Both of them worked in the hospital, but the hospital gave their salaries to their wives.
"Anyway, the two are one family, not separated." Xiang Daxiong, director of the Institute of Clinical Pharmacy of Central South University and director of the Hunan Provincial Research Center for Translational Medicine and Innovative Drug Engineering Technology, used this to compare the allocation of pharmacists and physicians in medical service fees.
For a long time, China's recognition criteria for the economic value of pharmacists have been very vague.
On April 13, under the guidance of the National Medical Security Bureau, the Notice of the Fujian Provincial Medical Insurance Bureau on the Trial Implementation of the Charging Policy for Pharmaceutical Services in Provincial Public Hospitals (hereinafter referred to as the "Notice") was made public, clarifying the price list of pharmaceutical medical service items in public hospitals, setting prices for 16 clinical pharmacy services, and implementing them for one year from July 1, 2022.
"It can be said that it is a refinement of clinical pharmacy services, setting a clear scope for these services." Kang Zhen, a professor at the School of Basic Medicine and Clinical Pharmacy of China Pharmaceutical University, told the health community that pharmaceutical services will move towards the "era of standardization" from now on.
"This is a major local breakthrough that should have a demonstration effect on the whole country and a positive effect on promoting the charging of pharmaceutical services nationwide." To Nobita to the health community.
"Pharmacy services are allowed to be charged, but there is a lack of mechanisms for pharmacists to reduce irrational use of drugs and control the growth of drug costs, which will most likely lead to an increase in the burden on patients and an increase in the expenditure of medical insurance funds." Wang Hongzhi, a senior partner at Peking University's Zongheng Management Consulting Group, said he was concerned that "pay-per-project" could lead to excessive pharmacists.
In addition, he believes that in order to establish a check and balance relationship between the doctor's prescription and the pharmacist's prescription, the pharmacist should "find fault" for the doctor and correct the doctor's unreasonable prescription.
"Charges" for pharmaceutical services are blocked
As early as 2009, the "Opinions on Deepening the Reform of the Medical and Health System" proposed that the drug bonus should be gradually reformed or abolished through measures such as increasing the price of drug purchase and sales, setting up pharmaceutical service fees and increasing government input.
However, the implementation of pharmaceutical service fees has not been smooth.
Fujian Sanming, known for its "cage for birds", increased the pharmaceutical service fee as early as 2018, which was fully borne by the medical insurance fund, and increased the charging standard in February 2021:
The city's second-level and above public hospitals will increase the Western medicine pharmaceutical service fee (outpatient), from 10 yuan per person to 15 yuan per person in tertiary hospitals and 13 yuan per person in secondary hospitals;
The cost of inpatient pharmaceutical services is adjusted from 30 yuan per person to 50 yuan per person in tertiary hospitals and 45 yuan per person in secondary hospitals.
"This kind of 'pay per head' may lead to under-service, and it is impossible to confirm whether the pharmacist provides the service." Wang Hongzhi told the health community.
Except for the pilot in a few areas of Sanming, Fujian Province, the pharmaceutical service fee has not been smoothly implemented nationwide.
As an innovation, Beijing and other places have explored medical service fees to include pharmaceutical service fees.
But Xiang Daxiong's feeling is: "Because there is no clear charge for pharmaceutical services, the hospital also believes that this has not made a direct income generation."
Professional value will not be continuously recognized without the blessing of economic value.
"In recent years, the ranks of pharmacists have weakened, and grass-roots hospitals have not been able to retain pharmacists, and a large number of pharmacists have been lost." This phenomenon described to Nobita is enough to confirm the above view.
"For the same service, the price of the top three hospitals is higher"
"Considering that the charging policy for pharmaceutical services is related to the vital interests of the people, the charging policy is a more complex and sensitive issue. At present, the existing technical specifications and evaluation standards of pharmacy services in our province are not perfect, the content and service methods of pharmacy services are still relatively general, the number of clinical pharmacists is not sufficient, the system of comprehensively supporting the direct provision of pharmacy services for patients alone has not yet been formed, and the sense of identity and acquisition of patient experience services needs to be further enhanced." The Fujian Provincial Medical Insurance Bureau said in the policy interpretation, therefore, the first trial exploration of the pharmaceutical service charging policy is limited to provincial public hospitals, and does not include traditional Chinese medicine treatment.
The promulgation of the Notice has changed the ambiguity of the items and standards of pharmacy service fees. According to the Notice, pharmacists who meet the required qualifications are pharmacists with intermediate or above professional and technical qualifications and have been engaged in clinical pharmacy work for 3 years or more.
The Notice stipulates that it is necessary to prevent price items with insufficient service content and the nature of "head fee" and "threshold fee". For the matters that should be fulfilled by hospitals such as traditional prescription review and adjustment, as well as service matters that belong to the internal management of hospital pharmacies, when designing policies, it is clearly considered as the comprehensive operating costs of public hospitals, and medical service price items are not set up separately.
"This time, Fujian for the first time clearly defined medical insurance to pay for pharmaceutical services, which can be said to be good news for all pharmacists, and undoubtedly injected a shot of strengthening agents into the construction of the pharmacist team and the development of related businesses." Kang Zhen said.
"But not anyone can charge for any service." Zhao Ning, deputy director of Peking University First Hospital, mentioned to the health community that the Notice makes clear requirements on what kind of qualifications people carry out what kind of services, how to evaluate, and how to charge fees.
"The service must be evaluated for pricing." Zhao Ning said.
It is worth mentioning that the Notice divides two criteria in pricing: the top three and the bottom three. Among the 16 clinical pharmacy service items, the prices of serum drug concentration determination, humoral antibiotic concentration determination, various types of drug abuse screening, drug sensitivity testing, and genetic testing for medication guidance are higher than those of the top three.
"The same service, the price of the big hospital is higher, the talent is running to the big hospital, the development of the grass-roots hospital will be more difficult." Kang Zhen believes that the pricing of pharmaceutical service fees should be at least the same price, and even the proportion of state subsidies should be inclined to grass-roots hospitals to promote their development.
The "Notice" also stipulates that the price of multidisciplinary comprehensive outpatient clinics should reflect the technical content of medical services and the degree of medical risk, take into account market supply and demand, comprehensively consider the masses and the level of local economic and social development and other factors determined by medical institutions independently, and maintain the price relatively stable in a certain period of time, the price adjustment cycle is not less than 6 months, the one-time increase shall not be higher than 20%, and the downward adjustment is not limited.
In any case, the 16 services are like a compass, "whether it is the study of school students or the training of pharmacists after they enter the workforce, they can be targeted." Zhao Ning said.
When the career positioning is clear, it will be followed by a series of access criteria, service capability assessments, etc. According to Daxiong's research, a series of supporting policies will be introduced in the follow-up. With the implementation of the policy, Xiang Daxiong believes that the positioning of pharmacists will be clearer, and the development of the pharmacist team will usher in a small climax.
Will it bring over-service?
In the midst of the cheers, some people raised doubts.
"Pharmacy services are allowed to be charged, but there is a lack of mechanisms for pharmacists to reduce irrational use of drugs and control the growth of drug costs, which will most likely lead to an increase in the burden on patients and an increase in the expenditure of medical insurance funds." Wang Hongzhi mentioned.
If we compare the reform of China's medical insurance system from "pay by head", "pay by project", and now "pay by disease/group (DRG/DIP)" path, the pharmaceutical charging system is moving from the "pay by head" of the pharmaceutical service fee in Sanming City to the "pay by the project" of the current pharmaceutical service fee.
"'Pay per head' can lead to under-service, while 'pay-per-project' now can lead to over-service and incentivize pharmacists to provide more services." Wang Hongzhi analyzed that whether it is DRG or DIP, one of the purposes of the current medical insurance payment reform is to change the drawbacks of "pay by head" and "pay by project".
In order to achieve the separation of medicine, it is far from enough to separate the doctor's prescription responsibility and the pharmacist's prescription responsibility professionally, and it is necessary to further separate the interests.
"There must be checks and balances between doctors' prescriptions and pharmacists' prescriptions." Wang Hongzhi further explained that pharmacists should "find fault" for doctors, whether from a professional point of view or from the perspective of interests, to correct the unreasonable prescriptions of doctors.
Wang Hongzhi believes that it is not enough to pay for pharmaceutical services, and it is urgent to establish a similar drug welfare management (PBM) system, so that pharmacists are responsible for the total drug cost and can profit from the savings. PBM, a third-party service in the medical service system, reviews the doctor's prescription through a large number of clinical data and personal medication history, and controls excessive medical treatment and drug abuse while supervising medical services, so as to play a role in controlling medical costs.
Compared with Wang Hongzhi's concerns, Xiang Daxiong's attitude is more optimistic, "We can't expect one document to solve all problems, and solving problems in development is the most important."
What Xiang Daxiong cares about is that once there is policy support, the exploration of the pharmaceutical service charging system in various places will have courage and confidence.
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Written by | Yang Ruijing Guhui