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January 2 National Health Commission releases first document of the year

Release date: 2020-01-03 Views: 0

Source: Cypress Blue  

On January 2nd, the first document of the National Health and Medical Commission in 2020 was issued-"Regulations on the Management of Internal Price Behavior of Medical Institutions". This year-heavy document was implemented from the date of its release.

In a notice, the National Health and Medical Commission stated that in order to strengthen the management of internal price behavior in medical institutions, promote the reform and development of health services, and safeguard the legitimate rights and interests of patients and medical institutions, the “Regulations on the Management of Internal Price Behavior in Medical Institutions” have been studied and formulated.

This regulation applies to all types of public medical institutions at all levels, and non-public medical institutions can also refer to the implementation; internal price behavior management of medical institutions refers to the price behavior of medical service items, drugs, and medical consumables that occur in the medical institution's diagnosis and treatment activities. Internal management.

Dean is responsible for hospital price management

The main person in charge of the medical institution is responsible for the internal management of the price behavior of the unit. The price management department of a medical institution shall specifically organize the internal price behavior management of the unit.

In addition, medical institutions should establish a medical institution price management system composed of medical institution leaders, medical management departments, price management departments, clinical departments, and procurement and supply of medical materials, and scientifically manage and reasonably monitor the cost of medical services to improve the quality of price management. .

Medical institutions shall set up price management committees. The members of the committee shall be headed by the medical institution, the price management department and the financial, medical, nursing, medical insurance, information, pharmaceutical, material management, medical technology, quality control, equipment, discipline inspection and supervision departments. The person in charge is responsible for the leadership, organization and decision-making of the whole hospital's price management work.

Medical institutions should strengthen the construction of internal price management departments. The third-level medical institution shall clearly identify the department responsible for internal price management, and shall be headed and supervised by the hospital; the second-level medical institution shall define the price management responsibilities in the relevant functional departments.

The third-level medical institutions shall be provided with 3-5 medical service price staff; the second-level and below medical institutions shall be provided with 1-3 medical service price staff. Each medical institution can appropriately increase or decrease the number of personnel according to the size of the institution and the amount of medical services. Each business department (department) has a part-time medical service staff, and each department (department or ward) has at least one staff.

Regularly check patient expenses and correct irregular fees

According to the regulations, the main duties of full-time staff for medical service prices are:

(1) Establish the concept of rule of law, carry out price management work in accordance with the law in accordance with and in compliance with the "Price Law of the People's Republic of China" and related laws, regulations and policies, master various policies on price management, grasp standards, strictly implement and operate;

(2) Internally manage the price behavior of medical institutions, be familiar with the connotation of each price item, organize and coordinate with relevant departments to scientifically and reasonably estimate the cost of medical service items, and propose suggestions and measures to improve management, reduce costs and increase efficiency;

(3) Participating in the bidding, procurement, and price negotiation of drugs, medical equipment, and medical consumables, as well as the fee demonstration and review of new technologies and new therapies before entering medical institutions;

(4) Participating in the price negotiation of medical insurance fund payment items and disease types;

(5) Cost calculation and price review of new medical service price items and new diseases (including disease diagnosis related groups, hereinafter referred to as DRG) at medical institutions, put forward price recommendations, and submit approval for existing items in accordance with prescribed procedures. Price adjustment for approval;

(6) Calculate the cost of medical service price items and medical institution preparations that have been implemented at market-adjusted prices, put forward price recommendations, and ask the price management committee to discuss and confirm the implementation and supervision;

(7) Strictly implement the pharmaceutical price policies and regulations, and timely adjust the price (including public price) standards of the price management system of medical institutions in accordance with changes in government medical service price policies;

(8) Guiding clinical and medical technology departments to correctly implement the price policy for medicines;

(9) Regularly check the expenses of outpatient (emergency) and inpatients, and report the results to the department to promptly correct irregular charging behavior;

(10) Receiving consultations on medical service price management, handling complaints related to medical service prices, writing complaint analysis reports for valid complaints, and putting forward rectification opinions;

(11) Regularly investigate and organize relevant business departments to discuss practical problems in price management of medical institutions and make suggestions;

(12) Provide price policy (business) guidance and training to part-time medical service price staff;

(13) Cooperate with relevant departments to conduct medical service price inspections;

(14) Complete various medical service cost and price-related investigations and statistics assigned by the competent authority, and provide true and reliable data for adjusting medical service price policies;

(15) Do other matters related to price management.

Hospital to establish price publicity system

For medical institutions, regulations require them to establish medical service cost measurement and cost control management systems, and on the basis of continuously improving medical institution and department cost accounting, establish and improve medical service project cost measurement systems. Medical institutions shall closely monitor changes in the cost and income structure of medical services, and proactively put forward suggestions and suggestions to the relevant departments to adjust the prices of medical services.

In accordance with the relevant regulations on price management of medical service items, medicines, and medical consumables, and under the premise of ensuring medical quality, a scientific management mechanism for cost control is established, and charges are scientifically standardized through pre-control, site control, and feedback control.

Medical institutions shall establish a price adjustment management system for medical services, ensure the strict implementation of medical service price policies, establish a smooth price adjustment notification process, and promptly adjust or notify relevant departments to adjust medical service prices.

Medical institutions shall establish a new medical service price item management system, and adhere to the technical standards of new medical service price items in accordance with the "Administrative Measures for the Clinical Application of Medical Technology" (National Health and Health Commission Order No. 1) and other relevant management regulations. The principle of entry (permission) is first, and the establishment and price declaration of new medical service price items are carried out. Standardize the internal review process for new medical service price items. After the price item of the new medical service is reviewed and verified by the price management committee of the medical institution, it can be reported to the provincial health and health administrative department for confirmation in accordance with the technical specifications of the medical service price item before the price can be declared.

Medical institutions shall establish a price publicity system. Medical institutions can use the agency's official website, electronic touch screen, electronic display, bulletin board, bulletin board, price list and other methods to publicly display the prices of commonly used medical services, medicines, and medical consumables at prominent locations of service places to ensure the patient's right to inquiry and knowledge When the price changes, the content of the announcement shall be adjusted in time. The price consultation and complaint telephone number of the unit shall be announced at a prominent place in the service place.

Medical institutions should establish an expense list (including electronic list) system to provide patients with medical services, medicines, medical consumables and other expense lists (except disease types and DRGs) in various forms, and provide printing services when patients need them. The main contents of the expense list should include: medical service items, names and codes of medicines, medical consumables, unit prices, pricing units, use dates, quantities, amounts, etc.

Medical institutions shall establish a self-examination system for medical service prices. The price management department randomly selects hospital records and discharge medical records and expense lists according to a certain percentage of the number of discharged patients for examination and records. Timely correct irregular charging behaviors, put forward rectification suggestions and inform relevant departments and personnel and incorporate them into monthly (quarterly) performance assessment management.

Medical institutions should establish a price complaint management system and implement a first-in-quest responsibility system. The person receiving the complaint shall record the content of the complaint, the results of the complaint, the rectification measures and the implementation. For a valid complaint letter transferred from a superior department to a medical institution, there should be a settlement report and rectification measures.

Medical institutions shall establish a price management reward and punishment system with clear rewards and penalties, and incorporate price management into the annual target assessment of medical institutions as an important indicator of department performance evaluation.

Medical institutions shall establish a file management system for medical service price policy documents, and shall keep special files on the medical service price policy documents. The basic data such as the basic data, expert opinions, related suggestions, and minutes of internal discussions in the process of price management of medical services must be kept in a complete record and kept in special volumes.

At the end of the regulation, public medical institutions at all levels must establish and improve the price management system and system of their own units in accordance with their business characteristics and actual conditions.

In addition, the above provisions will be implemented from the date of publication. The Interim Provisions on the Management of Internal Prices of Medical Institutions issued by the former Ministry of Health and the State Administration of Traditional Chinese Medicine (Wei Cai Cai Fa [2011] No. 32) shall be repealed simultaneously.

Regulations on the Administration of Internal Price Behavior of Medical Institutions

Chapter I General Provisions

The first is to regulate the charging behavior of medical institutions, strengthen the management of internal price behavior of medical institutions, promote the reform and development of health services, and safeguard the legitimate rights and interests of patients and medical institutions. Opinions on the Reform of the Medical and Health System, the Development and Reform Commission and other departments of the "Notice on Printing and Distributing Opinions on the Reform of the Price Formation Mechanism of Drugs and Medical Services" (Faikai [2009] No. 2844) and "Notice" (Fax Reform Price [2016] No. 1431) and other relevant policies and regulations, combined with the characteristics of medical service price management, formulated these regulations.

Article 2 These regulations apply to all types of public medical institutions at all levels, and non-public medical institutions may refer to them for implementation.

Article 3 The internal price behavior management of medical institutions in these regulations refers to the internal management of price behaviors such as medical service items, drugs, and medical consumables that occur in the medical institution's diagnosis and treatment activities.

Article 4 The main person in charge of a medical institution shall be responsible for the internal management of the price behavior of the unit. The price management department of a medical institution shall specifically organize the internal price behavior management of the unit.

Article 5 In accordance with relevant national regulations, local health and administrative departments at the county level and above (including the competent department of traditional Chinese medicine, the same below) guide, evaluate and inspect the price management of government medical institutions in their jurisdictions in accordance with these regulations. Other public medical institutions shall be guided, evaluated and inspected by the organizer with reference to these regulations.

Chapter II Organization

Article 6 Medical institutions shall establish a price management system for medical institutions consisting of medical institutions in charge of leadership, medical management departments, price management departments, clinical departments, and procurement of medical supplies, etc., to scientifically manage and reasonably monitor the cost of medical services and improve price management. quality.

Medical institutions shall set up price management committees. The members of the committee shall be headed by the medical institution, the price management department and the financial, medical, nursing, medical insurance, information, pharmaceutical, material management, medical technology, quality control, equipment, discipline inspection and supervision departments. The person in charge is responsible for the leadership, organization and decision-making of the whole hospital's price management work.

Article 7 Medical institutions shall strengthen the construction of internal price management departments. The third-level medical institution shall clearly identify the department responsible for internal price management, and shall be headed and supervised by the hospital; the second-level medical institution shall define the price management responsibilities in the relevant functional departments.

The third-level medical institutions shall be provided with 3-5 medical service price staff; the second-level and below medical institutions shall be provided with 1-3 medical service price staff. Each medical institution can appropriately increase or decrease the number of personnel according to the size of the institution and the amount of medical services. Each business department (department) has a part-time medical service staff, and each department (department or ward) has at least one staff.

Article 8 Basic requirements for full-time medical service staff:

(1) Be able to correctly understand, master and implement the price policy of medical services, and carry out price management in accordance with the law;

(2) Master basic knowledge of medical service price management, understand related business knowledge of health, accounting, economics, management, etc., and be familiar with the connotation and main cost components of medical service price projects carried out by business departments;

(3) Have good communication and coordination skills, and be able to properly handle consultations and complaints in terms of internal price management of the institution;

(IV) Able to adhere to the principle of work, do a good job in propaganda and interpretation of price policies in accordance with relevant provisions of medical service price management, guide clinical and medical technology departments to correctly implement medical service price policies, and check the implementation of various departments, which is not standard for medical institutions Charging behavior is corrected;

(5) Possessing a junior title or above, and receiving industry professional training every year.

Chapter III Institutional Functions and Post Duties

Article 9 The main functions of the price management committee of medical institutions:

(1) Conscientiously implement relevant pharmaceutical price policies and regulations to achieve standardized, scientific and institutionalized management;

(2) To study and formulate the internal price management system, business processes, evaluation indicators, rewards and punishment standards of medical institutions, and organize the implementation;

(3) Organizing, implementing and managing the whole process of declaration, adjustment, publicity, implementation, verification, assessment, and evaluation of prices of medical institutions;

(4) Convening a price management work meeting in a timely manner to regulate and control the price management of medical institutions based on the work deployment guidance of relevant departments and coordinating related work progress.

Article 10 The main functions (or duties) of the price management department (or full-time medical service price staff) of a medical institution:

(1) Establish the concept of rule of law, carry out price management work in accordance with the law in accordance with and in compliance with the "Price Law of the People's Republic of China" and related laws, regulations and policies, master various policies on price management, grasp standards, strictly implement and operate;

(2) Internally manage the price behavior of medical institutions, be familiar with the connotation of each price item, organize and coordinate with relevant departments to scientifically and reasonably estimate the cost of medical service items, and propose suggestions and measures to improve management, reduce costs and increase efficiency;

(3) Participating in the bidding, procurement, and price negotiation of drugs, medical equipment, and medical consumables, as well as the fee demonstration and review of new technologies and new therapies before entering medical institutions;

(4) Participating in the price negotiation of medical insurance fund payment items and disease types;

(5) Cost calculation and price review of new medical service price items and new diseases (including disease diagnosis related groups, hereinafter referred to as DRG) at medical institutions, put forward price recommendations, and submit approval for existing items in accordance with prescribed procedures. Price adjustment for approval;

(6) Calculate the cost of medical service price items and medical institution preparations that have been implemented at market-adjusted prices, put forward price recommendations, and ask the price management committee to discuss and confirm the implementation and supervision;

(7) Strictly implement the pharmaceutical price policies and regulations, and timely adjust the price (including public price) standards of the price management system of medical institutions in accordance with changes in government medical service price policies;

(8) Guiding clinical and medical technology departments to correctly implement the price policy for medicines;

(9) Regularly check the expenses of outpatient (emergency) and inpatients, and report the results to the department to promptly correct irregular charging behavior;

(10) Receiving consultations on medical service price management, handling complaints related to medical service prices, writing complaint analysis reports for valid complaints, and putting forward rectification opinions;

(11) Regularly investigate and organize relevant business departments to discuss practical problems in price management of medical institutions and make suggestions;

(12) Provide price policy (business) guidance and training to part-time medical service price staff;

(13) Cooperate with relevant departments to conduct medical service price inspections;

(14) Complete various medical service cost and price-related investigations and statistics assigned by the competent authority, and provide true and reliable data for adjusting medical service price policies;

(15) Do other matters related to price management.

Article 11 The main duties of part-time medical service staff:

(1) Receive training on medical service price knowledge, be familiar with medical service price policies and regulations, and publicize and implement the institution's price management system;

(2) Cooperate with the price management department of this institution to accept the medical service price check of the relevant department;

(3) Put forward proposals for price management work, apply to the price management department of this institution for the new medical service price items to be launched and the medical service price items to be phased out, and provide basic information;

(4) Assisting the price management department of this institution to do a good job in price management, publicity and explanation of medical service price policy for undergraduate departments;

(5) Assist the price management department of this institution to handle the consultation and complaints of medical service prices of the undergraduate department;

(6) Responsible for the self-inspection and correction of the price behavior of the interior of the undergraduate, timely correct the irregular charging behavior, and establish a long-term mechanism for internal inspection;

(7) Accept regular assessment by the price management department of this institution.

Chapter IV Management System

Article 12 Medical institutions shall establish medical service cost measurement and cost control management systems, and on the basis of continuously improving medical institution and department cost accounting, establish and improve medical service project cost measurement systems. Medical institutions shall closely monitor changes in the cost and income structure of medical services, and proactively put forward suggestions and suggestions to the relevant departments to adjust the prices of medical services.

In accordance with the relevant regulations on price management of medical service items, medicines, and medical consumables, and under the premise of ensuring medical quality, a scientific management mechanism for cost control is established, and charges are scientifically standardized through pre-control, on-site control, and feedback control.

Article 13 Medical institutions shall establish a price adjustment management system for medical services, ensure strict implementation of medical service price policies, establish a smooth price adjustment notification process, and promptly adjust or notify relevant departments to adjust medical service prices.

Article 14 Medical institutions shall establish a price management system for newly added medical services, and adhere to the new medical service prices in accordance with the "Administrative Measures for the Clinical Application of Medical Technology" (National Health and Health Commission Order No. 1) and other relevant management regulations. The project is based on the principle of technology access (licensing), and the establishment of new medical service price projects and price declaration are carried out. Standardize the internal review process for new medical service price items. After the price item of the new medical service is reviewed and verified by the price management committee of the medical institution, it can be reported to the provincial health and health administrative department for confirmation in accordance with the technical specifications of the medical service price item before the price can be declared.

Article 15 Medical institutions shall establish a price publicity system. Medical institutions can use the agency's official website, electronic touch screen, electronic display, bulletin board, bulletin board, price list and other methods to publicly display the prices of commonly used medical services, medicines, and medical consumables at prominent locations of service places to ensure the patient's right to inquiry and knowledge When the price changes, the content of the announcement shall be adjusted in time. The price consultation and complaint telephone number of the unit shall be announced at a prominent place in the service place.

Article 16 Medical institutions shall establish an expense list (including electronic list) system to provide patients with medical services, medicines, medical consumables and other expense lists (except disease types and DRGs) in various forms, and provide printing services when patients need them . The main contents of the expense list should include: medical service items, names and codes of medicines, medical consumables, unit prices, pricing units, use dates, quantities, amounts, etc.

Article 17 Medical institutions shall establish a self-examination system for medical service prices. The price management department randomly selects hospital records and discharge medical records and expense lists according to a certain percentage of the number of discharged patients for examination and records. Timely correct irregular charging behaviors, put forward rectification suggestions and inform relevant departments and personnel and incorporate them into monthly (quarterly) performance assessment management.

Article 18 Medical institutions shall establish a price complaint management system and implement a system of first-in-quest responsibility. The person receiving the complaint shall record the content of the complaint, the results of the complaint, the rectification measures and the implementation. For a valid complaint letter transferred from a superior department to a medical institution, there should be a settlement report and rectification measures.

Article 19 Medical institutions shall establish a price management reward and punishment system with clear rewards and penalties, and incorporate price management into the annual target assessment of medical institutions as an important indicator of department performance evaluation.

Article 20 Medical institutions shall establish a file management system for medical service price policy documents, and shall keep special files on medical service price policy documents. The basic data such as the basic data, expert opinions, related suggestions, and minutes of internal discussions in the process of price management of medical services must be kept in a complete record and kept in a special volume.

Chapter V Information Management

Article 21 Medical institutions shall establish and improve the information management system for price management, clarify the responsibilities and authorities of relevant departments and positions, and ensure the accuracy, completeness, standardization and safety of software system operation and maintenance data.

Article 22 When a medical institution adjusts the price of medical services, the system must have an adjustment record. It is necessary to strengthen the control of modification permissions and modification traces during data processing.

Article 23 Medical institutions shall strengthen the management of electronic information archives of medical service prices, including the storage, backup and custody of electronic files.

Chapter VI Supervision Inspection

Article 24. Local health and administrative departments at or above the county level shall perform quality control on the price management of medical institutions, and formulate evaluation standards for price management of medical institutions according to the specific conditions of each place.

Article 25 Local health and administrative departments at or above the county level shall establish a system of accountability for the price management of medical institutions, report violations of price management regulations and deal with them in accordance with relevant regulations.

Article 26 Medical institutions shall consciously accept social supervision, hire social compulsory supervisors, and give play to the role of external supervision and management.

Chapter VII Supplementary Provisions

Article 27. Provincial health and administrative departments shall formulate specific implementation rules in accordance with relevant national laws and regulations and these regulations, in combination with local conditions.

Medical institutions shall combine their business characteristics and actual conditions to establish and improve their own price management systems and systems.

Article 28 These Regulations shall become effective on the date of promulgation. The Interim Provisions on the Management of Internal Prices of Medical Institutions issued by the former Ministry of Health and the State Administration of Traditional Chinese Medicine (Wei Cai Cai Fa [2011] No. 32) shall be repealed simultaneously.

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