Recently, the State Council Medical Reform Office issued the Key Tasks of Deepening the Reform of Medical and Health System in 2017, and the issue of prescription outflow was mentioned again. On the basis of last year's "hospital does not restrict the outflow of prescriptions", this year's outflow of prescriptions will focus on retail pharmacies.

The Medical Reform Office proposed that the Ministry of Commerce, the Ministry of Social Affairs, the Health Planning Commission and the Food and Drug Administration should cooperate to explore the hierarchical management of retail pharmacies nationwide, encourage the development of chain pharmacies, and explore the interconnection and real-time sharing of prescription information, medical insurance settlement information and drug retail consumption information.

This means that the market situation of the outflow of prescriptions, such as the lack of docking of medical insurance, the difficulty of settlement and the inability of retail pharmacies to undertake the outflow of prescriptions, has been taken seriously. The problem of outflow of prescriptions from hospitals will become the focus of this year's medical reform.

1. separation of medicine background

Since the start of medical reform, separation of medicine is the key content. The reason behind this is that most of the income of public medical institutions and personnel in China comes from medicines. Compensation for medical treatment by the income of medicines exists in the situation of opaque sources, opaque distribution and inadequate supervision. It is easy to breed problems such as medical bribery, over-prescription and high medical expenditure.

The purpose of "separation of medicine" is to exclude drug revenue from the income of medical institutions, cut off the direct interest relationship between medical bidding, medical institutions, medical staff, pharmaceutical enterprises and drug distributors, and establish a system and mechanism for the separation of diagnosis, treatment and drug use.

In terms of policy, it can be traced back to the Guiding Opinions on the Reform of Urban Medical and Health System issued by the Medical Reform Office of the State Council in 2000, which pointed out for the first time that medicine should be "separately accounted for, separately managed, handed in uniformly and reasonably returned". This means that two accounts should be made within the hospital, and drug income should be recorded according to the new financial and accounting system. At the same time, the balance of drug revenue and expenditure shall be handed over to the health administration department, and the special accounts of the financial and social security fund shall be uniformly deposited. After examination, the balance shall be arranged as a whole, and then reasonably returned to the medical institutions.

However, there are many problems in the actual operation process of "separation of medicine from medicine". The most intuitive one is that after the separation of drug revenue from medical institutions, the benefits of medical staff do not match their labor costs, and there is no benefit compensation mechanism. In this case, "separation of medicine" is linked to the issue of improving the treatment of medical staff, and gradually explores the auxiliary means of increasing the cost of diagnosis and treatment, setting up the cost of pharmaceutical services.

BeiJing Medical Reform, which began in April this year, is an attempt to consider the implementation of medicine separately and comprehensively. According to the Implementation Plan of Comprehensive Reform of Separation of Medicine issued by Beijing, its main objective is to change the operation mechanism of public medical institutions and standardize medical behavior by canceling drug additions and setting up medical service fees.

In the specific implementation of Beijing's medical reform, the price and cost of medical equipment and consumables should be reduced by means of sunshine purchase of pharmaceutical products and medical insurance control fees. In addition, Beijing medical reform has established a dynamic adjustment mechanism on the price mechanism. By monitoring the changes of operating costs and income structure of public medical institutions, adjusting the prices of medical equipment consumables and medical service fees, we can not only ensure that the overall cost of patients seeking medical treatment and purchasing medicines does not increase significantly, but also clarify the labor value of medical staff.

Overall, the "separation of medicine" and the control of drug proportion by public medical institutions, the abolition of drug additions, medical insurance control fees and other synergies make drugs change from income to cost in the process of operation of public medical institutions, which forces public medical institutions to carry out the reform of separation of medicine.

2. prescription outflow related policies

In the process of implementing the comprehensive reform of separation of medicine, the outflow of prescriptions or the circulation of out-of-hospital prescriptions is one of the key contents, which means that the supply of drugs and pharmacy services previously undertaken by hospital pharmacies should be gradually released to other drug distribution channels dominated by retail pharmacies to ensure patients'demand for medicines.

On specific policies, regulators' attitude towards outflow of prescriptions is becoming clearer. From the encouragement to patients by exploring the new mode of "patients purchasing drugs independently from prescriptions to medical institutions or retail pharmacies" in 2014, to the promotion of "prohibiting the outflow of prescriptions from hospitals" in 2015, to the latest task of "medical reform" in 2017, "exploring the prescription information of medical institutions, medical insurance settlement information and drug retail consumption" "Information interoperability and real-time sharing" should focus on clearing up systemic barriers to the transfer of prescription outside the hospital.