Health care reform: the scope of payment, payment standards, payment methods of the linkage has much to offer

When it comes to health-care payment reform, the first thing that comes to mind is health-care payment reform, such as hot inpatient DRGs, DIP and outpatient pay-per-head, pay-per-performance, etc.
the author observes that the reform of medical insurance payment is also linked to the centralized recruitment of drug consumption through payment standards, and to the reform of treatment guarantee through the scope of payment.
this article, we say "pay three swordsmen."
Payment scope, payment standards, payment methods of the linkage "payment three swordsmen" are under the responsibility of medical services management (departments, departments, sections, rooms), all belong to the scope of medical insurance payment work and reform, three aspects of each other inseparable, mutual influence.
is not valuable: three aspects of reform go hand in hand.
such as the scope of payment, narrow from the health insurance drug catalog, the first sex is spatial, "cage for bird" meaning is obvious.
is time, the dynamic adjustment of the medical insurance catalogue, keeping up with the people's demand for therapeutic drugs, and supporting the innovation and progress of the pharmaceutical industry.
such as payment standards, relying on drug consumption concentrated recruitment results, there are currently Sichuan, Qinghai and other provinces from the provincial level to unify some of the payment standards for medical insurance drugs.
the beginning of the new machine, the blueprint is available.
, the first sex is time, the second sex is spatial.
such as payment methods, from a comprehensive coverage of all scenarios, the first is spatial, based on the total budget, mixed, multi-payment methods will cover all medical behavior.
second nature is time, as payment technology matures and performance is fully covered.
author's view, from the drug consumption concentrated recruitment in-depth implementation, not only to the medical insurance payment standard start conditions, but also to the balance of the medical insurance payment method space.
payment methods, payment standards will continue to fill the scope of the space connotation, "swordsman" with the times.
some examples of payment "three swordsmen" linkage application is the performance management of health insurance poverty alleviation.
the poor to implement health insurance poverty alleviation policies, such as financial assistance, medical assistance and so on.
the performance management of poverty alleviation in health insurance is not only a macro-management, but also a micro-management.
, in order to prevent and treat minor diseases and over-guarantee the poor, we should adhere to the agreement on the scope of medical insurance payment, payment standards and payment methods.
microcosmic, attention should be paid to whether the total medical expenses accumulated by the poor are normal and proportionable, in the diagnosis and treatment project, the amount of medication, hospitalization and so on.
is the fine management of medical assistance.
After determining the scope and level of medical assistance coverage, we should pay special attention to the leanness of medical assistance in the use of medical insurance payment scope, payment standards and payment methods, because the source of funds for medical assistance is mainly financial assistance, not directly subject to the total medical insurance budget, natural lack of efficiency supervision and incentives.
scope of medical aid and the scope of medical insurance payment are two important foundations for the fine management of medical aid, which need to be developed efficiently and in good condition.
is to implement the list of treatment guarantees.
to actively deal with excessive protection and reduce the hidden dangers of welfare rigidity, it is urgent.
the list of treatment guarantees will clarify the central and local rights and responsibilities of health care.
medical insurance payment standards will gradually improve the overall level, treatment reimbursement standards due to local secondary subsidies have been pushed up, should be clear funding sources, while receiving vertical management of higher-level departments of guidance and coordination.
, the implementation of the rules on volume procurement will gradually improve the problem of different prices for the same drugs in the provinces and the adjustment of the prices of medical services.
fourth is to maintain medical security treatment.
in DRGs, DIP and other disease-based payment methods, there is widespread concern about the decomposition of hospitalization, reduce the quality of medical services and other potential, driven by natural interests.
in the outpatient pay-per-person, pay-per-performance payment methods, the specific promotion of payment technology, regulatory technology, potential risk points still need to be worked out.
there is no doubt that payment methods should only keep medicar treatment moving forward, not that incentives for efficiency improvements should in turn affect treatment.
is to play the role of payment reform.
of the payment range, the various payment methods should account for the full range, and the payment methods have the ability to complement and re-connect.
include paying per project, and the ideal level of development can be coordinated with performance appraisal.
the standard of payment, re-assignment of the price of medicine, it is related to medical waste, with gold sales can be reduced back.
the same time, adhere to some traditional payment practices, such as low-cost medicine daily average cost standards, may encourage the sale and use of traditional Chinese medicine, Chinese medicine tablets.
health care payment reform has a long way to go, adhere to the efficient management, will certainly draw financing insurance, treatment protection, supervision and management of the whole chain of innovation and progress.
"what to pay, how much to pay, how to pay" and "what to buy, to whom to buy, how to buy" complement each other.
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