Great news! The Ministry of human resources and social security issued the recommended catalogue of paid diseases of medical insurance

Source: on March 26th, 2018, China Medical Insurance decided to pay for medical insurance according to local conditions All localities should choose diseases with clear diagnosis and treatment plan and entrance and exit standards, mature diagnosis and treatment technology, stable clinical path and little difference in comprehensive service cost to pay for medical insurance According to ICD-10 and icd-9-cm-3, the specific diseases are determined The inpatient surgical diseases and some simple treatment projects are the main ones The daytime operation and the eligible outpatient treatment of Chinese and Western medical diseases are gradually included in the payment scope of medical insurance fund diseases All localities shall determine that no less than 100 diseases shall be paid by disease When determining the paid diseases, adhere to the expert demonstration mechanism, organize experts to demonstrate the name of the diseases and the main treatment methods, so as to ensure that the clinical use is standardized and effective, and the standard formulation is scientific and reasonable The recommended catalogue of diseases paid by disease of medical insurance is a recommended catalogue of diseases paid by disease for all regions, mainly providing disease selection for all regions On this basis, each region can reasonably determine the range of paid diseases according to the actual situation of medical insurance management level and medical technology development When reasonably making the payment standard of medical insurance paid diseases, when determining the payment standard of medical insurance paid diseases in different regions, the factors such as the cost of medical service, the actual expenses incurred in the past, the bearing capacity of medical insurance fund and the burden level of insured personnel should be fully considered, and reasonably determined through consultation and negotiation with medical institutions in combination with the main operation and treatment methods of diseases We should strengthen the management of medical expenses paid by disease, monitor and analyze the individual burden of the insured, avoid the cost transfer and increase the individual burden All localities should establish a dynamic adjustment mechanism for the payment standard of paid diseases of medical insurance, adjust the payment standard of medical insurance in a timely manner according to the changes of medical prices and the application of appropriate technical services, as well as the evaluation results of the operation of medical insurance fund, and actively prevent the operation risks of the fund To do a good job in cost settlement, all localities should include the payment by disease into the budget control scope of the total fund, settle the expenses to the designated medical institutions according to the disease payment standard according to the results of performance appraisal, guide the medical institutions to actively control the cost, standardize the medical behavior, and control the unreasonable growth of medical expenses We will establish a mechanism to pay for the entry and exit of diseases, and improve the treatment of complaints by insured personnel Recommended catalogue of paid diseases of medical insurance