Xiamen set up a new model of health care governance to curb the rapid growth of medical expenses

Medical network January 26th, how to curb the rapid growth of medical expenses, ease the people to see a doctor difficult to see expensive? How to prevent passive purchase of health insurance and fraudulent insurance? In this regard, Xiamen City to carry out useful exploration, taking the lead in establishing the "Tnity" health care modernization governance model.
According to Xiamen officials revealed on the 25th, Xiamen continued to promote payment innovation, drug innovation, regulatory innovation, saving and saving nearly 1 billion yuan per year of the health insurance fund, the last three years accumulated for enterprises to levy nearly 5 billion yuan less medical insurance fees.
For minor hospitalization, minor illness treatment, decomposition of hospitalization, serious illness push, fund abuse and other issues, Xiamen based on the national medical insurance coding standards, the use of big data, in the inpatient and outpatient areas of the country's first disease catalog, a set of value-based payment standards, a set of payment evaluation system, the first to establish an efficient "total budget under the points method" payment mechanism.
In the past, medical insurance and hospital settlement mainly adopted the "quota-based, single-disease-based" approach, to a certain extent, to play a fee control effect, but did not consider the difficulty of disease, treatment methods and other differences, and clinical reality out of touch.
this end, Xiamen will be the city's 706 medical institutions in the past 3 years more than 1 million cases objectively classified as 4473 diseases, to achieve clinical cases and diseases between the payment method of information conversion.
related people said that the "score" of major diseases is high, minor illness is "score" is low, to achieve the quantitative value of diseases.
to the high set of points, abnormal cost growth of the hospital to remind, interview, the serious violation of the circumstances caused by the audit department for inspection and treatment, the end of the year will be the illegal income of the medical insurance fund withheld.
, the number of local insured people in Xiamen has dropped by 27%, patients have been discharged from hospital, decomposition and hospitalization have improved significantly, and the number of complaints has decreased by 90%.
In order to solve the dilemma of inflated drug prices, Xiamen has established a new mechanism for centralized procurement of drugs by the three departments of medicine, medical insurance and medicine, promoted the implementation of the centralized drug procurement policy, and promoted the effective convergence of the joint procurement platform, electronic settlement system and electronic payment system in Fujian Province, so as to realize the link between the medical insurance department and the medical insurance department. The direct settlement of drug purchase prices of distribution enterprises, the first national organization of centralized drug procurement and use of regulatory platform, to achieve production enterprises, distribution enterprises and hospital-side system data convergence, the application of big data and drug distribution, procurement, settlement, inventory, the use of the whole process of integrated supervision and integration.
In addition, in response to the health insurance management "many points, wide, long chain", false medical treatment, drug resold and other issues, Xiamen took the lead in the establishment of health insurance big data supervision system, has been a total of 12 cases of fraud across the country's 8 cities.
, Xiamen has taken the lead in establishing intelligent authentication system and intelligent video surveillance system, taking the lead in innovative drug packaging disposal methods.
among them, intelligent identification system will face identification nuclear body technology applied to the field of medical insurance supervision to ensure medical authenticity, intelligent video surveillance system has covered all the city's medical institutions below the first level more than 300, crack the problem of forensic difficulties.