Large expansion of the base drug directory: the quantity and the category A directory are comparable

With the advancement of the basic drug system to secondary and tertiary hospitals, the publication of the corresponding list of essential drugs has also been put on the urgent agenda.

The reporter learned from the national "two sessions" that are being held that the new edition of the basic medicine list is already under solicitation of opinions. It is expected that the expansion of basic medicines in the 307 countries will be doubled, including about 400 western medicines and 200 Chinese medicines.

However, the revision of the Essential Drug List has not yet been clearly defined as how to link up with the basic drug system that has been implemented at the grassroots level before, and how to ensure the use of these drugs in large hospitals and the corresponding compensation issues. Related to this, the controversy surrounding the basic drug system continues to continue.

Basic drug expansion

As early as November 2009, Xie Xiaoyu, Director of the Division of Essential Medicines of the Department of Pharmaceutical Administration of the Ministry of Health, disclosed on a forum that there are about 770 basic medicines used by public medical institutions at the county-level general hospitals and above, including chemical medicine and biology. There are about 580 pharmaceuticals and about 190 proprietary Chinese medicines.

Experts close to the decision-making level told the reporter that the above version was based on the WHO's recommendations, combined with the actual medication situation of large hospitals. "The number is roughly equivalent to the category of medical insurance."

According to the latest policy arrangements, the revised list of essential medicines will no longer distinguish between basic-level institutional versions and large-scale hospital versions. It also requires less than the original design. During the “two sessions,” the members of the National Committee of the Chinese People's Political Consultative Conference and Minister of Health Chen Biao disclosed. The upcoming list of new basic medicines mainly includes 400 western medicines recommended by WHO, and 200 Chinese medicines.

According to Chen Xi, on the basis of the first edition of the National Essential Drugs Catalogue issued in 2009, the new catalog summarized some additions with high usage rates based on the situation of drug additions in various regions. In addition, the first edition was mainly used for common diseases and there were no anti-cancer drugs. The 2012 edition added some specialty medicines. “The new 2012 edition is expected to cover medical institutions, including essential medicines in some large hospitals.”

According to calculations, the proportion of personal expenses in China's total health expenditure in 2010 has dropped to about 35%, which is equivalent to the current level in South Korea. This shows that the financial investment in health care has been considerable, and the level of protection of medical insurance in China has been low, indicating that the efficiency of financial subsidies is very low, and does not really make up for ordinary people. If basic medicines are to be pushed into large hospitals, the "zero margin" compensation fund that the government needs to invest will increase.

The aforementioned experts believe that the focus of public hospital reform this year will be on the county level, and 300 pilot sites will be launched. In conjunction with this, if the basic drug system is likely to follow the same path, the corresponding compensation liability will also fall on the county level. Finance. In the central government's system of “dividing stoves to eat” and the right to financial power are not matched, county-level financial pressure is actually very great.

“The larger the basic drug list, the more affordable the people can be, but can the compensation be able to keep up?” Yu Mingde, president of the China Pharmaceutical Enterprise Management Association, expressed doubts.

Operational dispute

At the time of the introduction of the national essential medicine system, it was proposed that the use of basic medicines in second and third-tier medical institutions should reach a certain percentage.

It is reported that the Ministry of Health is studying the proportion of the use of essential medicines in tertiary medical institutions, and has provided for the provisions in terms of equipment varieties and sales amounts. Its standards refer to the practice of Anhui Province to a considerable extent. For example, the number of basic medicines used in second- and third-level general hospitals must account for more than 95% and 80% of the total national basic medicine list.

As a result, essential medicines have both "ceiling" and "floor" properties at the grass-roots level and in large hospitals. The basic drug system, which was originally intended as the most basic drug use protection, was inappropriately given the burden of controlling the growth of medical expenses, completely deviating from the original intention of the system.

On the other hand, under the current distorting compensation mechanism, it is already an indisputable fact that public hospitals tend to use high-priced drugs, and forcibly setting the proportion of essential drugs may induce large hospitals to prescribe more “big prescriptions” to make them bigger. The cardinality approach is standard, and this move is often not easy to monitor.

It is reported that at the end of 2011, the Ministry of Health had organized expert seminars on continuing to promote the basic drug system. Many participants clearly expressed their opposition to this. One of them said bluntly: “The 12th Five-Year Plan for Medical Reform does not necessarily have to be continued”. Five 'period policy'.

As Beijing, Jiangsu, Shanghai and other developed provinces and cities have successively announced their accession, the introduction of the basic drug system to large hospitals is a matter of course. Experts in this regard suggested that instead of making rigid regulations, the proportion of reimbursement of essential medicines should be appropriately increased, and guidance should be given with medical insurance leverage.