DIP point payment is what has been called “big data DRGs” in the past, and it is disease point payment based on big data. Compared with DRG payment, which is an imported product from the West, DIP point payment can be said to be a medical insurance payment method with Chinese characteristics.
Extended information:
1. The mechanism of DIP: DIP score payment application system, based on the economic principles of "randomness" and "mean" and big data theory, through real Using the world's massive medical record data, we can discover the inherent patterns and correlations between diseases and treatments, extract data features and combine them, and compare the average disease and treatment resource consumption of each disease in the region with the average resource consumption of the entire sample. DIP scores are formed and aggregated into a DIP directory.
2. Scope of application of DIP: DIP point payment is mainly applicable to the settlement of hospitalization medical expenses. Cases with long hospitalization periods such as psychiatric, rehabilitation and nursing care should not be included. The adaptability and scalability of DIP can be explored and applied to the establishment of outpatient payment standards and the reform of charging standards in medical institutions.
(1) The National Medical Insurance Administration recently issued the "Notice on the Pilot Work Plan for the Total Budget of Regional Points Method and Payment by Disease Points". In order to avoid the problem of shrinking share of medical insurance payment caused by the loss of patients, medical institutions will reduce medical expenses, improve the quality and efficiency of medical services, etc.
(2) The method adopted by DIP is the realistic control method. The disease scores in the pilot cities are based on local data and follow unified disease combination rules and calculation methods. Under the premise of the total regional budget limit, the higher the sum of the scores of all medical institutions in the region, the lower the unit price; the lower the sum of the scores, the higher the unit price. Ensure that medical insurance funds never bottom out and "risks are controllable."
(3) DIP payment has wider coverage, high enrollment rate, and strong operability: DIP is based on massive data samples, based on the corresponding relationship between diagnosis and treatment, and is easy to be accepted by doctors, patients, and insurance parties. . At present, the DIP catalog covers nearly 99% of cases, except for psychiatric, rehabilitation and nursing long-term hospitalization cases. It achieves a balance between convenient operation and precise application, and is easier to implement in areas and medical institutions with low informatization level.
(4) Since the establishment of the National Medical Insurance Bureau, the National Medical Insurance Bureau has issued 15 nationally unified medical insurance information business coding standards, established a coding standard database and a dynamic maintenance platform, which also means that medical work It is changing from disorder to standardization and standardization.