By the third quarter of 2020, although the progress of the pilot cities is quite different, it has made significant progress compared with 20 19. Overall, among the 30 pilot cities, the progress of 29 cities basically meets the requirements of national deployment and has simulated operation conditions.
Among them? Seven cities have actually paid fees before the pilot; ? 22 cities have made preparations for the simulated operation after the start of the pilot, including the cities that actually paid the fees after the pilot? 2 cities that have entered the simulation operation stage? 4 cities and cities with conditions but not yet entered the simulation operation? 16 city. At the same time, the grouping technical methods and settlement rules of individual pilot cities are not perfect enough and need to be further adjusted and improved.
Jie Zheng, head of the National Technical Steering Group for DRG Payment, said that DRG payment itself is a very test for the infrastructure construction of medical insurance departments and medical institutions, and it can never be done overnight.
Even though unified technical specifications and guiding principles have been issued at the national level, it is normal that the preparatory work for related work has different progress and level due to the great differences in infrastructure construction and the historical problems accumulated over the years.
In order to help the lagging cities enter the simulation operation stage as soon as possible, the National Medical Insurance Bureau issued the list of fixed contact groups of the pilot expert group in June 5438+February, requiring the expert group to strengthen the guidance of the pilot cities by organizing research and irregular guidance, sort out and analyze the difficulties and problems existing in the pilot process, and promote the pilot work.
Now, the results of the statistical express of medical insurance development in 2020 show that the above efforts of the medical insurance bureau have been rewarded, and all the pilot cities have entered the simulation operation stage, which also laid the foundation for the actual payment of DRG.
Xiong Xianjun, director of the Department of Medical Service Management of the National Medical Insurance Bureau, said that the national pilot of DRG payment is an important task to implement the Guiding Opinions on Further Deepening the Reform of Payment Methods of Basic Medical Insurance issued by the State Council on 20 17 and further deepen the reform of payment methods of medical insurance. It is of great significance to promote the refined management of medical insurance, improve the efficiency of the use of medical insurance funds, give full play to the basic role of medical insurance in medical reform, and earnestly safeguard the health rights and interests of insured persons.
It is to promote the implementation of the national pilot project of DRG payment to standardize medical behavior, change the previous payment mode from project payment to disease payment, turn drugs and consumables into costs, and urge hospitals and doctors to change unreasonable medical behaviors such as prescribing large prescriptions for patients, using expensive drugs, consumables and large-scale inspection equipment. Doctors will consciously standardize medical behavior, improve the utilization efficiency of medical resources, actively seek to improve quality and efficiency to obtain reasonable income, and promote the dynamic mechanism of hospital operation to change from expansionary development to connotative development.
It is the openness and transparency of medical services that changes the past clinical medical behavior from "incomparable" to "comparable" through DRG grouping. It is clear at a glance how many cases and difficulties the hospital has handled. The treatment level of the same disease group can be quantitatively compared. People have a transparent and open platform for medical insurance payment and medical treatment.
Is to improve people's satisfaction with medical care. Through the implementation of DRG payment, we can reduce the water content in examination and treatment, effectively reduce the "big prescription" and "big examination", reduce the unnecessary medical expenses of the people, enable the people to obtain better and efficient medical services and improve medical satisfaction. The reform of DRG community health service payment will help to build a healthy China and increase people's sense of gain.