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    Home > Active Ingredient News > Drugs Articles > It's about you! There will be a big change in medicating reimbursement in the second half of 2020.

    It's about you! There will be a big change in medicating reimbursement in the second half of 2020.

    • Last Update: 2020-08-06
    • Source: Internet
    • Author: User
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    Pharmaceutical Network Policy and Regulations, july 23, "on the issuance and deepening of the reform of the medical and health system in the second half of 2020 key tasks notice" was officially issued.
    notice mentioned that in the second half of the year, we should continue to focus on promoting the treatment-centered transformation into the people's health-centered, deepen the reform of medical care, medical insurance and medicine, and continue to focus on solving the problem of difficult and expensive medical care.
    , there have been several big changes in health care reimbursements that people care about.
    the basic level of medical insurance will be raised specifically including: urban and rural residents per capita financial assistance standard increased by 30 yuan, and steadily raise the standard of individual contributions.
    improve the mechanism of guarantee for medical treatment and treatment of major outbreaks.
    also clearly carry out the pilot of direct settlement of outpatient expenses across provinces.
    this also means that in the second half of the year, the outpatient medical expenses of insured persons in different places can also be directly settled.
    ", in the past, cross-provincial medical treatment and relocation personnel can only be credit card reimbursement of hospitalization costs, some off-site medical personnel still exist outpatient medical expenses, advance difficulties and other issues.
    " industry insiders said that once the original patients need to be in the city outside the insured place to seek medical treatment, to the time of reimbursement, it will be a bit of a twist.
    and now carry out the outpatient expenses cross-provincial direct settlement pilot, this part of the patient reimbursement outpatient expenses no longer need to run both ends.
    the reform of the health insurance payment method to advance the notice clearly, to promote the disease diagnosis-related group pay national pilot and pay by disease.
    improve the mechanism of consultation and negotiation between medical insurance operators and medical institutions, where conditions exist, can increase the amount of forward payment of working capital, reduce the pressure on medical institutions to advance.
    explore the implementation of the total amount of the tight medical complex, strengthen supervision and assessment, balance retention, reasonable overspend sharing.
    develop guidance on establishing standards for the payment of medical insurance drugs.
    what are DRGs (paid by grouping related to disease diagnosis)? It is understood that this is a patient based on age, disease diagnosis, comorbidities, complications, treatment, severity of the disease and return and other factors, the patient into a number of diagnostic groups (DRG group) to manage the system.
    the health insurance payer will set payment standards according to the diagnostic team and the hospital will directly settle, the patient's own payment method, reimbursement ratio, etc. will not change.
    this kind of payment is conducive to controlling the excessive service of the hospital, promoting the rational use of hospital resources, and at the same time can further curb the phenomenon of expensive patients to see a doctor.
    pay by disease, in short, the health care department first through the unified disease diagnosis classification science to develop a fixed reimbursement standard for each disease, to give patients a clear cost expectations.
    this approach is also conducive to controlling the unreasonable growth of medical expenses, and effectively reduce the burden of medical treatment for the masses.
    health insurance fund management will strengthen the notice mentioned, promote the "Internet plus medical security", accelerate the construction of a unified national health care information platform, and do a good job with the national integration of government service platform docking.
    it is understood that the "Internet plus health care" contains two aspects of the content.
    on the one hand is the integration of demand side, that is, the integration of the Internet and the payer, including the integration with health insurance payment, personal out-of-pocket costs, big data analysis, and on the other hand, the integration with the supply side, that is, the application of Internet and medical services.
    this way is conducive to continuously improve the efficiency and service level, so that patients run less legs, more convenient, so that more people can share excellent medical resources, enhance the public's sense of access to health insurance work and satisfaction. At the same time,
    the notice also explicitly will improve the regulatory mechanism, carry out intelligent monitoring of health insurance based on big data, promote video surveillance, face recognition and other technology applications, explore the implementation of centralized provincial monitoring.
    .
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