The reform of medical insurance payment is accelerated, and many provinces issue action plans

Following the release of the "Three-Year Action Plan for the Reform of DRG/DIP Payment Methods" issued by the National Medical Insurance Administration in November last year, up to now, Shaanxi, Fujian, Anhui, Liaoning, Inner Mongolia and other provinces have successively issued three-year actions for the reform of DRG/DIP payment methods.
Plan to further clarify the implementation of the reform of medical insurance payment methods
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For example, in the plan of Gansu Province, it is proposed to start the reform of DRG/DIP payment method from 2022, and by the end of 2024, to achieve full coverage of DRG/DIP payment method in 14 cities, prefectures and the provincial level and Gansu mining areas
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In 2025, a new medical insurance payment mechanism covering all designated medical institutions carrying out inpatient services will be formed, which will be unified across the province, linked up and down, coordinated internally and externally, standardized, and efficient
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In addition, Gansu Province also stated that it will actively carry out exploration and innovation in five aspects: "full coverage, building mechanism, laying foundation, promoting collaboration, and strengthening research", extracting experience, and summarizing and promoting
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By the end of 2022, the province's 17 co-ordination areas will comprehensively carry out the DRG/DIP payment method reform to achieve full coverage in the co-ordination areas; by the end of 2023, all co-ordination areas will basically achieve full coverage of eligible medical institutions, diseases, and medical insurance funds; by the end of 2024, basically Establish a new medical insurance payment mechanism that is unified across the province, linked up and down, coordinated internally and externally, standardized, and efficient
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It is understood that, in fact, the so-called DRG payment refers to payment according to disease diagnosis-related groups.
It divides patients into diagnosis-related groups with similar clinical symptoms and resource consumption according to factors such as disease diagnosis, disease severity, and treatment methods
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On this basis, medical insurance pays according to the corresponding payment standard
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The DIP payment is paid according to the score of the disease.
Under the total budget mechanism, the point value is calculated according to the total annual medical insurance payment, the proportion of medical insurance payment and the total score of the cases of each medical institution to form a payment standard.
Standardize payments
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In recent years, in order to ensure the healthy and orderly development of the pharmaceutical industry, China has been accelerating the reform of medical insurance payment
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Since 2019, the National Medical Insurance Administration has successively launched the national pilot of DRG payment in 30 cities and the national pilot of DIP payment in 71 cities..
In December 2021, the National Medical Insurance Administration identified a batch of DRG/DIP demonstration cities, and a total of 32 regions were included in the list
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In the "Three-Year Action Plan for DRG/DIP Payment Method Reform", it is clearly stated that from 2022 to 2024, the task of DRG/DIP payment method reform should be fully completed to promote the high-quality development of medical insurance
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By the end of 2024, all coordinating regions across the country will carry out the reform of DRG/DIP payment methods, and pilot areas will be launched in the early stage to continuously consolidate the reform results; Diseases and medical insurance funds are fully covered
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At present, judging from the action plans issued by the provinces, localities have also refined some reform measures according to the actual situation
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In addition, it is worth mentioning that the pace of reform in some regions is relatively tight, and the time plan may be faster than the basic requirements of the National Medical Insurance Bureau
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Of course, it should be noted that under the reform, the new medical insurance payment method will also put forward higher requirements for the medical equipment and consumables industries
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In this regard, the industry believes that under the premise of ensuring the effect of diagnosis and treatment, high cost performance will become the main demand of the market
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At the same time, domestic substitution in the medical industry will continue to heat up, and the cost-effective advantage of domestic devices may become more prominent
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