In the joint examination of medical insurance, public security and health care, the medical experts drew out a copy of the prescription in the problem data, which was judged to be an unreasonable prescription. Experts explain that the normative name "compound sulfamethoxazole" should be used.
The Measures for the Administration of Prescriptions stipulate that "physicians shall use the generic name of the drug approved and published by the drug supervision and management department, the patented drug name of the new active compound and the drug name of the compound preparation" when prescribing prescriptions. Although the measures also indicate that "physicians can prescribe using the customary names of drugs published by the Ministry of Health", in fact the health department has never published the "list of customary names of drugs". Irregular names such as customary names and trade names of drugs have in fact been eliminated and must not be used when prescribing.
The agency's behavior does not comply with the relevant regulations. However, inspectors have different opinions on whether the medical insurance department should refuse to pay the costs arising from irregular prescriptions.
This article argues that the costs incurred by unreasonable prescriptions cannot be generalized and should be analyzed on a case-by-case basis.
The "Hospital Prescription Review Management Code" divides unreasonable prescriptions into irregular prescriptions, unsuitable prescriptions for medications, and extraordinary prescriptions.
The "Specification for Prescription Review of Medical Institutions" proposes that prescription review includes legality review, normative audit and suitability audit.
Prescriptions that have not passed the normative review are judged to be irregular prescriptions, and most of them have no direct causal relationship with the illegal use of the fund. Those who fail to pass the legality review and are judged to be abnormal prescriptions are generally related to the irrational use and waste of the fund.
Call on the medical insurance joint health department to classify the unreasonable prescription situation, divided into two categories related to the illegal expenditure of the fund and unrelated to the illegal expenditure of the fund, and issue a directory for grass-roots implementation. Only in this way can we prevent disputes and stop disputes and fundamentally solve this problem that plagues the grassroots.