Reform of the medical insurance payment method, the timetable for Guangdong 21

The reform of the medical insurance payment method is one of the core mechanisms to promote the "three medical linkage". The reporter learned from the Guangdong Provincial Medical Insurance Bureau that Guangdong Province has fully carried out the reform of DRG/DIP payment methods. Based on the continuous consolidation of the reform results of the pilot cities launched in advance, all the remaining cities have carried out the reform of DIP payment methods this year. By the end of 2022, the DRG/DIP payment method will cover all designated medical institutions in the province to carry out hospitalization services.

DRG/DIP payment will improve the efficiency of medical resources utilization

According to reports, at present, the basic medical insurance payment methods in my country are mainly as follows: paid by service projects, paid by service unit, paying according to the first disease, paid by single disease, paid by DRG -related groups (DRG), and illness according to the disease. Payment (DIP) payment, etc. Among them, paying according to service projects is the earliest and most widely used payment method.

DRG paid refers to paid according to the disease diagnosis of disease diagnosis. The disease is divided into different groups in accordance with the degree of severity, the complexity of the treatment method, and the treatment costs, 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 paid 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 medical insurance fund to determine the payment standard for each disease, and pay to the hospital according to this standard.

DRG and DIP payments are different from the traditional paid by the project. 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 and increase output, and improve the efficiency of medical resources. 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.

Reform of the medical insurance payment method, the timetable for Guangdong 21

At present, six pilot cities including Guangzhou, Shenzhen, Zhuhai, Shantou, Foshan, and Heyuan have completed the national DIP and DRG pilot tasks. Other cities have selected one of them (see the figure below) to comprehensively promote reform.

It is understood that at the end of 2021, the National Medical Insurance Bureau deployed the "Three -Year Action Plan for the Reform of DRG/DIP Payment Methods". Methods cover all eligible medical institutions that conduct hospitalization services. On the basis of the continuous consolidation of the reform results launched by Guangdong, Guangdong has carried out all the DIP payment methods reform this year, and will achieve full coverage two years in advance.

Source/Southern Network

Picture/Guangzhou Daily · Xinhua City Reporter: Liao Xueming Guangzhou Daily · Xinhua City Editor: Zhao Xiaoman

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