These two medical insurance payment methods will be spread out at the end of this year in Guangdong

Yangcheng Evening News reporter Chen Hui reported: On the 4th, the reporter learned from the official public account of the Guangdong Medical Security Bureau that Guangdong has fully launched the reform of DRG/DIP payment methods. On the basis of the continuous consolidation of the reform results launched in the early pilot cities, the rest of the city This year, all DRG/DIP payment reforms were carried out. By the end of this year, the DRG/DIP payment method will cover all designated medical institutions in the province. Compared with traditional payment methods, the new payment method is conducive to reducing excessive medical phenomena such as "big prescriptions" and "big inspection" and improving the effectiveness of medical insurance funds.

What is "DRG paid" and "DIP payment"?

It is understood that the basic medical insurance payment methods in my country are mainly as follows: paid by service items, paid by service unit, paid by the first disease, paid by single disease, paid by DRG (DRG) according to disease diagnosis, and disease types, according to the disease type Pay (DIP) pay. Among them, paying according to service projects is the earliest and most widely used payment method.

"DRG Paid" refers to paid according to the diagnosis of disease diagnosis, and divides the disease in accordance with the degree of severity, the complexity of the treatment method, and the different groups of treatment costs into different groups, and formulate medical insurance payment standards. Generally speaking, the more severe the disease and the more complicated the treatment, the higher the medical insurance payment standard.

"DIP payment" is paid according to the type of disease. It uses big data to use the combination of "disease diagnosis+treatment" as a paid unit, combined with the total amount of medical insurance funds to determine the payment standard for each disease, and to the hospital according to this standard according to this standard Pay.

What are the benefits of new payment methods?

Compared with traditional payment methods, what are the benefits of "DRG Paids" and "DIP Paids"?

"DRG Paids" and "DIP Paids" are different from traditional payment. It is a more scientific and more fine medical insurance payment model. By guiding the hospital to strengthen the standardized management of clinical medical behavior, save costs increase output, increase the use of medical resources, efficiency. It is conducive to reducing excessive medical phenomena such as "big prescriptions" and "big inspection", and improving the effectiveness of medical insurance funds.

The advancement of the reform of the payment method not only improves the efficiency of medical insurance funds, controls the unreasonable increase in medical expenses, and enhances the cost awareness of medical institutions. It also plays a role in regulating the medical service market to a certain extent. Cosmetic pattern. It has effectively promoted and supported the healthy development of medical care. The sense of medical treatment has been significantly enhanced. It has taken a solid step on the road to achieve high -quality development of hospitals, high -quality medical insurance, and high -quality medical treatment.

Guangdong will achieve full coverage two years in advance

At present, 6 pilot cities including Guangzhou, Shenzhen, Zhuhai, Shantou, Foshan, and Heyuan have completed the national DRG/DIP pilot tasks. In addition to Shanwei selected the "DRG paid" model in other cities, Huizhou, Maoming, Jiangmen, Zhongshan, Zhanjiang, Zhanjiang Wait for the city to choose the "DIP payment" model to comprehensively promote reform.

The National Medical Insurance Administration deployed the "Three -Year Action Plan for Reform of DRG/DIP Payment Methods" at the end of 2021, requiring that by the end of 2024, all the overall regions of the country will carry out the reform of DRG/DIP payment methods. By the end of 2025, the DRG/DIP payment payment is by the end of 2025. Methods cover all eligible medical institutions that conduct hospitalization services. Based on the continuous consolidation of the reform results of the pilot cities launched in theinian, the rest of the city will carry out the reform of DRG/DIP payment methods this year, which will achieve full coverage two years in advance.

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