At the same price of the same cities, Shandong uniformly packed and paid for the processing procedures in accordance with the disease

Shandong Unified Package Paper Paper Payment Regulations

Payment of the same disease to implement the same price in the same city

Since Shandong launched the pilot work of the disease -related group (DRG) in 2019, the cities have actively explored and practiced and achieved initial results. In order to further promote the reform of the DRG payment method of our province, recently, the Provincial Medical Insurance Bureau issued the "Notice on Printing and Distributing the Management Regulations (Trial of DRG) Pay Medical Security (Trial)> (hereinafter referred to as the" Regulations " ), Formulate the province's unified processing procedures, guide the cities to implement the national and provincial DRG paid technical standards and process processing processes, and do a good job of DRG paid reform.

What is DRG paid? Popular explanation is that the patient's hospitalization treatment cost no longer pays according to the project, but is paid by the disease type. Each disease has a payment standard. Combined with the actual situation of DRG paid reform in our province, the "Regulations" further refined and improved on the basis of the national DRG paid regulations, and the applicability and guidance were stronger.

The "Regulations" clarify the total regional budget management. In accordance with the requirements of national technical specifications and three -year action plans, the total regional budget of DRG paid is clearly expressed in the rules and regulations. Reasonable allocation of medical resources.

Strengthen fund budget management. DRG paid shall be managed by separate budgets as a whole. Strengthen the management of the process, discover and respond correctly in time for the abnormal implementation of the possible budget progress and the large number of people's heads. Stable medical institutions expect to enhance the enthusiasm of medical institutions to participate in DRG paid reform.

Do a good job of work together. Make DRG paid reforms with other payment methods such as head, bed and day, etc., negotiating drugs "dual channels", centralized pharmaceutical consumables procurement, outpatient protection guarantee, long -term care insurance and other tasks to form a positive stacking effect The implementation of the implementation of DRG paid reform.

Promote the same price of the same city. Choose a DRG disease group with basic clinical paths, clear admission standards, and low treatment difficulty, set up the same medical institution coefficient, implement the "same city and the same price", and gradually expand Classified diagnosis and treatment to improve the performance of the medical insurance fund.

Strengthen audit and audit. Emphasize the key review of high -sets, resolving hospitalization, transfer of hospitalization costs, insufficient service, pushing heavy sufferings, etc., and improve and improve the cost review system that is adapted to DRG.

Carry out special assessment and evaluation of DRG paid. Indexs related to DRG will be incorporated into DRG special assessment, such as organizational management, institutional construction, service quality, data quality, cost control, and insured satisfaction, and simultaneously include the overall performance assessment and evaluation system.

Regular DRG operation monitoring. In terms of medical insurance fund expenditure, review supervision indicators, medical service capabilities, medical service efficiency, the structure of disease treatment, the structure of the disease type, and personal burden, etc. The influence is continuously improved and improved the management supporting measures and evaluation mechanisms. Evaluation should be performed every quarter, and annual evaluation is performed after the annual liquidation is completed.

Public related indicators. It is clear that the medical insurance department must disclose the core factors such as the medical institutions, weights, and coefficients, and operate parameters such as rates, average hospitalization days, average of examples, etc., and give full play to the role of medical institutions' active control of medical costs. Promote fairness and fairness in public and transparency, and guide medical institutions fair and orderly competition. (Zhang Chunxiao)

(Responsible editor: Nie Junqiong, Liu Yingjie)

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