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 total budget for the medical insurance fund.
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 expenditure of the medical insurance fund actually occurring during the year for the fixed-point medical institutions in accordance with the method of "residual balance 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 amount of 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 is improved and a good working environment is formed, the salaries of primary care workers will naturally rise.
Impact II: before easing the pressure on the expenses of primary medical institutions, there are health hospitals due to the problem of medical insurance fee control 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 work capital 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 also be set aside for general outpatient clinics, outpatient special chronic diseases, special medicines, off-site medical treatment and manual reporting.
Impact III: After regulating the reasonable diagnosis and treatment of primary-level doctors and the implementation of total drug control fees, the more fixed-point medical institutions overspend, the more hospitals pay out-of-the-fund, the specific overspend part of the share ratio is as follows: (1) overspending 5% (inclusive), by the health insurance fund and Medical institutions shall share in the proportion of 6:4; (2) 5%-10% (inclusive) of the overspend shall be shared by the medical insurance fund and medical institutions in the proportion of 5:5; and (3) if the overspend is more than 10%, all the medical institutions shall bear the 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.
Four: No longer only "medical insurance is in charge" "Measures" put forward, 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 is no longer just "health care" unilateral requirements, but the two sides stand on a more equal footing to communicate and negotiate.
At the same time as 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 implemented in many places before, the future focus is how to refine the health insurance payment rules reasonable use, for all primary medical institutions and primary care doctors are a test.
/ Qinghai Provincial Medical Security Bureau