Discussion 丨 What are the relationship between the reform of the medical insurance payment method?

The reform of the medical insurance payment method is an important part of deepening the reform of my country's medical security system. Since the establishment of the State Medical Insurance Bureau in 2018, the reform of the medical insurance payment method has accelerated significantly, the reform coverage of DRG, DIP and other payment methods has continued to expand, and the average growth rate of diagnosis and treatment costs has been significantly controlled. The burden of hospitalization was relieved. Under the background of the slowdown in the growth of medical insurance funds under the influence of the new coronary pneumonia, the reform of medical insurance payment methods is not easy.

However, while achieving achievements, there is certain concern for reform.

First, the growth rate of medical insurance funds and the increasing control of the growth rate of medical expenses. At present, the risk control of the medical insurance fund is good, but the medical expenses are still growing rapidly. According to the data of the "China Health and Health Statistical Yearbook", since 2010, the growth rate of medical expenses of medical and health institutions has maintained more than 10%(2020 due to epidemic causes due to epidemic causes. A negative growth).

Second, the outpatient and hospitalization cost control is unbalanced. The growth rate of hospitalization expenses is relatively good. In the context of the medical insurance payment method, the outpatient and hospitalization expenses of medical institutions are undergoing structural changes in outpatient and hospitalization expenses. Rising again.

The third is the imbalance of paid reform and the progress of payment reform. At present, the progress of the reform and payment reform is relatively lagging, leaving room for the risk of the transfer of the supplier. According to the "National Health Finance and Finance Annual Report", the proportion of medical insurance funds in public hospitals continues to rise from 2011 to 2018. After 2019, 2019, and after 2019, 2019 The downward trend has emerged for two consecutive years.

Fourth, the flow of patients and medical insurance funds has not improved significantly. The proportion of patients using high -level hospitals is still rising. Patients have rebounded rapidly after the epidemic control is controlled after the epidemic control.

Fifth, there is still much room for improvement in the reform of medical insurance payment methods and supply -side structural reforms. On the one hand, the structural reform of the supply side of health services is relatively lagging, and the diagnosis and treatment service capacity of grass -roots medical and health institutions is slowly improved, which is not conducive to guiding residents to sink to the grassroots at the grassroots level. On the other hand, during the reform of the medical insurance payment method Patients pay attention to medical management, and lack the roadmap and timetable for advancing the first diagnosis of the grassroots.

The reform of the medical insurance payment mechanism is an important prerequisite for achieving the high -quality development of the medical insurance system. In response to the hidden concerns and problems in the reform process, it is urgent to strengthen system thinking and introduce the perspective of strategic purchase to promote reform.

In my opinion, the reform of the medical insurance payment mechanism in the future needs to deal with the following four pairs of relationships: one is to balance the medical insurance fund risk control and insured person's medical expenses control; Gradually realize the balance between outpatient guarantee and inpatient protection proportion; third, we must adhere to the work of the hospital with the grassroots level, strengthen medical management, coordinate the structural reform of the supply -side supply side of medical and health services, explore the establishment of an incentive restraint mechanism of orderly medical treatment, optimize the flow of patients and medical insurance Fund flow; Fourth, the reform of payment methods that accelerate the prepaid system and supplemented by the post -payment system. These four pairs of relationships are not only the core elements of my country's medical insurance payment mechanism reform, but also an important part of medical insurance to achieve strategic purchase. Balance the above four pairs of relationships will help further deepen my country's medical insurance payment mechanism reform and achieve the high -quality development of my country's medical insurance system.

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