Reform of medical insurance payment methods promotes a win-win situation for the three parties

On December 18, the National Medical Insurance Administration held the first China Medical Insurance Payment Method Reform Conference and officially launched the three-year action plan for the reform of medical insurance payment methods
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What exactly is the reform of medical insurance payment methods? How will this reform affect our medical treatment? The traditional way of paying by item The new way of package pricing China's traditional medical insurance payment method is payment by item, that is, the amount of medicines, medical service items, and medical consumables used in the diagnosis and treatment process is paid according to the proportion of medical insurance and patients
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However, under this model, excessive medical behaviors such as "big prescriptions" and "big inspections" are prone to occur, which not only causes a waste of medical resources, but also causes the insured to spend more money and the medical insurance fund
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The two new payment models, DRG and DIP, after the reform, use packaged pricing to allow medical institutions to actively control costs
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Packing pricing to determine the payment standard DRG is to pay according to the disease diagnosis-related group, that is, according to the patient's disease type, severity of the disease, treatment methods and other factors, the patients are classified into the diagnosis-related groups with similar clinical symptoms and resource consumption, and the group is The unit packs and determines the medical insurance payment standard
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DIP pays based on the value of the disease type, that is, using big data, the disease is based on the "disease diagnosis + treatment method" combination as the payment unit.
The medical insurance department determines the payment standard for each disease based on the total amount of medical insurance funds that should be paid each year
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How can reforms promote a win-win situation for the three parties? After the payment standard is determined, the surplus cost of disease treatment will become the hospital's income, and the hospital will be responsible for the excess expenses.
It will promote a more scientific clinical path and a more reasonable use of medicines and consumables.
Through the use of surplus, patients, medical insurance and medical institutions can achieve a win-win situation
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Long Xuewen, person in charge of the Medical Security Management Center of the National Medical Security Administration: Retaining the balance means that after the price is packaged, the difference between the charge and the price is left to the hospital, which becomes a reasonable benefit for it
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And if it (the hospital) overspends, the unreasonable part may be borne by the hospital itself
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my country has launched pilot reforms of medical insurance payment methods in many places
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Although this reform refers to the settlement between medical insurance and hospitals, it is closely related to the medical burden of the people.
Next, we will go to the pilot hospital to see if patients can really enjoy the benefits? Shaoyang, Hunan: After the reform, the average length of stay and the average cost per time dropped by about 20%.
Recently, Uncle Liu, 72, who was treated for acute pancreatitis caused by gallbladder stones in Shaoyang City, Hunan, found that he was discharged from the hospital when he was discharged from the hospital.
Compared with the same symptoms last year, This time not only the length of hospital stay has been shortened, but the cost has also been reduced
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Uncle Liu from Hunan patient: The self-pay part has been reduced, originally it was 2500 yuan, this time it was 2100 yuan
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Last time it was ten days, this time it was eight days
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The hospital where Mr.
Liu visited, Shaoyang Central Hospital in Hunan Province, implemented payment method reforms as a pilot hospital
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Since the actual payment of DIP in October this year, the average length of stay and the average cost of patients admitted to this hospital have dropped by about 20%
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National Medical Insurance Administration: The length of hospital stay and the average cost of patients have been reduced.
According to the National Medical Insurance Administration, under the new payment model, medical institutions in pilot areas actively control costs, reduce unnecessary diagnosis and treatment, medicine and consumable items, and improve the level of refined management.
Significantly reduces the burden of patients seeking medical care
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Long Xuewen, head of the Medical Security Management Center of the National Medical Security Administration: The hospital’s performance indicators such as medical efficiency and resource allocation have been significantly improved, with fewer mild cases, a steady increase in the degree of difficulty of hospitalized cases, and average cost per case.
It also declines year by year
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The reform of the medical insurance payment method will be rolled out to the whole country within three years.
At present, 30 cities across the country have launched DRG payment trials and 71 cities have launched DIP payment trials
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According to the three-year action plan, the payment method reform will be rolled out from 101 pilot cities to the whole country within three years
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Long Xuewen, head of the Medical Security Management Center of the National Medical Security Administration: The reform of payment methods plays a fundamental and guiding role in the process of medical reform
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By the end of 2024, all coordinated areas across the country will carry out payment method reforms
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By the end of 2025, the payment method reform should cover all eligible medical institutions that provide inpatient services
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