According to the National Health Insurance Bureau (NHIB), Beijing, Tianjin, and other cities carrying out national pilots of DRG payment have all passed the pre-simulation assessment and evaluation, and have entered the simulation operation stage.
As of the third quarter of 2020, the progress of the pilot cities' pilots, while varying widely, has made significant progress compared with 2019. Overall, among the 30 pilot cities,?29 cities' progress is basically in line with the requirements of the national deployment and have the conditions for simulated operation.
Among them,?7 cities have actually paid before the pilot;?22 cities have been prepared to have the conditions for simulation operation after the launch of the pilot, including?2 cities that have actually paid after the pilot,?4 cities that have entered the stage of simulation operation, and?16 cities that have already possessed the conditions but have not yet entered the simulation operation. Meanwhile, the grouping technical methods and settlement rules of individual pilot cities are still not perfect enough and need further adjustment and improvement.
Zheng Jie, head of the National DRG Payment Special Technical Steering Group, said, the DRG payment itself is a very test of the medical insurance department and medical institutions infrastructure work, want to make it can never be completed overnight.
Even if the national level has issued unified technical specifications and guiding principles, but due to the large differences in the infrastructure of each region, and each facing the accumulation of historical legacy problems for many years, and therefore in the preparation of the relevant work inevitably appeared in the progress of the level of the situation is not the same, which is a normal phenomenon.
In order to help the lagging cities to enter the simulation operation stage as soon as possible, the National Health Insurance Bureau released a list of fixed contact subgroups of the pilot expert group in December, and asked the expert group to take the unified organization of research and occasional guidance according to the fixed contact subgroups arrangement, strengthening the guidance to the pilot cities, sorting out and analyzing the difficulties and problems in the process of piloting, and promoting the pilot work to move forward. The first step is to make sure that you have a good understanding of what is happening in the marketplace.
Now, the results of the 2020 Statistical Snapshot of the Development of the Health Insurance Business show that the Bureau's efforts have paid off, with all the pilot cities entering the simulation phase, and laying the foundation for DRG to move toward actual payment.
Xiong Xianjun, director of the Department of Medicine Service Management of the NHPA, said, that carrying out the national pilot of DRG payment is an important work to implement the Guiding Opinions on Further Deepening the Reform of Basic Medical Insurance Payment Methods issued by the State Council in 2017, and further deepen the reform of the payment methods of medical insurance, to push forward the fine-tuning of the management of medical insurance and to improve the The use of health insurance fund efficiency, give full play to the fundamental role of health insurance in health care reform, and effectively safeguard the health rights and interests of the insured, is of great significance:
It is to promote the standardization of medical behaviorThe implementation of the national pilot work of DRG payment, changing the previous mode of payment by item, shifting to payment by patient group, and transforming medicines and consumables into costs, will prompt hospitals and doctors to change the previous mode of prescribing large quantities of drugs, consumables and large-sized medicines to the patients. expensive drugs, consumables and large-scale inspection equipment and other unreasonable medical behaviors. Doctors will consciously standardize medical behavior, improve the effectiveness of medical resource utilization, and actively seek to improve quality and efficiency to obtain a reasonable return, prompting the hospital to run the power mechanism from the expansion of the development of connotative development change.
It is the openness and transparency of medical services
Through the DRG grouping, the clinical medical behavior of the past "incomparable" into "comparable", the hospital admitted how many cases, the difficulty of how much, at a glance. The level of treatment for the same group of patients can be quantified and compared. The medical insurance payment, the masses have a transparent and open platform.
It is to enhance people's satisfaction with medical careThrough the implementation of DRG payment, compression of the water in the examination and treatment, effectively reduce the "big prescription", "big examination", reduce the people's unnecessary medical expenditures, so that the majority of people The CHS-DRG payment reform will contribute to the construction of a healthy China and continuously increase the sense of achievement of the general public.