On August 11, the Zhejiang Provincial Healthcare Security Administration issued the Notice of the Zhejiang Provincial Healthcare Security Administration on Publishing the First Round of Dynamic Price Adjustments under the Pilot Program for Deepening Medical Service Price Reform (Draft for Comments).
The first round of dynamic price adjustments for medical services in Zhejiang involves 287 medical service prices, including 76 laboratory-testing fees, covering routine biochemistry, tumor markers, infectious-disease screening, autoimmune testing and many other areas.
Overall, price reductions range from about 9% to 19%, with the largest cut — 19% — applied to blood lead testing. In addition, results for emergency calcium testing and emergency serum bicarbonate testing must be issued within half an hour.
The seven-autoantibody lung-cancer test (p53, GAGE 7, PGP9.5, CAGE, MAGE A1, SOX2, GBU4-5) is limited to patients with space-occupying lung lesions, pulmonary opacities or atypical pulmonary hyperplasia.
On March 3, eight departments — including the Zhejiang Provincial Healthcare Security Administration, the Zhejiang Provincial Health Commission, the Provincial Development and Reform Commission and the Provincial Department of Finance — jointly issued the Implementation Plan of Zhejiang Province for Deepening the Pilot Reform of Medical Service Prices (hereinafter "the Plan"). The Plan officially took effect on April 2.
The Plan sets out 7 major tasks covering 21 sub-items; the parts most relevant to clinical laboratories mainly encourage price cuts and the implementation of "separating technical fees from consumables":
Rationally determine the total amount of price adjustment: establish a province-wide management mechanism and indicator system for the total amount of price adjustment. Public medical institutions are encouraged to proactively lower the prices of examination and testing items that are set too high, and the corresponding reductions can be counted toward the total amount of price adjustment.
Explore the "separation of technical fees from consumables": in line with the principle of keeping technical labor separate from material consumption, gradually separate high-value disposable medical consumables from price items and explore the creation of a catalogue of consumables that can be billed separately. Strengthen coordination between medical service pricing and the centralized procurement of medical consumables, expand the scope of centralized volume-based procurement of high-value consumables, and keep driving down the procurement prices of consumables that are used heavily in clinical practice, priced excessively high or the subject of prominent disputes, with "zero-markup" sales implemented.
Deepen the comprehensive reform of public hospitals: reasonably determine remuneration levels in public hospitals, reform and improve the assessment and evaluation mechanisms, make the remuneration of medical staff transparent and open, strictly prohibit revenue-generation targets, and forbid linking medical staff remuneration to business revenue from drugs, sanitary materials, examinations or laboratory tests.
Work in the clinical laboratory is not simple mechanical operation; it requires the integrated application of highly specialized knowledge and skills. Before samples are tested, laboratory technicians must carry out strict quality control and pre-treatment to ensure sample quality meets requirements; while operating instruments, they must set up and adjust the equipment according to the characteristics of the sample and the requirements of the test item.
When an instrument malfunctions or results are abnormal, the technician must also troubleshoot and interpret the data to ensure the accuracy and reliability of the results. Although the three routine tests — including the CBC — are basic testing items, their "value" is actually far from low! Rechecking, reviewing and reporting abnormal results — which laboratory professional would dare to claim mastery without years of painstaking work? Only clinical laboratory professionals with a solid level of expertise can handle various interference factors, abnormal cells or pathogenic microorganisms with ease. What is more, the more basic a test item is, the greater its potential influence on the direction of clinical diagnosis and treatment.
It would be highly inappropriate to overlook the value of this technical labor. Although the NHSA has mentioned in its notices leaving pricing room to repay laboratory staff for their labor, it is hard to say how much of this is really taken into account when the authorities set price standards.
As laboratory professionals, when testing prices are adjusted we sincerely hope that, in addition to easing the burden on patients and the medical insurance fund, the labor value of laboratory technicians will also be respected!
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