DRG payment standard issued by the state health insurance bureau is officially unified

The National Health Insurance Bureau held a meeting to announce the important standards, and DRG payment, one of the payment methods of health insurance, was formally changed from decentralized to unified On the morning of October 23, the National Health Insurance Bureau held a meeting to officially announce the notice on the technical specifications and grouping schemes of DRG paid countries (hereinafter referred to as the notice), including the technical specifications for DRG grouping and payment of national health insurance (hereinafter referred to as the technical specifications) and the grouping scheme of national health insurance DRG (chs-drg)（ Hereinafter referred to as "group plan") two documents, medical insurance payment method ushered in important changes Jicengyishi was invited to attend the meeting Before we get to know the contents of the notice, let's explain what DRG payment is DRG, or diagnosis related groups, is short for DRG According to the age, gender, length of stay and clinical diagnosis of patients, patients are divided into diagnosis related groups with similar clinical symptoms and resource consumption, and the price, charge and medical insurance payment standard are determined by groups This payment method is widely used in the world at present Generally speaking, it is to divide related diseases into a group and pay for them in a package, instead of paying for them as before For example, for pneumonia, it can be divided into several levels according to the severity of symptoms In the past, "blood test" and "film making" are all charges DRG payment is to carry out the settlement according to the disease and symptom level The examination and test required for various related symptoms of pneumonia diagnosis are all paid in packages according to pneumonia and the corresponding symptom level, instead of a separate charge Since the 1980s, after more than 20 years of development, several DRG versions have been successively formed In order to ensure the smooth implementation of DRG payment national pilot, the National Health Insurance Bureau compiled the "chs-drg grouping and payment technical specifications" based on the previous DRG pilot experience of all regions Chs-drg has become the only standard for DRG payment in the national health insurance department The notice requires all pilot areas to carry out the pilot work in strict accordance with chs-drg standard and the unified deployment of the National Health Insurance Bureau The national health insurance department implements the unified, coordinated and healthy development of DRG standard In June this year, four departments, including the National Health Insurance Bureau, identified 30 cities as pilot cities of DRG payment countries They are required to focus on the goal of "developing a set of standards, improving a series of policies, establishing a set of procedures, training a team, and creating a batch of models", and follow the three-year three-step promotion strategy of "top-level design, simulation operation, and actual payment" Carry out the work Beijing, Tianjin, Handan, Linfen, Wuhai, Shenyang, Jilin, Harbin, Shanghai, Wuxi, Jinhua, Hefei, Nanping, Shangrao, Qingdao, Anyang, Wuhan, Xiangtan, Foshan, Wuzhou, Danzhou, Chongqing, Panzhihua, Liupanshui, Kunming, Xi'an, Qingyang, Xining, wupanshui Lumuqi City, Urumqi City (directly under the Corps, 11th and 12th divisions) Adhere to the combination of unification and division, and gradually form a DRG payment system with Chinese characteristics According to the notice, each pilot city shall follow the basic principles, scope of application, definition of terms, data requirements, data quality control, standardized upload specifications, grouping strategies and principles, weight and rate determination and other requirements of DRG grouping determined in the technical specifications Strictly implement the grouping scheme, formulate local subdivision DRG grouping according to the unified grouping operation guide and the actual situation of each region The purpose is to create a pilot "one chess", accurate "localization", specific payment in line with the actual situation of each region, so that chs-drg becomes the "common language" in the field of national health insurance Chs-drg is developed on the basis of ICD-10 code (including 2048 categories of disease diagnosis, 10172 suborders, 33392 items) and icd-9-cm3 code (including 890 suborders of operation and operation, 3666 suborders, 13002 items) in the national medical insurance version, which can cover all critical and short-term (within 60 days) inpatients Traditional payment by single disease, once a complex case is encountered, the medical institution may transfer the hospitalization expenses for not exceeding the payment standard, otherwise it will fall into the situation of more difficult and miscellaneous cases more loss Chs-drg payment mode can basically achieve full coverage of hospitalization expenses and disease treatment The large-scale implementation of DRG payment will bring the following three major impacts: First, promote the standardization of medical behaviors The implementation of DRG payment national pilot work will change the previous mode of payment by project, turn to payment by disease group, and turn drugs and consumables into costs, which will urge hospitals and doctors to change the unreasonable medical behaviors such as prescribing large prescriptions for patients, using expensive drugs, consumables and large-scale inspection equipment Doctors will consciously regulate medical behaviors, improve the effectiveness of medical resources utilization, actively seek to improve quality and efficiency to obtain reasonable benefits, and promote the transformation of the power mechanism of hospital operation from expansion development to connotation development Second, medical services are open and transparent Through DRG grouping, the "incomparable" clinical medical behaviors in the past have been changed into "comparable" It is clear how many cases the hospital receives and how difficult it is The treatment level of the same disease group can be compared quantitatively There is a transparent and open platform for medical insurance payment and public medical treatment Third, improve people's satisfaction with medical treatment Through DRG payment, the water content in examination and treatment will be reduced, the "big prescription" and "big examination" will be effectively reduced, the unnecessary medical expenditure of the common people will be reduced, the public will get more high-quality and efficient medical services, and the medical satisfaction will be improved Chs-drg payment reform will help build a healthy China and increase people's sense of access In addition, the meeting pointed out that for cases that cannot be settled by DRG, we should further promote the work of payment by disease, payment by bed and payment by head based on big data, and establish a multiple composite medical insurance payment system.