On July 15, the Shanghai Municipal Health Commission and the Administration of Traditional Chinese Medicine issued the "Shanghai Municipality's Key Action Plan for Deepening Medical Reform (2020-2022)", which documented plans for consumable management and centralized procurement.

　　▍Change point 1: The scope of centralized procurement of consumables will be expanded, and public hospitals will operate a new mechanism

The notice pointed out that by 2022, substantial progress will be made in the reform of the supply side of medical services, the scope of centralized procurement of pharmaceutical consumables will be further expanded, the compensation mechanism for public hospitals will be further optimized, and the medical and prevention coordination mechanism will be improved. Under the framework of the total budget, the “four in one” (DRG , Big data types of diseases, pay per bed per day, pay per capita) multiple compound medical insurance payment models have basically achieved full coverage.

　　▍Change point 2: Primary medical care will be the focus, and the medical consortium will be rolled out

The notice pointed out that focusing on the grass-roots level, focusing on prevention, and combining prevention and treatment; using medical consortia as a link, establishing a division of labor and collaboration mechanism for medical institutions, and accelerating the construction of a hierarchical diagnosis and treatment system; vigorously developing smart medical care through innovation in technology, models, and processes. Plastic medical and health management and service model.

　　▍Change point 3: Medical insurance, medical treatment, medicine linkage, use of consumables price space

　　In the future, we will continue to adhere to the three-medicine linkage. Promote the integration of medical insurance, medical and pharmaceutical linkage reform systems, strengthen policy and management coordination, use the price reduction space after centralized procurement of pharmaceutical consumables, improve the dynamic adjustment mechanism of medical service prices, optimize the performance compensation system of public hospitals, and improve the public welfare operating mechanism of public medical institutions .

　　▍Change point 4: New medical institutions to respond to emergencies

　　 The notice pointed out: The major public health emergency management system and mechanism will be improved. Accelerate the realization of standardized, standardized, and homogeneous management of infectious disease source detection and the construction of standardized equipment, and build a tertiary infectious disease covering comprehensive medical institutions (including Chinese medicine medical institutions) and pediatric, obstetrics and gynecology, psychiatric and other specialized medical institutions Treatment system. Improve the medical treatment cost guarantee mechanism for major epidemics, and ensure that medical institutions treat first and charge later when an epidemic occurs.

　　▍Change point 5: Quantity procurement will be reformed, and quality will be the focus

　　 The notice pointed out that the reform of centralized drug procurement will be deepened. Actively undertake the daily work of the national joint procurement organization, take the lead in implementing the results of the national organization of centralized drug procurement and supporting measures, and play a demonstrative and leading role. Implementing the retention of medical insurance fund balances for centralized procurement of varieties, and further increasing the enthusiasm of medical institutions and medical personnel to participate in the reform.

　　 Speed up the construction of the information traceability system, implement the traceability of the whole process for the winning bidders, and realize the quality supervision of the whole cycle of production, circulation and use.

　　▍Change point 6: There will be a trial of bargaining procurement, and there will be opportunities if the bid is not won

　　The plan pointed out that it will encourage and promote the trial of centralized drug procurement through bargaining. Encourage public medical institutions to carry out centralized bargaining purchases of drugs that are not included in the centralized procurement in the form of medical consortia, single or voluntary procurement alliances, etc., as an effective supplement to centralized procurement of drugs. Improve the scale effect of bargaining on the Internet.

　　▍Change point 7: Encourage third parties to participate in procurement to prevent monopoly

　　The plan pointed out that a sound incentive mechanism will be established to retain the balance of the medical insurance funds for the trial implementation of centralized bargaining drugs, and the participation and implementation of medical institutions will be included in the performance appraisal. Strengthen supervision and management, adhere to sunshine procurement, ensure the benefit of patients, and ensure quality and supply. Encourage and regulate the participation of third-party centralized drug procurement organizations to prevent monopoly and form industry standards for fair competition.

　　▍Change point 8: Reduce the price of high-value consumables and increase sampling

　　 Steadily promote the centralized procurement of high-value medical consumables. Adhere to the principle of "quantity-for-price, categorized procurement, comprehensive bidding, payment coordination, and three-medicine linkage", with small incisions and paths, and steadily promoting the centralized procurement of high-value medical consumables on the basis of pilot trials. Focus on meeting reasonable clinical needs, giving play to the role of market mechanisms, transparent workflow rules, and effectively reducing the falsely high prices of high-value medical consumables.

Establish and improve the incentive and supervision mechanism, coordinate the promotion of medical insurance payment standards, disease-based payment, medical service item price management, etc.; incorporate the implementation of medical institutions into performance assessment, standardize medical service behavior; conduct full life cycle supervision of selected products, and increase Sampling inspections in mass production and distribution links ensure product quality.

　　▍Change point 9: Establish price and credit evaluation system

　　 Establish a credit evaluation system for medicine prices and recruitment and procurement. Relying on the pharmaceutical procurement sunshine platform and implementing national requirements, the system integrates mechanisms such as trustworthy commitments, credit rating, graded disposal, and credit restoration, and establishes a pharmaceutical price and tender procurement credit evaluation system with equal power and responsibility, coordination and linkage, and promotes the honesty and trustworthiness of all parties. Work together to create a fair, standardized, and upright circulation order and trading environment to effectively protect the interests of the people and the safety of medical insurance funds.

　　▍Change point 10: High-value consumables catalog management, department procurement is strictly prohibited

　　 Improve the supervision of the use of pharmaceutical consumables. Increase the use of consumables to ensure effective results. Strengthen the management and standardization of drug catalogs in medical institutions, promote timely adjustment and optimization of drug catalogs in medical institutions, and establish a comprehensive monitoring mechanism for key drugs by the end of December 2020. Standardize and strengthen pharmaceutical management.

Take high-value medical consumables with a relatively high proportion of unit price and resource consumption as the key management objects, consolidate the results of the special management reform of high-value medical consumables, standardize the catalog management of high-value medical consumables, strengthen surgical management involving high-value medical consumables, and establish high-value medical consumables. It is worthy of the admission selection mechanism for medical consumables in the hospital, and it is strictly forbidden for departments to purchase by themselves.

　　▍Change point 11: Improve the price of medical devices, and new devices should be put into clinical application as soon as possible

　　 Improve the price management of newly-added medical service items and medical equipment with additional charges. Improve the collective review system for prices of new projects. Establish standardized and standardized review procedures and pricing rules to improve the efficiency of collective review work. Improve the expert review system for new projects and the health economics evaluation system to further improve the scientific and standard nature of pricing.

　　 Improve the dynamic adjustment mechanism of the medical device catalog with additional charges, and promote the clinical application of new technologies and new devices in medical services as soon as possible. Research and establish a classification access system for medical service items, explore the establishment of a pricing mechanism that conforms to market laws for innovative and breakthrough new projects, and give play to the enthusiasm of medical institutions and medical staff.

　　▍Change point 12: Implement DRG payment trial and expand the scope of the trial

　　 Deepen the reform of medical insurance payment methods. We will steadily implement large-data disease-based medical insurance payment and DRG-based trials to expand the scope of the trial in an orderly manner. By 2022, it will be fully implemented on the basis of the city's pilot program, and realize the "four-in-one" (DRG, big data type of disease, pay per bed per day, pay per person) under the framework of the total budget.

　　Promote a big data disease-based payment system centered on regional medical centers, a DRG payment system centered on improving the use efficiency of high-quality medical resources in tertiary hospitals, and a per capita payment system in the medical federation centered on the family doctor contract service system. Establish a bed-by-day payment system in line with the characteristics of long-term hospitalizations such as mental rehabilitation and nursing, and explore a multiple compound payment system for dominant Chinese medicines with clear diagnosis and consistent efficacy evaluation.

　　Reasonably determine and dynamically adjust the total budget indicators of the medical insurance fund and payment standards according to disease types. Improve the collective consultation mechanism between medical insurance departments and medical institutions.