DRG, or Disease Diagnosis-Related Grouping, manages patients in a number of diagnostic groups based on factors such as their age, disease diagnosis, comorbidities, complications, treatment modalities, severity and regression of the disease and resource consumption. In this way, the health insurance fund is able to pay for each case more accurately, avoiding the problems of over-treatment and waste of resources that may have resulted from itemized payment in the past.The advantage of the DRG payment model is that it encourages healthcare institutions to provide more reasonable and efficient diagnostic and therapeutic services, as hospitals can only receive the corresponding health insurance payment if they provide diagnostic and therapeutic services that meet the criteria of the DRG grouping. Meanwhile, for patients, the DRG payment model makes treatment costs more transparent and predictable, helping to reduce their financial pressure.
The benefits of paying medical insurance are as follows:
1. It is conducive to improving labor productivity and promoting the development of production. Medical insurance is the inevitable result of social progress and production development. In turn, the establishment and improvement of the medical insurance system will further promote social progress and the development of production. On the one hand, medical insurance relieves workers of their worries and enables them to work with peace of mind, thus increasing labor productivity and promoting the development of production: on the other hand, it also ensures the physical and mental health of workers and ensures normal reproduction of the labor force;
2. It regulates the difference in income and embodies the fairness of society. Medical insurance is used to regulate income differences through the collection of medical insurance premiums and reimbursement of medical insurance service fees, which is an important means of income redistribution by the government;
3. It is an important guarantee to promote the reform of the economic system, especially the reform of state-owned enterprises.
In summary, the health insurance reform DRG is a positive exploration and innovation, which helps to optimize the health insurance payment method, improve the efficiency of the use of health insurance fund, and promote the improvement and enhancement of medical services.
Legal basis:
The Social Insurance Law of the People's Republic of China
Article 23
Employees shall participate in the basic medical insurance for employees, and the basic medical insurance premiums shall be paid by the employer and the employees in accordance with the state regulations*** together. Individual industrial and commercial households without employees, part-time employees who do not participate in the basic medical insurance for employees at their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.