Medical network May 11 - along with our country reform into deep waters, and coordination to promote health, health care, medicine, linkage (i.e., "3 d linkage") reform has gradually gain the consensus, and become the present and future a period of national health priority. In fact, from the top-level design level, the national top also repeatedly stressed that the reform of "3 d linkage", is the people's livelihood, or a political issue, but also economic problems. 

 

Despite the interest game is complex, but around in "3 d linkage" reform and innovation in window, the comprehensive reform model of fujian sanming bright eye, the new farming and serious illness insurance mode of anhui and Shanghai family doctor signing has outstanding representative and so on. Behind the development of regionalization and personalized health reform, the core of the "three-doctor linkage" is becoming clear that health care is the nose of health care reform. The area of health reform has not been a central leverage in the rational allocation of health care and medical resources. In fact, the health care reform is change ", is both the main experience of the developed countries in the world medical health reform, also is the present our country comprehensively deepen reform one of the important subjects need to face. 

 

Third, the central role of medicare 

 

From the policy level, in January 2016, the state council issued "on the opinions of the integration of urban and rural residents basic medical insurance system", formally put forward to promote urban residents medical insurance and new farming and system integration; In June 2016, people club department issued by the "about promoting instructional advice on the reform of medical treatment, health care, medical linkage", is people club department to promote "three medical linkage" clearly, the first articles and health care were established in the core position in the "3 d linkage". The author thinks that this is the inevitable result of the combination of urban and rural health insurance and the proportion of medical expenses paid. "After the joining together of two bao", health care coverage, financing policy, to ensure treatment, catalog merge, designated on the management, fund management, "six reunification", combined with the management on most of the provinces with clear right after the "joining together of two insurance" in the social sector, largely promoted people club department in the health care reform. 

 

On May 5, 2017, the state council general office issued by the deepening medical and health system reform in 2017 key task "(countries do hair [2017] no. 37), in addition to further clarify the nationwide payment push health-care reform, deepen medical expenses regulation, also put forward pilot can set up the medical insurance fund management center, around the bear funds payment and management, medicines procurement and payment, payment standard, designated agency agreement management and billing and other functions. This is a country to reform the "fujian model" affirmation, is also in the reform of "3 d linkage" further intensified, health care and medicine, medical linkage in the future, health care deeply embedded drug procurement, negotiation and use will be the trend of The Times. 

 

Health insurance is typically involved in drug procurement 

 

On April 10, 2017, gansu province development planning commission, one club hall 7 departments jointly issued by the implementation of medical procurement and healthcare linkage work implementation opinion ", clear will be paid to develop health care reform and drug procurement, hierarchical diagnosis and treatment of the key links such as "3 d linkage" measures, become another innovation of health and medicine, medical linkage. Before this, existing in fujian, anhui, zhejiang, tianjin, chongqing and other provinces and cities to medicare lever and the organic combination of drug purchase, the health care in different degree of involvement in drug purchase link. 

 

 

 

Health insurance and drug adoption trends are expected 

 

The chart above shows the typical pattern of healthcare payments affecting drug purchases, but the impact varies. Fujian is deeply involved in the procurement, payment and settlement of pharmaceutical products in the form of centralized health insurance, and the most important part of the procurement of medical insurance intervention. As recently the province the pharmaceutical joint limit sunlight procurement directory (first batch) and health care the highest selling price and payment settlement price ", combined with the area union bargaining a wave hit, manufacturers are facing price and share of the game will be more complex anxiety. Tianjin health of drug purchase involvement is higher also, gathering the national linkage, the lowest price and the price that it can be seen from the city health annual focus. Anhui and zhejiang similar, all is based on the national minimum price adjustment of medical insurance payment reference price, but the health of dominant of drug purchase were not as good as tianjin, fujian province, the role of the health care is more like guarantee the lowest price for passive payment, and to a certain extent in order to protect the medical. Chongqing, which is dominated by a shortage of medicines by the health care sector, has taken a big step forward in its procurement model, which has already taken the lead and multi-sector approach. Is use small province, gansu province, but its "3 d linkage" determination and actions have to be reckoned with, from the above files can be concluded that the health of drug purchase linkage degree is higher, coupled with the recent reform policy frequent release, gansu has a multi-pronged, combination of reform. 

 

From the above table, we can see that the dynamic adjustment and low price linkage of medicare payment standard have become the "regulation action" for medical participation in drug procurement. In fact, a tightening in the medical insurance funds and the cost of the people's livelihood pressure, lower drug prices has become an important breakthrough of health reform, therefore, by the hospital as the main body, dynamic adjusting medicare pay bargaining the measure standard, may also be generalized in the future. Bargaining enthusiasm, in addition, to encourage the hospital "balance reward retention" almost become a provincial health care payment policy, a necessary option, but the thorough analysis, the hospital successfully get a "balance" often face several rounds before the game, in fujian province as an example, the hospital to balance, must choose the lowest price in competitive species, but faces curative effect cannot guarantee, increase the embarrassment of doctor-patient contradiction, or the use of competition, and there will be a burden on patients. More importantly, based on the total amount of medical insurance for most hospitals in the budget more extensive management system, therefore, save medicare and bargaining to get the total which is more "cost-effective" still need to balance according to the actual operation of medical institutions comprehensive account. 

 

To sum up, with the vast majority of provinces "two unity", health level as a whole from cities as a whole may be implemented as the provincial plan as a whole, largest payer health-care as medicine and health care costs, leading to participate in drug centralized purchasing has its natural policy and theoretical basis. Numerous health reform practices have also repeatedly shown that the true role of the "three doctors" is inseparable from the main role of health care. Therefore, as the provincial 2017 medicare catalog supplement, as well as varieties of health talks further expansion, the future health care deeply embedded drug purchase would be the trend of The Times. "(author mou qiong is a researcher at the institute of strategic development in Shanghai.)