Private Medical Institutions Free Pricing Challenges**

Recently, a survey released by the Institute of Public Policy of the Institute of Economics of the Chinese Academy of Social Sciences revealed that there are prominent contradictions in many pilot regions of the new medical reform: In many reforms of the medical insurance payment methods promoted, the total amount of prepaid medical insurance has finally become total control. Including the control of medical expenses, the allocation of medical resources and other due effects have not been fully realized.

One of the reasons for the conclusion is that the price of medical services has not been let go. Under this premise, whether it is a total amount of prepaid or other payment methods, eventually evolved into a form of payment based on service items. With many efforts, not only has the service prices for non-public medical institutions been liberalized, but non-public medical institutions have also been incorporated into the medical insurance payment system to operate. Then, what are the challenges faced by the Medicare payment method for the ever-changing free pricing system?

He Jiming:

Private hospitals welcome "late love"

Opening prices is a “late love” for non-medical institutions because many private hospitals have long been doing this. Now, this is just normalizing and legalizing this practice, but this legalization has changed the The behavior is crucial.

He Jiming, deputy director of the Guangzhou Municipal Medical Insurance Bureau, said that everyone recognizes the drawbacks of “doing things with medicine”, but not everyone wants to change. The good news is that the medical insurance department, pharmaceutical companies, etc. are all changing in different ways. The appearance of those bad behaviors must have its inevitability. It is easy to find the reasons from the comparison of some economic mechanisms.

Specific to the payment of medical insurance, this is a complex multiple payment system. Payments by project must be the most scientific, easiest, and most accurate payment method, whether it is now or in the future. Although the current implementation will have twists and turns, the future payment by project will be the most valuable way.

In recent years, the development of private hospital business is very fast, and many developments in Guangzhou are good. Of course, there are also a few that are not very good. This part of the private sector is often ulterior motives. It only advertises without real strength.

At present, the focus of private hospital treatment is mainly: First, sequelae of cerebrovascular disease; Second, coronary intervention; Third, pulmonary infection. From the perspective of the medical insurance settlement of these three medical services, the total number of services provided by private and public hospitals is relatively close, but the total amount of medical expenses varies greatly.

He Jiming said that Guangzhou uses a project-based fee, the general out-patient for chronic diseases has a limit of 150 yuan, and the general out-patient clinic has a limit of 300 yuan. The closer the final settlement total cost is, the more it shows how much it can be reported. medicine. It stands to reason that doctors should be treated according to the disease, the result is to see more money to prescribe medicine.

He said that private hospitals responded strongly after liberalizing prices. It is hoped that the limit of self-pay rate will be liberalized; hope that the price paid for medical insurance can be clearly crossed, certain high-price inspections and drug risk lines will be set, and the excess will be paid by the patient; hope that the average limit will be based on basic medical expenses, and then pay proportionately. .

Liu Junshuai:

Institutional changes change fate

Non-public medical institutions have entered the Qingdao medical service market for more than 20 years and have not shown much improvement. The medical insurance department forcibly intervened ten years ago, but the result has driven the development of private hospitals. The overall scale has greatly improved. Of course, some deep-seated problems have not been resolved.

After medical insurance access is completely liberalized, the benefits of medical insurance management will be very prominent. However, the capital is highly profitable, the economic attributes are heavy, the concept of short-term arbitrage is outstanding, and the moral hazard is high. In particular, out-of-office management may not be possible. Physicians and patients may join forces.

Liu Junshuai, director of the Qingdao Municipal Social Security Bureau, pointed out that the development of non-public medical institutions is basically to adapt to the diversification of service needs, but the diversification of the payment system after price liberalization is a challenge to medical insurance. Total control can easily lead to the consolidation of benefits. Medicare should respond to the total control of non-public hospitals in the early stages of development and adopt a payment system that is more flexible to the scale of the business.

“What we are doing now is how to break the current pattern of interests and minimize the unfair treatment of non-public hospitals.” Liu Junshuai bluntly stated that there are two aspects of the medical insurance department to do enough and must be strengthened. First, to establish an open system, this should be done without any control. Second, market-led positioning creates private hospitals that can compete with public hospitals.

He pointed out that there are several key points in the development of non-public hospitals: including diversification and equalization, but also to grasp the two elements of talent and capital. The shortage of talent is the biggest shortfall in the development of non-public hospitals. This is the result of the distortion of the talent management system. Capital investment does not need to be considered for public hospitals, but non-public hospitals must guarantee follow-up support.

In the final analysis, the release of non-public medical institutions and the liberalization of medical insurance qualifications really opened the curtain for medical reform. In fact, public hospital reform has a set of plans. However, the current conditions are not mature. By supporting non-public medical institutions, it is in fact a way to save the country through curves.

If there is no private capital for the development of non-public medical institutions, it will be difficult for China's medical service market to undergo a qualitative change. At the same time, the impact of marketization factors such as efficiency and fairness on non-public medical institutions will gradually deepen. Efficiency and fairness are the current medical conditions in China. What is lacking in the service industry is also an element of reform that is urgently needed and dependent on the development of medical insurance.

Zhang Lin:

The share of commercial insurance is too small to have the right to speak

In 2013, Medicare plus NCMS was 1.2 trillion yuan, and all commercial insurance agencies added together 120 billion yuan, almost 10% of the former. All health insurance may be only 5%, accounting for about 1% of the income of a large hospital. “So, when we talked to the hospital, the hospitals were too lazy to do it because the contribution to the hospital was too small.”

Talking about the reform of private hospitals, Zhang Lin, deputy general manager of Ping An Pension Insurance, believes that China is still far from such a stage. There are many potential challenges and problems in the era of universal health care. With the acceleration of aging, medical expenses in many cities have risen rapidly, but the level of funding for Medicare continues to decline.

At the same time, we also see that 90% of medical insurance costs are placed on government agencies and there is no incentive to increase the efficiency of cost control. Of course, the advantage lies in the guarantee of public welfare. It may be more fair than the commercial insurance company, but there are still institutional constraints on the effectiveness.

He pointed out that commercial insurance and medical insurance should have a clearer position. The medical insurance department should be basic and then handed over to the market through a variety of ways. The state has clearly stated that commercial insurance is a supplement to basic medical insurance.

Zhang Lin believes that opening up is the process of the social system's social development. There are three aspects worth exploring.

First, after the major illness insurance, gradually opening up new market space; secondly, from the perspective of services, many project medical insurance institutions and the New Rural Cooperatives cannot do it because the mechanism cannot keep up; Third, the purchase services are diversified and enriched. Manage resources.

People's demands for services are getting higher and higher, and there are many demands on the resources that are handled. However, if medical insurance thinks that more cooperation is needed in handling resources, commercial insurance is very willing to support the development of the pharmaceutical industry. Commercial insurance is complementary to some medical insurance agencies in the country, not competition.

Finally, he called for information sharing. Only the sharing of information can boost the development of the market. The experience of medical reforms in the United States tells us that in order to achieve sharing between medical insurance, we can take in-depth cooperation. With the advancement and opening of national policies, this area will become a very important market.