Medical Network January 8th, 2021 - By the end of January 2021, the total budget of the unified regional points method and the method of paying for settlement according to the value of the disease shall be formulated; This is the Inner Mongolia Autonomous Region Medical Security Bureau on January 7 on the official website of the Inner Mongolia Autonomous Region Medical Security Bureau, the Ministry of Finance, the Health and Health Commission jointly issued the "on the issuance of the Inner Mongolia Autonomous Region regional points law total budget and pay according to the disease score work programme notice" (hereinafter referred to as "Notice") disclosed the timing.
This time included in the scope of the DIP, in addition to last year included in the total budget of the regional points method and pay by disease value of the national pilot of Ordos City, Chifeng City, Hulunbel City 3 City, as well as the DRG national pilot Wuhai City, other non-pilot areas have also set a completion time limit - only one month later than the pilot city.
industry warned that the change or the Inner Mongolia hospital drug, supplies market triggered a major reshuffle.
Unreasonable diagnosis and treatment easy to be quickly identified in accordance with the "Notice" requirements, Inner Mongolia will use 1-2 years of time, the overall regional total medical insurance budget and the point method combined, the full implementation of hospitalization to pay according to the value of the disease-based multi-composite payment method.
In fact, since the National Health Insurance Administration last year issued the "Regional Points Act Total Budget and Pay-per-Disease Pilot Work Programme Notice", many countries have been prepared for big data-based medicare big data-based diseases (Big Data Diagnosis-Packet, DIP) pay-per-view reform.
It is worth mentioning that Inner Mongolia's plan emphasizes the principle of "total control, monthly advance payment, monthly advance settlement and annual liquidation" and requires the medical insurance agencies in the integrated regions to make monthly advance payments after deducting the security deposits in accordance with the total amount of expenditure of the current year's fund budget.
Specifically, according to a certain proportion of the monthly average of the total amount of hospitalization expenses actually paid by the co-ordination fund in the previous year, each locality shall determine the total monthly pre-settlement, and then the monthly pre-settlement shall be made with the medical institution in accordance with the agreed rules according to the sum of the total amount of pre-settlement and the total score of the diseases in the current month.
the end of the year, according to the total number of points provided by each medical institution and the budget index of the expenditure of the regional medical insurance fund, the actual value of each point is derived and the actual points of each medical institution are paid.
At the same time, relevant departments will improve the intelligent monitoring system, formulate regulatory indicators, strengthen quantitative assessment based on diseases, establish a standard system for quality monitoring of medical insurance costs, and realize big data-based monitoring and supervision over the total regional points budget and pay-per-view for diseases.
The head of the local health insurance department who has launched the DIP-related pilot said that the analysis function of the intelligent supervision system of the disease score payment can clearly show the degree of discreteness between case data and the city average, quickly detect anomalies and further data mining analysis and processing.
time, it can also be through the disease cost deviation indicators and other thematic early warning, quickly identify unreasonable diagnosis and treatment behavior, or the use of big data characteristics to achieve the group high sets and other violations of the prompt.
the "monthly advance payment, monthly pre-settlement" proposed by Inner Mongolia, it is more likely to shorten the feedback time of the regulatory authorities, timely correction of unreasonable medical treatment behavior of medical institutions.
In fact, in its specific work programme, it also requires all co-ordination areas to refine monitoring indicators, will be repeated hospitalization rate, disease cost growth rate, disease coding accuracy, large-scale equipment positive rate, "three major directory" external cost ratio, reasonable drug use, referral rate, etc., into cost control and quality supervision.
"insider competition mechanism" or reconstruct the market pattern in fact DIP for medical institutions and enterprises in-house market team, the most critical place is actually the introduction of "insider competition mechanism."
because the budget management of the medical insurance department in the pilot area changed from the total control of individual medical institutions to the budget allocation of different types of medical services in the region, it is more scientific and reduces the objections of medical institutions on the basis of the analysis of historical data.
the end of the year, the actual value of each point will be derived from the total number of points provided by each medical institution and the budget indicators for the expenditure of the regional health insurance fund, and the actual points of each medical institution will be paid.
achieved to a considerable extent, encouraging competition among hospitals and encouraging them to strengthen their self-management.
the same time, we explore comparing the basic medical insurance index of each hospital with the average level of hospital management index, promoting the transparency of regional medical service, and avoiding unreasonable behavior such as high-set coding and punching points.
the landing of DIP reform may promote the spontaneous formation of scientific and reasonable classification of diagnosis and treatment model.
Zhu Hengpeng, director of the Center for Public Policy Research, deputy director of the Institute of Economic Research of the Chinese Academy of Social Sciences, has written an analysis that medical institutions can spontaneously form a pattern of division of labor and cooperation according to their own strengths, comparative advantages and the direction of professional development.
Because all levels and types of hospitals can find suitable for their own disease services, and thus form a standard hierarchical mode of diagnosis and treatment: three-level hospitals focus on difficult and complex diseases, critical critical illness, specialized hospitals pay attention to specialized diseases, while primary medical institutions are mainly responsible for common diseases, multiple incidence of diagnosis and treatment.
for the pharmaceutical industry, dip reform, overlaying the centralized procurement of drugs, so that pharmaceutical enterprises in-house marketing more difficult.
also forced more pharmaceutical companies to turn their attention to the out-of-hospital market, online and off-the-court retail channels are expected to become a new focus of the strategic transformation of pharmaceutical companies.
the total budget of the regional points method of Inner Mongolia Autonomous Region and the work table account paid according to the disease score