北京出台药事服务收费新规

8月16日，北京市发布了地方层面的医疗服务价格调整通知，明确界定了公立三级医院药学门诊诊查费及住院个性化用药等关键药事服务费用的具体标准，其中药学门诊费用设定为每次30元，且完全基于患者自愿选择的原则，同时引入动态调整机制，确保费用设置的合理性与灵活性。该规定将于9月21日正式生效。 

2023年9月，国家卫健委印发《全国医疗服务项目技术规范（2023年版）》，首次纳入药师门诊诊察、处方/医嘱药品调剂、住院患者个性化用药监护3个药学服务收费项目。包括河北、福建、陕西在内的八个省份已相继出台地方政策，积极响应并落实药事服务收费制度。 

药事服务，作为独立于传统医生开方、药师审方模式之外的新型服务模式，其核心在于促进安全合理用药，为患者提供个性化、高质量的药物治疗指导。以药师门诊为例，该服务直接面向患者，依据其既往病史、身体状况等个性化因素，提供精准的用药建议和干预措施，有效提升了药物治疗的有效性和安全性。此外，药事服务的范畴还广泛涵盖基因检测指导用药、药敏测试等前沿领域，体现了药学技术的专业价值。 

目前的地方政策均规定药事服务费遵循患者自愿选择的原则，不得与门诊处方绑定。此外，传统的处方审核等仍作为医院的综合运行成本不予收费。除了湖南省的药事门诊诊查费不纳入报销范围，其他省份的本类费用均可医保报销。 

在医改的大背景下，如何摒弃“以药养医”模式，设置合理健康的补偿机制以体现医疗服务人员的劳动价值被各界广为讨论。长期以来，药师在保障患者用药安全、提升药物治疗效果方面发挥着不可替代的作用，但由于缺乏明确的收费依据，其劳动价值往往难以得到充分体现。药事服务费的设立正是对这一问题的有力回应，它作为“零加成”政策的重要配套措施，旨在通过合理的费用补偿机制让药师帮助患者合理用药、减少不必要的药物支出，提高治疗的有效性和安全性。

然而，在政策的具体实施过程中也面临一些挑战。例如，根据当前的药事服务费标准尚不能完全覆盖药师的劳务成本；同时，政策主要聚焦于三级公立医院，基层医疗机构的药师群体尚未充分受益。针对这些问题，未来需进一步完善相关政策措施，加大投入力度，确保药事服务费用的合理性与公平性。 

On August 16, Beijing issued a local-level notice announcing the adjustment of medical service prices. The notice marks an important step in the regulation of pharmacy service fees in tier-three public hospitals. It outlines the fee structure for key pharmacy services, including outpatient consultations and inpatient medication management. Notably, pharmacy outpatient fees are set at RMB 30 per visit, allowing patients to decide whether or not to use the service. Additionally, a dynamic adjustment mechanism has been introduced to ensure flexible and reasonable pricing. The policy will come into effect on September 21, 2024. 

The National Technical Specifications for Medical Service Items (2023), introduced by the National Health Commission(NHC) in September 2023, was the first to include three pharmacy services: outpatient consultations, prescription drug dispensing, and inpatient medication monitoring. This move has prompted eight provinces, including Hebei, Fujian, and Shaanxi, to introduce local policies actively implementing the pharmacy service fee system. 

Pharmaceutical services represent a new model where the pharmacist's role extends beyond merely reviewing prescriptions. Pharmacists now enhance the safe and rational use of medications by offering patients personalised, high-quality guidance on medication therapy. For instance, pharmacist outpatient clinics engage directly with patients, offering precise medication advice and intervention measures tailored to each patient's medical history and physical condition. Pharmacy services also include advanced areas like genetic testing for medication guidance and drug sensitivity testing, underscoring the professional value of pharmacy technology. 

According to local policies, prescription reviews are included in hospitals’ comprehensive service offerings. Patients can then choose whether to use the paid pharmacy services associated with these reviews. Notably, with the exception of Hunan Province, where pharmacy outpatient consultation fees are not covered, all other provinces allow for the reimbursement of pharmaceutical service fees under basic health insurance. 

In the context of China's ongoing healthcare reform, transitioning from a model where hospitals generate revenue through medication sales to a more sustainable and transparent compensation system is crucial. Pharmacists have long played an essential role in ensuring safe medication use and enhancing treatment efficacy. However, the absence of a clear charging structure has often undervalued their contributions. The introduction of pharmacy service fees addresses this issue by properly recognising pharmacists’ labour and expertise. This policy also complements the "zero-plus-medication" initiative, which aims to eliminate hidden service fees in the cost of medication. The goal is to reduce unnecessary drug expenditures and improve treatment outcomes through a reasonable fee reimbursement mechanism. 

Despite the policy's well-intentioned design, challenges remain in its implementation: 

• Insufficient coverage of pharmacists’ labour costs: The current fee standards may not fully cover the labour costs of pharmacists, potentially limiting the policy's effectiveness in enhancing service delivery and utilisation. 

• Limited focus on tertiary hospitals: The policy primarily targets tertiary public hospitals, leaving pharmacists in primary care settings with limited benefits. 

To ensure that pharmaceutical service fees are reasonable and fair, continued policy improvements and increased investment are needed.