"Taste" DRG payment in 30 cities including Hefei and Qingdao

Medical network may 22 news brewing for a long time, and finally has a phased progress On May 21, reporters learned from people familiar with the matter that on May 20, the National Medical Security Bureau held a video conference to launch the pilot work of DRG paying countries It is understood that there are 30 pilot cities in DRG payment countries Qingdao, Hefei, Xiangtan, Jinhua, Kunming and other places have been included in the pilot cities The full list will be published later   In fact, in June 2017, the former national health and Family Planning Commission held a pilot kick-off meeting on the collection and payment of fees by disease diagnosis related groups, announcing the public hospitals and three provinces and cities in three cities, namely, Shenzhen City, Guangdong Province, Karamay City, Xinjiang Uygur Autonomous Region, Sanming City, Fujian Province, the Affiliated Union Hospital of Fujian Medical University, the first hospital of Fuzhou City and the first hospital of Xiamen city The DRG pilot was carried out simultaneously in the level-2 hospitals The aforementioned people told reporters that since then, DRG payment country pilot work will be led by the National Health Insurance Bureau DRG is a method of classifying and grouping inpatients According to the severity of inpatients' condition, the complexity of treatment methods, the consumption (cost) of resources for diagnosis and treatment, as well as the complications, complications, age, hospitalization outcome and other factors, the patients are divided into several "disease diagnosis related groups", and the prices, charges, medical insurance payment standards, etc are determined in a package based on the groups Why are the pilot cities Qingdao, Hefei, Xiangtan, Jinhua, Kunming, etc? In December last year, the state health insurance bureau issued the notice on applying for the pilot program of payment by disease diagnosis related grouping countries, proposing that in principle, each province can recommend 1-2 cities (municipalities directly under the central government take the whole city as the unit) as national pilot candidate cities The pilot cities are required to have strong willingness to participate in DRGs payment mode reform or have carried out DRGs payment work The pilot cities' medical insurance information system has relatively uniform medical insurance drugs, diagnosis and treatment projects and consumables codes; it can provide complete, standardized and standardized medical insurance settlement data in the past three years At least 3 medical institutions in the pilot cities have the conditions to carry out DRGs based payment pilot And the above-mentioned cities have already practiced this For example, since January 1, 2018, Kunming has carried out the pilot project of group settlement related to disease diagnosis in five hospitals including Yan'an Hospital of Kunming, and achieved some results In 2018, the growth rate of medical insurance hospitalization expenses of urban employees and urban and rural residents in the five hospitals settled in pilot fell to 1.58% and 4.49%, respectively, down 4.97 and 4.29 percentage points compared with 2017 Jinhua City has launched the payment reform of "disease group points method" in 7 hospitals in 2016, and carried out the pilot of multiple composite payment reform Xiangtan City has previously unified the city's medical insurance information system, built an integrated medical insurance hospital system, and fully used the drug standard code management Some places have deployed the next pilot work Kunming, which has carried out pilot projects before, will set up a DRG payment pilot work leading group linked by provinces and cities to guide the overall planning areas to gradually unify the national standards in response to the outstanding problems in the reform process in accordance with the unified requirements of the national pilot In addition, Hefei will set up a DRG payment national pilot work leading organization headed by the municipal government, formulate the implementation plan of the pilot work, clarify the work objectives and tasks, and actively and steadily promote the pilot work, according to people.com According to the relevant person in charge of Xiangtan medical insurance bureau, by the end of September 2019, we will improve the supporting information system of medical insurance and medical institutions, improve the local DRG grouping work, start the simulation operation before December 2020, ensure that Xiangtan medical insurance fund will use DRG mode to make real payment in 2021, and make sure that the masses can get real benefits in the payment mode reform Led by the payer of medical insurance, the ability of fee control is stronger Although there have been local pilot projects before, the DRG payment country pilot project is still of great significance in the industry As early as 2017, the former national health and Family Planning Commission carried out DRG pilot work In the future, DRG payment country pilot work will be led by the National Health Insurance Bureau According to the institutional reform plan of the State Council, the new rural cooperative medical system of the former health and Family Planning Commission, the basic medical insurance and maternity insurance for urban workers and urban residents of the Ministry of human resources and social security, the price management of drugs and medical services of the national development and Reform Commission, and the medical assistance of the Ministry of civil affairs are all included in the scope of responsibilities of the medical insurance bureau Zhao Heng, founder of latitude health, a medical consulting company, believes that the former national health and family planning commission does not represent the payer of medical insurance, so it is impossible to predict the future trend through the relevant pilot, and the pilot of medical insurance bureau has a strong trend significance in the future In addition, the work is led by the payer of medical insurance, with stronger ability to control fees Zhao Heng said that DRG is a package payment, which will promote the cost control of hospitals, so as to change the current extensive management mode and carry out refined hospital management For pharmaceutical companies, it mainly limits the use of drugs The same is true for consumables and inspection, because package payment means that drugs and inspection can not be used as unrestricted as before, and the specific dosage shall be calculated for each operation, which will limit the use of drugs and consumables Liu Zhichen, a senior DRG expert and a postdoctoral in public management of Fudan University, also pointed out that the medical insurance bureau is positioned as the main purchaser of medical services, so as to better play its decisive role in the development of the medical service system and the allocation of health resources Therefore, what the medical insurance bureau should study and formulate is not its own department level DRG standard, but a unified top-level design scheme at the national level At the same time, Liu said that the DRG related achievements previously led by the former national health and Family Planning Commission were not in conflict or contradiction with the pilot and this work The previous research on DRG will be valuable for the construction of the standard system and the exploration of the payment system of the medical insurance bureau.