Let's analyze these two points.
First: the setting of medical insurance drug use area.
The Interim Measures for the Fixed-point Management of Medical Security in Retail Drugstores stipulates that drugs should be classified and managed in different regions according to the requirements of the Quality Management Standard for Pharmaceutical Trading, and the drugs sold should be clearly labeled with medical insurance drugs.
In the past, the classified management of pharmacy industry required that drugs and non-drugs, prescription drugs and over-the-counter drugs should be displayed in different regions with obvious signs.
After that, in the original place and over-the-counter area, it is necessary to carry out detailed classification, set up medical insurance areas and non-medical insurance areas, and hang obvious signs.
This work is not difficult, but it means that the focus of pharmacy work has shifted from the original quality management to medical insurance management. The pharmaceutical industry has become an industry that is strictly regulated by both the drug supervision department and the medical insurance department.
Second: the responsibility for violating the medical insurance agreement is to "sit together."
Paragraph 14 of Article 40 of the new measures clearly stipulates: If the legal representative, person in charge or actual controller of the headquarters of a designated retail pharmacy chain enterprise violates laws and regulations, the medical insurance agreement of one branch of the chain retail pharmacy will be terminated, and other retail pharmacies with the same legal representative, person in charge or actual controller will also terminate the medical insurance agreement.
The reason why the new method is called the strictest medical insurance regulation in history is mostly because of this regulation.
As soon as the opinion draft came out, many people thought this article was too harsh. If the branches of chain pharmacies violate the relevant provisions of medical insurance, it should be clear about the division of responsibilities between personal behavior and corporate behavior. In the case that the enterprise has a system and strict standardized management, the employees of specific stores and specific responsible persons shall be investigated for misconduct.
However, this article has been retained in the new method, which shows the attitude and determination of the relevant administrative departments on the management of medical insurance funds.
At the same time, the Interim Measures for the Fixed-point Management of Medical Insurance in Medical Institutions is similar to the management measures of retail pharmacies, but there is no similar provision that will affect other departments because one department violates the medical insurance agreement.
The implementation of the strictest medical insurance regulations in history shows that the medical insurance fund is under great pressure, and it also shows that there are many problems in the use of medical insurance funds in the pharmaceutical industry.
For pharmacies, whether the medical insurance card can be used is the most critical factor to determine the fate of pharmacies, so the new medical insurance policy is bound to become the lock of the fate of the pharmacy industry.
The ownership and nature of the personal account of the insured's medical insurance card are controversial. Many people think that this part should belong to consumers, so they can control it freely.
But the law is the law, and once it is determined, it must be unconditionally observed.
Comparatively speaking, the use scale of medical insurance fund in retail pharmacy industry is much lower than that in medical institutions, because consumers only use the personal account part of medical insurance card to buy medicines in pharmacies.
For most of the insured, the amount returned to the personal account of the medical insurance card every month is only 100 yuan. The establishment of personal accounts has the consideration of improving people's enthusiasm for participating in insurance, but now the participation rate is close to 100%, so canceling personal accounts should not have much impact, but it will have many benefits.
There is almost no loss for the insured to cancel the personal account of medical insurance. This part can be used to offset the medical insurance expenses paid, and it can also reduce the burden on some enterprises.
Cancelling the personal account of medical insurance can unload a big burden for managers. There are many pharmacies scattered, and the management work is complicated and trivial. It is also necessary to set up special institutions and increase a large number of supervisors, which will undoubtedly consume a lot of management costs. If the personal account of medical insurance is cancelled, it can be concentrated in medical institutions, which will get twice the result with half the effort.
Cancellation of medical insurance personal accounts can create a more level playing field for pharmacies. It can effectively control the disorderly development of pharmacy industry and let pharmacies focus on drug quality and professional services.