The reform of Guizhou's medical insurance payment method has achieved a win -win development of the "medical, insurance, and affected" three parties

In December 2020, the Provincial Party Committee and the Provincial Government issued the "Implementation Opinions on Deepening the Reform of the Medical Security System". /DIP payment method reform work, focus on giving full play to the role of medical insurance regulation of medical services, guiding the allocation of medical resources allocation, promote the high -quality coordinated development of medical insurance and medical services, and effectively reduce the burden on the cost of participating patients.

On July 28, the Guizhou Provincial Government Information Office held a press conference on the reform of the Guizhou Provincial Medical Insurance Payment Method to report the reform and promotion of the reform of medical insurance payment methods in our province.

Zhu Zhaolin, a member of the Party Group and Deputy Director of the Provincial Medical Security Bureau, introduced the relevant situation

How is the reform of the province's medical insurance payment method?

What goals and plans are there in the next step?

1. Strengthen organizational guarantee and form an overall reform of reform.

The Provincial Medical Insurance Bureau, together with the Provincial Department of Finance, the Provincial Health and Health Commission, and the Provincial Traditional Chinese Medicine Bureau, established the joint meeting mechanism of the reform of the Guizhou Provincial Medical Insurance Payment Method, strengthened the coordination and linkage of the department, and jointly solved the key difficulties in the reform of medical insurance payment methods. The overall, systematic, and synergistic "three medical linkage" reforms of medical insurance, medical care, and medicine to ensure the smooth and orderly advancement of payment methods. At present, 10 medical insurance coordinated areas in the province have fully launched the reform of the DRG/DIP payment method. Liupanshui City and Tongren City have implemented DRG payment methods. The remaining medical insurance coordinated areas have implemented DIP payment methods.

2. Strengthen coordinated advancement and promote the development of pharmaceuticals.

Fifteen national medical insurance information business codes are used in designated medical institutions in the province, standardized the homepage of the medical insurance case, and the completeness, qualification rate, and accuracy of the medical insurance settlement list are improved. At present, most of the medical institutions, CMI values, hospital medical case quality, and proportion of medical service revenue have increased. The consumption index and cost consumption index have been reduced.

3. Strengthen supervision and assessment and standardize medical services.

Improve the management of medical insurance service agreements, establish a supervision mechanism for advance, during, and afterwards, and coding the medical insurance settlement list and the homepage of the medical insurance case, the course record, and surgery records to ensure that the medical records are reasonably entered, avoid changing coding, high sets of high sets, high sets of high sets, high sets Entering the group and other situations occur. Taking Qiannan Prefecture as an example, after the DIP reform, the number of patients per capita hospitalization dropped from 9.3 days before the implementation to 8.4 days, down 9.68%. Essence

Fourth, strengthen policy connection to form a positive superposition effect.

Within the DRG/DIP policy framework range, the dominant disease of the hospitalization of traditional Chinese medicine is incorporated into the reform, and the value coefficient is tilted to support the inheritance and innovation development of traditional Chinese medicine. Coordinated the reform of the daily paid reform of the bed and the implementation of the total paid reform of the total number of medical communities in the county. Establish a centralized procurement system for pharmaceutical medical consumables, implement the "dual channel" management policy of national medical insurance negotiation drugs, combine the decline in the price of drugs and consumables, and appropriately adjust the weight of DRG/DIP diseases to guide medical institutions to rationally enhance medical income. Policy superposition effects are beginning to show.

In the next step, the Provincial Medical Insurance Bureau will continue to deepen the reform in strict accordance with the timetable and roadmap determined by the three -year action plan. By the end of 2024, all the province's medical insurance overall division will carry out the reform of DRG/DIP payment. Medical institutions that develop hospitalization services basically achieve full coverage of diseases and medical insurance funds, strive to achieve a win -win development of the "medical, insurance, and affected" three parties, and contribute to the high -quality development of the province's economic and social development!

Wonderful Q & A

CCTV reporter: The National Medical Insurance Administration issued the "Three -Year Action Plan for the Reform of DRG/DIP Payment Methods". What is DRG and DIP? What benefits can the implementation of DRG/DIP payment methods bring to the people?

Zhu Zhaolin, a member of the Party Group and Deputy Director of the Provincial Medical Security Bureau, answered questions from reporters

For a long time, the traditional medical insurance payment method in my country is to pay according to the project. In popular terms, it is based on all the drugs, medical service items, and medical consumables used in the diagnosis and treatment process. The parts that need to be paid. This medical insurance payment method is relatively easy to implement, but it is prone to excessive medical behavior such as "big prescriptions" and "big inspection".

DRG paid is to pay for groups related to the diagnosis of the disease. In other words, in accordance with factors such as disease diagnosis, severity of the condition, and treatment methods, patients are divided into related groups that consume similar clinical conditions and resource consumption. On this basis, medical insurance pays in accordance with the corresponding paid standards.

DIP payment refers to paid according to the diseased score. Use big data to combine the hospitalization case in accordance with the "disease diagnosis+treatment method" as a paid unit, combined with the total medical insurance fund to determine the payment standard for each disease, and to the hospital in accordance with this standard according to this standard Payment is a medical insurance payment method with Chinese characteristics.

The implementation of DRG/DIP payment methods will achieve a win -win development of the "medical, insurance, and affected". The first is to improve the efficiency of medical insurance funds and ensure the safe operation of the fund. The second is to guide medical institutions to strengthen clinical path management and improve medical technology services. The third is to reduce the burden of medical expenses for patients participating in the insurance and improve the medical experience. At the same time, with the in -depth advancement of DRG/DIP paid reform, the medical service capabilities of local medical institutions have continued to improve, and patients participating in insurance can get better treatment locally, thereby improving the patient's medical satisfaction and sense of gain. China Network reporter: The provincial government requires that the reform of the medical and health system should be continuously deepened, and the reform of the "three medical" linkage ("three medicine" refers to the abbreviation of medical insurance, medical care, and medicine) to improve the management efficiency of public hospitals. What are the measures in the process of deepening the reform of medical insurance payment in our province?

Yang Hui, Director of the Medical and Health and Medical Management Department of the Provincial Health and Health Commission, answered reporters' questions

Public hospitals will enhance the connotation of medical services in all directions and promote high -quality development. By promoting service models such as multi -disciplinary diagnosis and treatment, day surgery, and overall nursing of responsibility systems, the quality of medical services is improved. The point is to do the following aspects:

The first is to strengthen hospital capacity building. Efforts will be made to enhance key clinical specialty capabilities, create a number of regional key features clinical specialty groups, and enable the masses to enjoy high -quality medical services nearby.

The second is to strengthen the management of clinical restrictions on diagnosis and treatment. Supervise medical institutions to strictly implement the record system for restricting diagnosis and treatment technology, strictly implement diagnosis and treatment services in accordance with medical diagnosis and treatment specifications, and prevent "over -medical care".

The third is to promote the innovation of medical service model. Always adhere to the "people's health as the center", innovate service concepts, actively promote multi -disciplinary joint diagnosis and treatment, inspection and inspection results mutual recognition, day surgery, high -quality care, etc., and continuously optimize the service process.

The fourth is to strengthen comprehensive supervision. The nine criteria for the integrity of medical institutions and their practitioners are used as rigid requirements and discipline red lines; adhere to the large -scale hospital inspection system, severely crack down on the industry's illegal and illegal acts, and form a strong deterrent.

The fifth is to strengthen the internal management of the hospital. Supervise and guide medical institutions to establish and improve the management system of modern hospitals, improve the hospital articles of association, strengthen refined management, accelerate the construction of smart hospitals, and enhance the new momentum of high -quality development of public hospitals.

Sixth, strengthen the construction of hospital information. Supervise medical institutions to establish integrated hospital management platforms such as business operation, performance assessment, financial management, and cost accounting, promote the medical service process and service model with electronic medical records as the core, further improve the level of clinical paths and homepage management, and constantly standardize medical care Service behavior.

Through efforts, continue to improve the modern management level of medical institutions in the province, improve the level of medical capacity in the province, standardize medical services, promote the high -quality development of medical institutions, and provide the masses with more high -quality and efficient medical services.

Guizhou Daily Reporter: Liupanshui City People's Hospital, as a DRG paid national demonstration hospital determined by the National Medical Insurance Administration, what results have been achieved since the implementation of DRG paid in 2019?

Lang Qinghua, deputy secretary of the Party Committee and Dean of Liupanshui City People's Hospital, introduced the relevant situation

Since the pilot of DRG paid reform in Liupanshui City People's Hospital in 2019, the quality of medical services in the hospital has been further improved on the one hand. Through DRG paid reform, the hospital focuses on adjusting the cost structure, reducing operating costs, and improving the overall service capabilities of the hospital. The CMI value, DRG disease group usage rate, and the proportion of third- and fourth -level surgery have increased year by year. promote. The hospital conducts performance reforms with DRG as an important indicator. It has implemented excellent work and excellence, excellent performance, and greatly enhance the enthusiasm of medical staff to participate in reform. In 2021, the hospital's medical income increased by 12.9%, and the per capita income of employees increased by 8.1%.

On the other hand, hospital medical insurance management capabilities have been further improved. The application of DRG paid management mechanisms, strengthen medical insurance standardization and standardized management, control the unreasonable expenditure of medical insurance funds, and ensure the safe use of medical insurance funds. The expenses of policy scope dropped from 8.3%to 7%; the average hospitalization costs from January to June 2022 decreased by 518.83 yuan compared with the same period of 2021, a decrease of 5%, and effectively reducing the burden on patients' medical treatment. In other words, while promoting the high -quality development of hospitals, the reform of medical insurance payment has really benefited from participating patients.

Reporter of Guizhou Radio and Television: It was just mentioned that the provincial level, Guiyang, and Anshun City will uniformly carry out the DIP payment method reform. What preparations do the Guizhou Provincial People's Hospital have done to promote reform?

Liu Jian, Secretary of the Party Committee of Guizhou Provincial People's Hospital, introduced the relevant situation

The reform of the DIP payment method is coexisting for opportunities and pressure for hospitals. From the perspective of opportunities, it is conducive to promoting the development of the hospital priority, attach importance to the connotation construction of the hospital, and strengthen refined management. In terms of pressure, the reform of the payment method has promoted the quantification and comparison of medical behavior, and put forward higher requirements for the professional and technical capabilities of medical staff.

Provincial People's Hospital attaches great importance to the reform of DIP payment methods and has made corresponding preparations.

The first is the initial formation of connotative development layout. We firmly seize the opportunity for the establishment of the National Regional Medical Center, and strive to create a new pattern of the Guanshan Lake Hospital, the Guizhou Women's Children's Hospital, and the Guizhou Provincial Emergency Clinical Cost Center (National Emergency Rescue Base). The connotation layout of quality cities medical, disciplines, scientific research and teaching mutual integration. The national tertiary public hospital's performance assessment, the Provincial People's Hospital has ranked the top 100 in the country for three consecutive years. Second, the effectiveness of discipline construction is obvious. Our hospital has 5 national key specialist specialists and construction projects, 1 key laboratory of the National Health and Health Commission, 16 provincial key disciplines and colleges, 1 provincial key specialty college, 1 academician workstation and post -doctoral scientific research workstation, provincial provincial province 9 scientific and technological innovation talents, 3 provincial branch centers of the National Clinical Medicine Research Center, 4 provincial clinical medical research centers, 6 provincial talent bases, 15 provincial medical quality control centers, 29 inpatients standardized training professional bases Essence Internal, breathing, orthopedics, and outside the heart have entered the top five in the Southwest District Specialty Rankings of the Southwest District of Fudan University Hospital Management Institute for 4 consecutive years.

Third, the talent team continues to grow. There are currently 4,431 employees in our college, including 815 senior titles, 274 doctoral degrees, 172 doctoral and master tutors, and national health family planning has outstanding contributions to young and young experts, provincial core experts, provincial management experts and experts in government special allowances. 41 people.

Fourth, the basic conditions for reform are good. In recent years, our hospital has continuously strengthened operations and management, vigorously promoted the construction of informatization and standardization, completed the overall upgrade and transformation of the information system of the entire hospital, and formed a full quantity and real -time data concentration. It can provide data support for scientific research, clinical, and operations. We believe that as one of the leading hospitals in Guizhou Province, the Provincial People's Hospital will be able to play an example and leading role in the reform of the payment method.

Reporter of Guizhou Health Daily: As one of the first batch of reform pilot medical institutions in Qiannan Prefecture, Junan County Traditional Chinese Medicine Hospital has achieved excellent results in the DIP paid pilot reform of Qiannan Prefecture in 2021. As a county -level traditional Chinese medicine hospital, how can Lu'an Traditional Chinese Medicine Hospital stand out in the reform of medical insurance payment? Do you think grass -roots medical institutions meet the requirements of reform and development?

Song Yan, Dean of the Traditional Chinese Medicine Hospital of Jianan County, Qiannan Prefecture, answered questions from reporters

In the promotion of DIP payment reform, our hospital closely focused on the reform of "one main line, two guarantees, three enhancements, and four hardware".

The first is the main line of quality management of the homepage of the medical case.

By formulating the quality control standards for the homepage of the medical case, filling out the training of the homepage of the medical case, the quality inspection and feedback of the homepage of the medical case, the improvement of the quality of the homepage of the medical case, continuously improve the quality of the medical homepage, and ensure that the quality of the uploading data meets the medical insurance requirements.

The second is to organize coordination and ideological understanding of the "two" guarantees.

Established a DIP work leader group with the party committee secretary and dean as the dual group leader to set up a special work class to improve the three -level DIP work meeting of the hospital, department, and group level in layers to achieve strong organizational guarantee. At the same time, through extensive publicity and launch, carrying out special training, unified ideas, improve employees' understanding of DIP work, and ensure that ideas recognize it.

The third is to strengthen the talent team, institutional system, and business capabilities.

To strengthen the construction of talent teams through the staffing of Qiangqiang Medical Insurance Section, Quality Control Section, Case Room, and Information Section; improve the work plan, system and standards related to DIP management, and strengthen the construction of the system and system; Teaching "and other methods to carry out training to enhance the DIP business capabilities of medical staff.

The fourth is to pay close attention to informatization, clinical paths, supervision and inspection, and performance assessment.

Further regulate clinical diagnosis and treatment, improve medical service capabilities, reduce medical costs, ensure the safety of medical insurance funds, and realize the "five liters and four drops" of medical insurance energy efficiency management. That is: the first page pass rate of the hospital's medical case is 86%, an increase of 43%year -on -year, and the income of medical services accounts for 45.6%, an increase of 2.8%year -on -year. A year -on -year increase of 20.4%, patient satisfaction of 95.6%, an increase of 9%year -on -year, the medicine proportion of 17.6%, a decrease of 0.8%year -on -year, 7.5%, a year -on -year decrease of 0.8%, the test and inspection accounted for 18.11%, a decrease of 1.3%year -on -year, and the year -on -year decrease of 1.3%. The average hospitalization date was 7.3 days and a year -on -year decrease of 0.4 days, achieving the goal of win -win development of the "medical, insurance, and affected".

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