The two ministries and commissions jointly issued the opinions on the supporting measures for the centralized procurement and use of high-value medical consumables (artificial joints) organized by the state
2022-03-31
In recent days, the State Medical Insurance Bureau will promote the centralized procurement of joint products and ensure the stable use of relevant products (hereinafter referred to as the "national medical insurance bureau") and the timely implementation of "centralized procurement of joint products", so as to ensure the stable supply of relevant products The general office of the National Health Commission jointly issued the opinions on supporting measures for the centralized procurement and use of high-value medical consumables (artificial joints) organized by the state (hereinafter referred to as the opinions). Standardize the work and price of product networking According to the opinions, the selected products of artificial joint centralized procurement (hereinafter referred to as "selected products") are linked to the network on the provincial pharmaceutical centralized procurement platform according to the selected prices of "including incidental service fee" and "excluding incidental service fee", and the relevant expenses such as distribution and special surgical tools are included in the selected prices. Accompanying services include providing compliant "follow-up" services, assisting in the assembly of tools, necessary tool use guidance, surgical operation training, etc. non-surgical personnel shall be strictly restricted from entering the operating room. Medical institutions choose whether to provide accompanying services according to the actual situation, and pay according to the corresponding price. Public medical institutions (including military medical institutions, the same below) uniformly charge according to the zero difference rate of the winning price including the accompanying service fee. The cleaning and disinfection of non special power tools and related tools shall be borne by the medical institutions, and the relevant expenses shall be included in the medical service fee. Medical institutions and third-party institutions shall not charge additional fees from the selected enterprises in the links of admission and inventory. If the non winning artificial joint products contain the parts of the winning product, the network shall be linked according to the winning price of the parts. For other parts, the network price high line can be reasonably set in combination with the actual transaction price. For products beyond the price high line, certain restrictions shall be imposed during the network, and relevant enterprises shall be guided to gradually adjust the price to a reasonable level. If the components of non selected artificial joint products are composed of different components of the selected products, the total price shall not be higher than the price of the selected products of the same category of the enterprise. Semi hip prosthesis and single condylar prosthesis products can refer to the successful prices of a full set of hip and knee products, and hang the net according to the principle of matching performance and price. Implement the prepayment policy of medical insurance fund The opinions pointed out that local medical insurance departments should timely organize medical institutions to sign purchase agreements with selected enterprises. Each overall planning area shall calculate the agreed purchase amount in time according to the selected price of the selected products, the purchased products and quantity agreed by the medical institutions and enterprises. Based on the total budget management of the medical insurance fund, a prepayment mechanism shall be established. After the medical institution signs the purchase agreement with the selected enterprise, the medical insurance fund shall be prepaid to the medical institution at no less than 30% of the annual agreed purchase amount. The medical institution shall settle the payment with the enterprise in time, and the settlement time shall not exceed the end of the next month when the consumables are used. Medical insurance agencies shall settle accounts with medical institutions in time and allocate medical insurance funds in time. On the premise of implementing the main responsibility of payment for goods in medical institutions, encourage medical insurance funds to settle directly with pharmaceutical enterprises. Do a good job in the connection of medical insurance payment policies The opinion points out that the selected products of artificial joint centralized purchase shall be paid according to the selected price including the accompanying service fee, which shall be included in the payment scope of medical insurance, and the medical insurance fund shall be paid according to the specified proportion. If the non winning artificial joint belongs to the payment scope of the medical insurance fund, all localities shall take measures to gradually adjust the payment standard within two years to not exceed the maximum winning price of the products selected in the same group. Insured patients use products whose price exceeds the payment standard of medical insurance, and the part exceeding the payment standard shall be paid by the patients themselves. All localities should give overall consideration to the setting of network price, self payment proportion of patients and medical insurance payment standard to avoid aggravating the cost burden of patients. Implement the balance retention policy and coordinate the price adjustment of medical services The opinions requires that all provincial medical insurance departments should guide the overall planning areas to improve the rules for the retention of medical insurance fund balance in accordance with the requirements of the guiding opinions on the centralized purchase and use of high-value medical consumables organized by the state (medical insurance Fa [2021] No. 31) and with reference to the relevant practices of the state for the retention of medical insurance fund balance in the centralized purchase of drugs. For regions where DRG / Dip payment is carried out, the weight score of the corresponding DRG / Dip group will not be adjusted in the first year, and the subsequent adjustment shall take into account the changes of labor cost and consumables cost, and increase or decrease scientifically and reasonably. All incentives should be well connected to avoid duplication. All localities should guide medical institutions to improve and implement the internal assessment methods for surplus retention, transmit the incentive policies to medical personnel, and encourage the rational, standardized and priority use of the selected products. According to the dynamic adjustment mechanism of medical service price, in 2022, the total amount of price adjustment can be inclined to the surgical items related to artificial joint replacement. In areas where the proportion of trans provincial patients with joint replacement is large, and the price of core projects such as "artificial joint replacement" is significantly lower than the national median price and the price of surrounding provinces, the price of relevant projects can be specially adjusted. If public medical institutions adopt intelligent systems such as "surgical robot" to assist surgical operation, they shall adhere to the principle of balancing labor value and equipment contribution, and matching charges with functions. According to the actual functions of the intelligent system, they shall increase charges by a certain proportion based on the price of "artificial joint replacement", and do not set up separate charging items. It is reported that due to the complex technical classification and combination of orthopaedic consumables, it is difficult to compete directly. It has been a difficulty in centralized procurement for a long time. The price is obviously high and the burden on patients is heavy. On September 14, 2021, the National Medical Insurance Bureau organized the centralized procurement of artificial joints. The average price of hip joints to be selected decreased from 35000 yuan to about 7000 yuan, and the average price of knee joints decreased from 32000 yuan to about 5000 yuan, with an average price reduction of 82%. Taking Hainan Province as an example, it was implemented on March 25 this year, with a total purchase of 3356 sets in the first year, and it is expected to save 70 million yuan of purchase funds per year. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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