The national version is released according to the paid catalogue of diseases! Tumor and orthopedics are focused on

Source: from February 26, 2018 to February 27, 2018, the website of the Ministry of human resources and social security issued the notice of the general office of the Ministry of human resources and social security on Issuing the recommended catalogue of diseases paid by disease of medical insurance (hereinafter referred to as the notice), and recommended the recommended catalogue of diseases paid by disease of medical insurance (hereinafter referred to as the catalogue) According to the reporter, the catalogue covers 130 diseases, including routine treatment of gallstones, internal and external hemorrhoids, varicose veins of lower limbs, as well as large-scale operations such as total knee replacement, total hip replacement and repair of atrioventricular septal defect The contradiction of medical insurance payment in orthopedics, oncology and cardiovascular diseases is prominent, and the huge pressure of fee control leads to the concentration of the number of payment methods by disease, including 23 orthopedic diseases, 22 tumor diseases, 16 heart and vascular diseases The total number of treatment methods in the three fields accounts for more than 45% of all diseases The catalogue of recommended diseases of medical insurance paid by disease is proposed by the notice for local reference It is the reform task proposed in document 55 to focus on the implementation of paid by disease It is of great significance to improve the payment mechanism and benefit regulation mechanism of medical insurance, regulate medical service behavior, guide the rational allocation of medical resources and control the unreasonable growth of medical expenses Human resources and social security departments at all levels should attach great importance to the comprehensive implementation of multiple and compound medical insurance payment based on payment by disease, gradually expand the implementation scope of designated medical institutions and improve the coverage of payment by disease on the basis of strengthening the budget management of medical insurance fund The notice further requires that all localities select diseases with clear diagnosis and treatment plans and admission standards, mature diagnosis and treatment technology, stable clinical path and little difference in comprehensive service cost to pay by disease based on the recommended directory of payment by disease, and all localities shall determine that no less than 100 diseases should pay by disease The catalogue mainly provides disease selection for each region On this basis, each region can reasonably determine the range of paid diseases according to the actual situation of medical insurance management level and medical technology development In addition, the notice also made it clear that all localities should establish a dynamic adjustment mechanism for the payment standards of medical insurance paid diseases, adjust the payment standards of medical insurance in time according to the changes in medical prices and the application of appropriate technical services, as well as the evaluation results of the operation of medical insurance funds, and actively prevent the operation risks of the funds; make full use of the information system for medical institutions, patient groups, and diseases carrying out the payment by disease Monitoring and analysis shall be carried out for the scope and cost of diseases, and the payment for diseases by designated medical institutions shall be included in the scope of management and assessment of designated service agreements, and the supervision of medical service behaviors shall be strengthened to ensure the quality of medical service, so as to avoid problems such as prevarication of patients, decomposition of hospitalization or insufficient treatment High pressure of adjuvant In fact, since June last year, Jiangsu Provincial Department of human resources and social security and provincial health and Family Planning Commission issued the guidance on the integration of urban and rural residents' basic medical insurance system operation and management, and launched the implementation of the reform of national medical insurance payment, all provinces in the country have successively issued documents, and introduced the implementation plan of payment by disease, including the number of diseases, the medical institutions implemented and the time limit for implementation The cost control effect of pay by disease has a profound impact on the pharmaceutical industry Previously, in an interview with the reporter, experts in the industry told the reporter: "paying by disease type and remaining balance will urge medical institutions to actively control costs If the standard of disease payment is 5000 yuan, the cost of the hospital is 4000 yuan, and the hospital can obtain 1000 yuan of profits However, if the traditional payment by project is still adopted, the hospital wants to earn 1000 yuan of profits, and the possible consumption of resources will exceed 8000 yuan Yuan " It can be seen that the core goal of payment by disease is to comprehensively use the payment lever of medical insurance and optimize medical behavior, so as to reasonably control the cost under the premise of ensuring the quality of medical service Medical insurance pays according to the standard of disease type Each disease has a standardized diagnosis and treatment management path, that is, from the patient's admission to the clinical treatment standard discharge, the diagnosis, treatment, surgery, anesthesia, nursing, drugs, consumables and beds in the whole process have a clear and fixed cost criterion The new payment mode of medical insurance will make doctors and hospitals take the initiative to adopt the treatment mode of cost saving as soon as possible in the shortest possible time, so as to achieve the clinical satisfactory treatment effect and improve the overall service performance Otherwise, if the overspending part of medical insurance and patients refuse to compensate and pay, the final cost will inevitably fall on the medical institutions The fundamental change of this payment method will force the pharmaceutical industry to re-examine the value chain of products It is not difficult to predict that, in the context of payment by disease and prepayment of total amount, adjuvant drugs with small clinical risk and no substantial clinical effect will face greater market pressure.