Chinese herbal pieces) should be controlled at around 30%, and the cost of health materials consumed in the medical income of 100 yuan (excluding drug income) should be reduced to less than 20 yuan. The proportion of drugs is to control irrational drug use, and the cost of consumables for medical income of 100 yuan mainly controls the irrational use of high-value consumables. In addition, the reform of payment methods will be carried out. In the first four batches of 200 pilot cities, the payment methods will be reformed, and the number of diseases will not be less than 100. There are also requirements for informatization, requiring at least 60% of primary medical institutions to establish telemedicine information systems with higher-level hospitals, and implement information communication to provide information basis for the construction of medical associations, telemedicine and counterpart support. At the same time, the proportion of appointment referral in the pilot cities that require reform should reach more than 20% in the outpatient visits of public hospitals.

　　Liang Wannian said that the county-level public hospitals have all pushed forward the reform in 2015, but the reform is on the way, and it is not said that the reform has been completed. We have put forward some specific requirements for the reform of county-level public hospitals that has been pushed forward. For example, the reform of payment methods requires that this year, the reform of compound payment methods, which is mainly based on disease-based payment and coexistence of multiple payment methods, be comprehensively promoted. The core problem is to greatly reduce the current post-payment system of project-based payment, and change it into payment by disease, payment by head and payment by bed day, including DRGs. In addition, it is necessary to further optimize the charging structure of county-level public hospitals, so as to further reduce the proportion of pharmaceutical consumables and further increase the proportion of labor technology prices. Therefore, it is still necessary to increase efforts in "changing cages for birds".

　　He further pointed out that in order to further promote the reform of county-level public hospitals, the state has selected one county in four provinces and cities, namely, Anhui, Jiangsu, Fujian and Qinghai, as demonstration counties for the comprehensive reform of county-level public hospitals, such as Tianchang in Anhui, Youxi in Fujian, Huzhu in Qinghai and Qidong in Jiangsu. This year, we asked all provinces to do demonstrations, and asked each province to have a national demonstration to strengthen the leading role of demonstration in a wider scope.

　　In addition, in the reform of urban public hospitals, we also require all provinces to choose corresponding cities to demonstrate the reform of urban public hospitals. On this basis, the state will select some cities as the national demonstration of urban public hospitals, with the aim of giving play to the leading role of demonstration and giving play to the enthusiasm of the central and local governments. At the same time, local governments are encouraged to explore and innovate boldly to overcome some obstacles and policy bottlenecks in the reform of institutional mechanisms, so that the effectiveness of our reform can really benefit the people in a wider range as soon as possible.