On June 30, the medical website said that to make people no longer "sick" and "sick", the health insurance payment is about to be reformed. Where does it go? How to change? These contents are written into the state council general office recently issued by the "on further deepening the reform of the basic medical insurance payment instruction opinion", the hospital left left down these changes will occur in the future
Where will the health care reform change?
We will implement the multi-component medical insurance payment method
For in-hospital medical services, mainly according to the disease type, according to disease diagnosis and related group pay, long-term, chronic diseases hospitalization service can be paid by bed day
For primary-care services, pay per head, and actively explore the combination of paying per head and managing chronic diseases
For complicated cases and outpatient expenses that are not suitable for packing, you can pay by project
We will explore ways to pay for the characteristics of TCM services and encourage the provision and use of appropriate TCM services
The emphasis is on the payment of diseases
Gradually, the day operation and the conditions for the treatment of traditional Chinese and western medicine are included in the payment range of medical insurance funds
Establish and improve the negotiation consultation mechanism and the cost is always the basis of the data and the ability to pay medical insurance fund, on the basis of guaranteed results science reasonable macro-reforms standard Chinese and western medicine, lead to use appropriate techniques
We should make sure that the fees and payment standards are properly determined by the combination of medical fees and payment policies
To carry out the pilot for payment by disease diagnosis
According to the severity of the disease, the complexity of the treatment method and the actual resource consumption level, the group was carried out, and the open group, the open group logic and the base rate were made public
Can disease diagnosis related group technology as a support for diagnosis and treatment cost and the effect of measurement evaluation of a medical institution, strengthening the crosswise comparison between different medical institutions same disease group, using the evaluation results to improve the medical insurance payment mechanism
Gradually, the disease diagnosis and related groups are used to pay and expand the application scope
The total medical costs of the diagnosis of the related subgroups, including medicare funds and individual fees, are included
Improve the payment method by paying per head and paying per bed
The overall planning area should specify the scope of the basic medical care package paid by the head, and ensure the payment of medicines, basic medical services and general medical treatment in the health insurance catalogue
Gradually, starting with the standard of diabetes, hypertension, chronic renal failure and other treatment program standards, and the specific chronic diseases, the special chronic diseases are paid by the head
Conditional region can explore residents will sign the outpatient service fund capitation payment to basic medical and health institutions or family doctor team, referral of patients to hospital, by the grassroots health institutions or family doctor team pay referral fees
For mental illness, hospice care, medical rehabilitation, need long-term hospitalization and average daily cost relatively stable disease, can be paid by the bed date, at the same time, strengthen the average hospitalization days, average daily expenses, and to evaluate therapeutic effect
Strengthen the regulation of medical care
According to the functional orientation and service characteristics of various medical institutions at all levels, the scientific and rational assessment system is classified and improved, and the assessment results are linked to the insurance fund payment
The assessment indexes of TCM medical institutions should include the proportion of TCM services
Conditional local medical insurance agencies can pay a portion of their health insurance funds to the medical institution in accordance with the agreement to ease the pressure on their fund operation
How will health care reform be changed?
We will strengthen the budget management of the health care fund
We will accelerate the disclosure of the medical insurance fund's final accounts
For the reasonable increase of the workload of the medical institutions of the total control index, the compensation may be given according to the agreement
The total control indicators should be appropriately tilted to the primary medical and medical institutions and children's medical institutions, and the process should be made public to the medical institutions, relevant departments and the public
Conditional region can actively explore the points method and combining the total budget management, according to macro-reforms, gradually using total area (or a certain range) medical insurance fund control instead of total amount control of medical institutions
We will improve health care payment policy measures
Strictly regulate the basic medical insurance responsibility boundary, basic health care focus on security in accordance with the "clinic needed, safe and effective, price reasonable" principle of drugs and medical services and basic services
Public health expenses, physical fitness or health care consumption that are not directly related to the treatment of diseases shall not be included in the coverage of medical insurance
Around the ability to pay medical insurance fund should be fully considered, the social overall capacity and ginseng protect individual responsibility, adhere to the principle of basic guarantee and liability, and adjust the treatment according to the specified procedures
Combination of hierarchical diagnosis model and signing the family doctor service system construction, guide the ginseng protect personnel prior to the first option at the grass-roots level, to conform to the provisions of the referral hospitalized patients can continuous computing starting line, signing will conform to the provisions of the family doctor service charge included in medical insurance to pay limits
We will explore the role of the "gatekeeper" in the health care charge of the family doctors by paying the total amount of medical insurance in the cooperative mode of the medical consortium, such as the medical consortium of vertical cooperation
Encourage fixed-point retail pharmacies to ensure the supply of chronic diseases. Patients can choose to buy drugs in medical institutions or to medical institutions by prescription
We will work together to reform the medical and health systems
We will carry out clinical path management and improve the transparency of clinical practice
We will promote mutual recognition of medical examination results of medical institutions at the same level and reduce repeated inspections
The establishment of an open mechanism of the efficiency and cost information of medical institutions and the regular disclosure of such indicators as cost and burden of patients should be subject to social supervision and provide reference for the choice of medical treatment
Standardize and promote more practice of medical staff |
