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    Home > Active Ingredient News > Drugs Articles > DRG payment country pilot is coming! 30 cities announced

    DRG payment country pilot is coming! 30 cities announced

    • Last Update: 2019-05-27
    • Source: Internet
    • Author: User
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    [pharmaceutical Station industry trends] on May 20, the National Medical Security Bureau held a video conference on the pilot work of DRG payment countries According to the industry, this marks that the reform of DRG based medical insurance payment mode has been put on the agenda It is reported that DRG (diagnosis related group) translates into disease diagnosis related groups, which is a management system that divides cases into several diagnosis groups (generally 700-1000 groups) according to the two dimensions of similar clinical diagnosis and treatment process and similar resource consumption, referring to clinical diagnosis, age, complications, disease severity, outcome and other factors The author understands that this meeting introduces the preparation and main contents of DRG payment national pilot work DRG payment is a way to group inpatients according to the principle of similar clinical treatment and similar consumption of medical resources Medical insurance fund and individual patients pay medical expenses to the hospital according to the principle of the same cost of common diseases group In accordance with the "top-level design, simulation operation and actual payment", the pilot work will be carried out in three years in an orderly manner Through the pilot work, the goal of "five ones" will be achieved, that is, to formulate a set of standards, improve a series of policies, establish a set of procedures, train a team and create a batch of models It is reported that DRG payment is quite different from the project-based payment under the total amount control implemented in the past For example, DRG needs to consider patients' age, gender, complications, disease severity, etc., classify the diseases with similar clinical process and similar consumption of resources into a group, and control the total amount according to the restructured medical expenses The two payment and settlement methods are also different DRG is more flexible for differential patients to enter into more detailed groups In terms of treatment effect, DRG can be flexibly enrolled in the group when complications occur Medical staff need not worry too much about medical expenses, and patients can also receive timely and effective treatment In addition, the meeting also stressed the importance of fully recognizing DRG paid country pilot Improving the payment mechanism of medical insurance is a major strategic decision of the Party Central Committee and the State Council We should make full use of the method of big data, through the reform of payment method, promote the reform of the supply side of medical service, strengthen the standardized and refined management of medical insurance, improve the incentive and restraint mechanism of medical service, and better protect the people's health level The meeting also requested that all pilot areas should strengthen organizational leadership, implement relatively unified DRG grouping rules, payment policies and handling management standards, improve the medical insurance information system, and improve the management level of billion yuan Establish a level by level training, regular evaluation, regular reporting, communication and coordination mechanism, and do a good job in publicity
    Some people in charge of pilot cities said that after the implementation of DRG, the medical insurance will be paid in groups according to the workload of the hospital, and no specific limit will be set for a single hospital, which can not only effectively control the unreasonable growth of medical expenses, but also effectively alleviate the current problems of expensive medical treatment and difficult hospitalization, and play an important role in improving the service level of medical institutions and promoting sustainable development Through the reform, the goal of "the masses get benefits, the hospital develops well, and the medical insurance keeps running" has been realized Next, the pilot city will focus on ensuring the basic medical needs of the insured, adhere to the budget management of medical insurance fund revenue and expenditure, determine the payment standard scientifically and reasonably, improve the efficiency of fund use, and ensure the safe and sustainable operation of medical insurance fund Establish a reasonable and appropriate incentive and restraint mechanism, improve the negotiation and consultation mechanism between medical insurance and medical institutions, promote the rational use of medical and health resources, and improve the performance of medical institutions List of pilot cities: Beijing, Tianjin, Handan, Shanxi, Wuhai, Inner Mongolia, Shenyang, Jilin, Harbin, Shanghai, Wuxi, Jinhua, Hefei, Nanping, Shangrao, Qingdao, Anyang and Wuhan Xiangtan City of Hunan Province, Foshan City of Guangdong Province, Wuzhou City of Guangxi Zhuang Autonomous Region, Danzhou City of Hainan Province, Chongqing City, Panzhihua City of Sichuan Province, Liupanshui City of Guizhou Province, Kunming city of Yunnan Province, Xi'an city of Shaanxi Province, Qingyang City of Gansu Province and Xining city of Qinghai Province Urumqi is designated as a pilot city by Xinjiang Uygur Autonomous Region and Xinjiang production and Construction Corps.
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