New changes in Medicare payments directly affect primary care physicians.

Not long ago, the Central Committee of the Communist Party of China and the State Council issued the Opinions on Deepening the Reform of the Medical Security System, referring to the continuous promotion of the reform of the payment methods for medical insurance and the improvement of the budget method for the total amount of medical insurance funds.
recently, the opinion landed in Qinghai Province, the provincial medical security bureau issued a notice on the issuance of Qinghai Province's total medical insurance payment management interim measures.
Qinghai Province will liquidate the actual expenditure of the medical insurance fund in the fixed-point medical institutions during the year in accordance with the method of "residual retention and reasonable overspend sharing", and the total amount of medical insurance fund payments for 2020 shall be approved as soon as possible.
the rules for the use of health insurance funds will have on primary health care institutions and primary care doctors, let's see.
Impact One: Primary doctors' salaries are expected to increase Under the total medical insurance payment system, in accordance with the overall requirements of "one dozen, three down, one control and one mention", through the continuous implementation of special actions to combat fraud and fraud insurance, to further reduce the inflated prices of drugs and medical supplies, reduce the cost of inspection and treatment of large-scale equipment, control the unreasonable increase in secondary medical costs, and gradually raise the price of medical services.
the price of medical services is really higher, the value of doctors themselves can be further reflected, while at the same time promoting more high-quality medical personnel willing to sink to the grass-roots level.
when the capacity of primary health care services has been improved and a good working environment has been formed, the salaries of primary care workers will naturally increase.
Impact II: to ease the pressure on the cost of primary medical institutions Before there are health hospitals due to the problem of medical insurance control fees caused by the hospital almost unable to pay wages, Qinghai Provincial Health Insurance Bureau in order to reduce the pressure on fixed-point medical institutions to advance funds, medical insurance agencies in the approved annual total payment at the same time, the establishment of a work capital advance system.
based on the average monthly amount of the co-ordination fund allocated by the fixed-point medical institution in the previous year, the medical turnover of one month shall be pre-allocated to the fixed-point medical institution at the beginning of each year and recovered at the end of the year.
addition, in accordance with the principle of "balance of payments, slightly balance", not less than 10% of the income of the health insurance fund for the current year as a risk reserve for unforeseen fund expenditures in the current period.
, funds will be set aside for general out-patient clinics, outpatient speciality and chronic diseases, special medicines, off-site medical treatment and manual reporting.
Impact III: standardizing the basic doctors reasonable diagnosis and treatment and drug use after the implementation of total control fees, the more fixed-point medical institutions overspend, the more hospital out-of-the-money, the specific overspend part of the share of the ratio is as follows: (1) overspending 5% (inclusive), by the medical insurance fund and medical institutions according to the ratio of 6:4; (2) If the overspend is 5%-10% (inclusive), the medical insurance fund and the medical institution shall share the cost by 5:5; (3) if the overspend exceeds 10%, the medical institution shall bear the full burden.
addition, the use of the medical insurance catalogue is included in the assessment, the use rate of the three catalogues of health insurance has not reached 80%, each drop of 1 percentage point, the total annual payment of 1 per cent deduction.
if medical expenses are abnormal, an early warning notice or interview will be issued.
impact four: no longer only "health insurance in charge" "Measures" proposed to strengthen consultation and negotiation with fixed-point medical institutions, communication and coordination, to the relevant fixed-point medical institutions to inform the settlement of medical expenses.
means that in the future, it will no longer be just "health care" unilateral requirements, but the two sides stand on a more equal footing to communicate and negotiate.
While establishing an incentive mechanism for "residual retention", the Measures also state that medical institutions should strictly enforce the entry and exit of hospitals, strictly prohibit the decomposition of hospitalization, hospitalization or early discharge of non-conforming conditions;
, under the total cost of health care, primary health care institutions must begin to learn the total fee control, in order to obtain a considerable income.
total fee control fee is also in many places before the implementation, the future focus is how to refine the health insurance payment rules reasonable use, for all primary medical institutions and primary doctors are a test.
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