The consideration behind the Beijing Medical Insurance New Deal?Interview with Zheng Jie, the leader of the National Medical Insurance DRG Technology Guidance Team

"The main role of DRG is to standardize medical behavior. Supporting medical innovation is‘ icing on the cake ’, but it cannot erase its most basic 'sending charcoal in the snow'."

"According to the international maturity experience, it must be surrounded by the main plan of DRG, and various supporting measures are gradually formed to escort it."

"In the end, the payment standard can be used, it should be very different, not a large range."

Recently, the Beijing Medical Insurance Bureau issued the "Notice on Printing and Distributing CHS-DRG Pay New Drug New Technologies Except for Payment Management Measures (Trial)" (hereinafter referred to as except payment). Essence

As soon as the news came out, it was like a flood discharge action that made the innovative drug industry ushered in a long -lost "Ganlin".

However, everything cannot be separated from the essence, and if you want to correctly understand the new policy, you must think about the meaning of deeply behind.

DRG is one of the important management tools carrying the development of the entire medical industry:

On the one hand, through big data summary decisions, withdrawn from people's pricing, scientifically and reasonably distribute medical resources, and accurately control the use of overall medical insurance funds.

On the other hand, effectively guide continuously optimizing medical services, from enterprises to hospitals, and step by step to deeply guide the value medical orientation of all industries in the future.

It is precisely because of such an important role that DRG has become "the top of the industry". Every move has attracted much attention, and even many times have been over -interpreted. What needs to be correctly understood is that as a policy that maintains the same frequency as clinical needs, DRG must also evolve continuously. A perfect way to pass, rather than a signal, it is a kind of attitude that Beijing is the first step in the first step in the country's leading medical market.

As for how big this "export" is? What are the inherent considerations of review standards and threshold design? What will the Beijing New Deal's demonstration effect on the country? Mowing

Recently, Zheng Jie, the leader of the National Medical Insurance DRG Technical Guidance Group and director of the Beijing Medical Insurance Management Center, interviewed Zheng Jie, the above industry.

Zheng Jie is an expert in domestic DRG research. The process of participating in the formulation of the CHS-DRG grouping scheme throughout the process, deeply understanding the nature and meaning of DRG. In the face of the excitement of the policy of removal policies, he repeatedly reiterated that "to medicine for medicine An innovation leaves an exit is just an extension. You must not forget the essence of DRG. "

*For the original intention of loyal statement, this article is presented in the form of question and answer.

Considering the introduction of the New Deal?

Medical Trend: After the policy was introduced, the market seemed to be beaten with a strong needle. What do you think of this enthusiasm?

Zheng Jie: Indeed, many people think that this policy is good for medical innovation and great response, but I want to pull back a little bit. We cannot get rid of reality. The essence of DRG is to regulate medical behavior. The supporting mechanism is to leave a exit for medical innovation. This is just a extension of DRG.

Should medical innovation should be supported. However, supporting medical innovation is not a medical insurance department, or a DRG policy can be done, which requires the coordinated advancement of the entire regulatory authority.

Medical Trend: What does the extension you mentioned mainly refer to?

Zheng Jie: It is very simple. DRG is actually a tool to collect medical behavior by big data. Find the rules in historical data, and organize medical behavior; then use historical data as a reference to form payment standards.

Therefore, DRG's grouping standards are very historic, but medicine cannot be unchanged. It must be developed and progressive. There will be newly developed medicines, consumables, and technologies. This is one of them.

Second, with the expansion of the scope of protection, the State Medical Insurance Bureau will benefit the people every year to increase new reimbursement medicines, such as rare diseases, tumor targeted drugs, etc. The law. What should I do if these new rules do not apply to the DRG formed based on historical data? Therefore, it is necessary to give an ex -payment policy that allows new products to show its possibility of new formation of the law, allowing the market to fully verify it, accept it, and run into it.

Medical trend: Before Zhejiang and Guangdong, other places have also issued some policies to remove payment. Beijing is not the first, but it is the most systematic. How do you consider the time point of the introduction?

Zheng Jie: The reason why it is introduced is mainly because the construction of the DRG system has reached this step.

DRG is imperfect. According to international maturity experience, it must be gradually formed to escort it around the main plan. It may cause policy -oriented to enlarge its defects, and it is also due to prevention of prevention.

What are the thinking of design review standards?

Medical Trend: The point you just mentioned, when formulating the application threshold, such as the three years of listing, improving the clinical effect, and the standard of payment standards for the DRG disease group, have it been considered to be considered?

Zheng Jie: Yes, because we know what the purpose is, we have set up these conditions to make the except more meaningful instead of deviating from the essence of DRG.

For example, one of our conditions is to pass clinical arguments. What is it? There are a lot of medical innovation. If you want to use the perspective of encouragement, you should invest all, but in fact we cannot use the money of so many people to encourage innovation. Therefore What are meaningful and innovative, and for those pseudo -innovation, we do not want it to occupy the share. The point of the expert demonstration is here. Medical Trend: How to ensure fairness and justice in the process of demonstration.

Zheng Jie: The first point is that if the experts release the water, it is equivalent to losing their future costs. Products that are meaningless are now put in. Under DRG, once it exceeds it, it will be borne by themselves.

The second point is that in addition to experts demonstrate, we also need to see big data -whether the DRG grouping and standards formed by historical data include this medicine tool technology.

If the original historical data has been included, it proves that it is within our calculation range and standards, and it will definitely not pass.

There is also a situation that the current products and technology have replaced the previous one, but there is no big cost difference. For example, low -value and easy -to -consume and drugs, there is no need to remove. product.

Medical Trend: Do you calculate before introducing the policy. How many innovative products and technology can we meet the requirements?

Zheng Jie: It is now in the judging stage, and it is unknown. There is no way to give accurate quantification, but our control is very strict. In the end, those who can pass the payment standards in the end should be extremely different. It will not be a large scale. of.

The main role of DRG is standardized behavior. Supporting medical innovation is "icing on the cake", but it cannot erase its most basic function "sending charcoal in the snow".

Therefore, the role of payment is not so great. We just regulate the clinical behavior, respect the laws of the real clinical development in the future, and give a reasonable release of space.

If you want to give it too much expectations, DRG will taste, and you can't go, because it is contrary to the original intention.

Medical Trend: How to pay for innovative products and technical plans incorporated this time?

Zheng Jie: This is important. Except for payment, it is not within the DRG packaging fee, and can be charged separately and paid separately. However, it does not change the policy and regulations of the State Medical Insurance Bureau. Class A is Class A, and Class B is Class B, and Class C must pay at its own expense.

It must be emphasized that except for payment does not mean that they are included in reimbursement. This is not a concept. It is just that it is not within the scope of the packaging. The management regulations and reimbursement policies are still the same.

Medical trend: Some doctors have given feedback before. After DRG's execution, doctors in patients with severe illnesses have a headache. If they receive it, the cost is too high; if it is not accepted, it is to push patients. So, is there any except for patients with severe illness?

Zheng Jie: Yes, special cases are also one of the key directions of this policy. At the end of the year, we will calculate a account, remove special cases in proportion to relieve the worry of doctors and hospitals.

Except for payment, is it universal?

Medical Trend: Beijing's status in the domestic medical market is still very special. Some people have proposed that the payment policy is barely barely except for medical insurance funds. What do you think of this?

Zheng Jie: Yes. I think that according to the work deployment of the State Medical Insurance Bureau, it will definitely expand, but it may not form nationwide. Beijing's medical resources are relatively concentrated and have strong innovation capabilities. Generally speaking, the leading and backward medical market is 5-10 years, so there is a demand for removal payment.

For other smaller medical markets, one that cannot be cured is sent to Beishangguang, and there is no such demand.

The second is that the demands of different regions are different. It may be a general demand in the country, except for the relatively leading and academic medical markets such as Beishangguang. However, in the non -ultra -large medical market, many contents need to be used in first -tier cities have been put into clinical use.

Therefore, this is a very regional work. We do not encourage the scope of active expansion. The more the better, but the except the actual needs.

Medical Trend: Can Beijing the first to introduce the new policy, can it be regarded as a signal of the Medical Insurance Bureau -is gradually making up for the defects of DRG?

Zheng Jie: Instead of the release of the signal, I prefer to interpret it to release an attitude -DRG is not only restricted, but also a guidance effect. It is a scientific system, which is matched with the objective laws of medicine, and we have an attitude of traveling with medical progress.

This orientation significance is more significant than the substantive meaning for Beijing.

Face -oriented positive cycle?

Medical Trend: Beijing's current application materials have been collected. When can the fastest time be started?

Zheng Jie: After receiving the materials, we need to demonstrate the data. After a month, the trial is estimated to be in the fourth quarter.

Medical Trend: From the perspective of foreign experience, such as Germany, there is a complete payment from except to dividends to the long -term payment of DRG in the future. Will our policy also have such mechanisms?

Zheng Jie: I will definitely. After 2-3 years, we fully release the laws and have enough data to accumulate. Let's pack the grouping and return to the process of standardization.

Medical trend: Even after the perfect policy is landed, various problems will be encountered. What do you think is the biggest challenge after this policy landing?

Zheng Jie: That is the gap between the high expectations of the market and the actual effect.With high expectations, it is found that our essence is not like this, and there may be gaps. This is the difference between market demand and our actual ability, a eternal contradiction.Medical Trend: To what extent do you think this policy is implemented, can it be said that it has achieved a successful orientation role?

Zheng Jie: Go for pseudo -savings.Through this policy, if you can regulate medical behavior, you can find the clinical direction of future development and fulfill the real clinical value, and I think it will be successful.

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